Algorithm

Treatment planning computer algorithm was developed to calculate dose distribution in a fast,
easy and accurate way. Austin Cancer Centers (ACC) uses Pinnacle3 Treatment Planning
System for its external beam radiation therapy and Collapsed Cone Convolution (CCC),
Adaptive Convolve (AC) and fast convolve algorithms for calculating dose.

The physicist explained that CCC, which is a model-based algorithm, has the biggest advantage
of calculating dose inhomogeneities based on its calculation of primary beam, scattered beam
and electron contamination. To calculate varying tissue densities, the dose is computed by
combining both terma and dose kernel. Terma is total energy released per unit mass and kernel is
the dose matrix per unit terma. So it is pretty accurate in calculating the dose distribution in air,
lung or bone. CCC has the drawback as being slower compared to the other two because it
calculates every single pixel. On the other hand, adaptive convolve calculates the fourth pixel in
the array and interpolate the data between the pixels. This is the reason adaptive is faster but less
accurate compared to CCC. When the dosimetrists generate a treatment plan, it automatically
defaults to adaptive convolve rather than CCC. If Pinnacle determines that the dose changes too
quickly, it switches to CCC. This is the reason this facility uses Pinnacle for its accuracy and
speed.

The physicist stated that Monte Carlo was the best type of algorithm and the gold standard for
dose calculation, but is very slow. I asked the physicist if this facility will ever utilize a Monte
Carlo algorithm. He said that it was very expensive for Pinnacle to develop the program. So, is
the cost is more important than the accuracy or the efficiency of treatment facility?