Dosimetric validation of a commercial Monte Carlo based IMRT planning system

Methods: Absolute dose profiles, depth dose curves, and output factors calculated by Monaco were compared with measurements in a water phantom. Different static on-axis and off-axis fields were tested at various source-skin distances for 6, 10, and 18 MV photon beams. Four clinical IMRT plans were evaluated in a water phantom using a linear diode detector array and another six IMRT plans for different tumor sites in solid water using a 2D detector array. In order to evaluate the accuracy of the dose engine near tissue inhomogeneities absolute dose distributions were measured with Gafchromic EBT film in an inhomogeneous slab phantom. For an end-to-end test a four-field IMRT plan was applied to an anthropomorphic lung phantom with a simulated tumor peripherally located in the right lung. Gafchromic EBT film, placed in and around the tumor area, was used to evaluate the dose distribution. Results: Generally, the measured and the calculated dose distributions agreed within 2% dose difference or 2 mm distance-to-agreement. But mainly at interfaces with bone, some larger dose differences could be observed. Conclusions: Based on the results of this study, the authors concluded that the dosimetric accuracy of Monaco is adequate for clinical introduction.