To investigate the sensitivity of Monte Carlo (MC) calculated lung dose distributions to lung tissue characterization in external beam radiotherapy of breast cancer under Deep Inspiration Breath Hold (DIBH). EGSnrc based MC software was employed. Mean lung densities for one hundred patients were analysed. CT number frequency and clinical dose distributions were calculated for 15 patients with mean lung density below 0.14 g/cm³. Lung volume with a pre-defined CT numbers was also considered. Lung tissue was characterized by applying different CT calibrations in the low-density region and air-lung tissue thresholds. Dose impact was estimated by Dose Volume Histogram (DVH) parameters. Mean lung densities below 0.14 g/cm³ were found in 10% of the patients. CT numbers below -960 HU dominated the CT frequency distributions with a high rate of CT numbers at -990 HU. Mass density conversion approach influenced the DVH shape. V_4Gy and V_8Gy varied by 7% and 5% for the selected patients and by 9% and 3.5% for the pre-defined lung volume. V_16Gy and V_20Gy, were within 2.5%. Regions above 20 Gy were affected. Variations in air- lung tissue differentiation resulted in DVH parameters within 1%. Threshold at -990 HU was confirmed by the CT number frequency distributions. Lung dose distributions were more sensitive to variations in the CT calibration curve below lung (inhale) density than to air-lung tissue differentiation. Low dose regions were mostly affected. The dosimetry effects were found to be potentially important to 10% of the patients treated under DIBH.

Aims. This work aims to develop and investigate the feasibility of a hybrid model combining Monte Carlo (MC) simulations and deep learning (DL) to predict electronic portal imaging device (EPID) images based on MC-generated exit phase space energy fluence maps from dynamic radiotherapy treatment plans. Such predicted images can be used as reference images during in vivo dosimetry. Materials and methods. MC simulations involving a Varian True Beam linear accelerator model were performed using the EGSnrc code package. Two custom variants of the U-Net architecture were employed. The MLC dynamic chair sequence and 17 clinical treatment plans, spanning various cancer types and delivery methods, were used to acquire experimental data, and in the MC simulations. The proposed method was tested through 2D gamma index analysis, comparing predicted and measured EPID images. Results. Results showed gamma passing rates of 38.65%, 74.16% and 96.17% (minimum, median, maximum) for a simpler model variant and 52.72%, 80.61% and 96.80% for the more complex model variant. Conclusion. The study highlights the feasibility of integrating MC and DL methodologies for in vivo dosimetry quality assurance in complex radiotherapy delivery.

Purpose. To investigate the response of the CC13 ionization chamber under non-reference photon beam conditions, focusing on penumbra and build-up regions of static fields and on dynamic intensity-modulated beams. Methods. Measurements were performed in 6 MV 100 × 100, 20 × 100, and 20 × 20 mm² static fields. Monte Carlo calculations were performed for the static fields and for 6 and 15 MV dynamic beam sequences using a Varian multi-leaf collimator. The chamber was modelled using EGSnrc egs_chamber software. Conversion factors were calculated by relating the absorbed dose to air in the chamber air cavity to the absorbed dose to water. Correction and point-dose correction factors were calculated to quantify the conversion factor variations. Results. The correction factors for positions on the beam central axis and at the penumbra centre were 0.98–1.02 for all static fields and depths investigated. The largest corrections were obtained for chamber positions beyond penumbra centre in the off-axis direction. Point-dose correction factors were 0.54–0.71 at 100 mm depth and their magnitude increased with decreasing field size and measurement depth. Factors of 0.99–1.03 were obtained inside and near the integrated penumbra of the dynamic field at 100 mm depth, and of 0.92–0.94 beyond the integrated penumbra centre. The variations in the ionization chamber response across the integrated dynamic penumbra qualitatively followed the behaviour across penumbra of static fields. Conclusions. Without corrections, the CC13 chamber was of limited usefulness for profile measurements in 20-mm-wide fields. However, measurements in dynamic small irregular beam openings resembling the conditions of pre-treatment patient quality assurance were feasible. Uncorrected ionization chamber response could be applied for dose verification at 100 mm depth inside and close to large gradients of dynamically accumulating high- and low-dose regions assuming 3% tolerance between measured and calculated doses.