ARTICLE IN PRESS

Radiotherapy and Oncology xxx (2010) xxx–xxx

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Radiotherapy and Oncology

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Original article

Monte Carlo-based analytical model for small and variable fields delivered
by TomoTherapy
Edmond Sterpin a,c,*, Brian T. Hundertmark c, Thomas R. Mackie b,c, Weiguo Lu b, Gustavo H. Olivera b,c,
Stefaan Vynckier a
a
Université Catholique de Louvain, Department of Radiotherapy and Oncology, Brussels, Belgium; b TomoTherapy Inc., Madison, WI, USA; c Department of Medical Physics,
University of Wisconsin, Madison, WI, USA

a r t i c l e i n f o a b s t r a c t

Article history: Background and purpose: Extend to very small fields the validity of a Monte Carlo (MC) based model of Tomo-
Received 19 October 2009 Therapy called TomoPen for future implementation of the dynamic jaws feature for helical TomoTherapy.
Received in revised form 15 December 2009 Materials and methods: First, the modelling of the electron source was revisited using a new method to mea-
Accepted 20 December 2009
sure source obscuration for very small fields (<1 cm). The method consisted in MC simulations simulations
Available online xxxx
and measurements of the central dose in a water phantom for a 10 cm  FW field scanned to deliver a
10  10 cm2 fluence. FW, the longitudinal field width, was varied from 0.4 to 5 cm. The second part of the work
Keywords:
consisted of adapting TomoPen to account for any configuration of the jaws in a fast and efficient way by using
Monte Carlo simulation
TomoTherapy
routinely only the phase-space file of the largest field (5 cm) and interpolated analytical information of phase-
Small fields space files of smaller field widths.
Results: For the electron source fine tuning, it was shown that the best results were obtained for a 1.1 mm
wide spot. Our single phase-space method showed no significant differences compared to MC simulations
of various field widths even though only longitudinal intensity and angular analytical functions were applied
to the 5 cm phase-space.
Conclusion: The designed model is able to simulate all jaw openings from the 5 cm field phase-space file by
applying a bi-dimensional analytical function accounting for the fluence and the angular distribution in the
longitudinal direction.
Ó 2009 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology xxx (2009) xxx–xxx

Hi-ArtTM TomoTherapy allows high modulation in the trans-
verse plane by means of the simultaneous movement of the gantry
and a binary multileaf collimator (MLC) [1]. The longitudinal reso-
lution is controlled by the size of the field in this direction, which is
limited in the present configuration of the TomoTherapy machine
to three values: 1, 2.5 and 5 cm. However, more freedom could
be given to the user by increasing the number of available field
sizes, or better, by allowing the jaws to move dynamically during
irradiation. Doing so would sharpen the treatment penumbra in
the inferior–superior direction and speed up TomoTherapy deliv-
ery by two to three times over the current implementation [2].
Arbitrary jaw openings involve new challenges in dose compu-
tation for TomoTherapy. Efficient and realistic modeling of the
jaws may be required, especially for the smaller fields, which
may be achieved by models based on Monte Carlo (MC) simula-
tions. Indeed, those are widely recognized as the most accurate
method available to model treatment delivery and compute dose
* Corresponding author. Address: Université Catholique de Louvain, Department
of Radiotherapy and Oncology, St-Luc University Hospital, 10 av. Hippocrate, 1200
10 Brussels, Belgium.
E-mail address: esterpin@yahoo.fr (E. Sterpin).
in tissue [3]. However, for very small fields (<1 cm), the validity
of MC models are strongly dependent on the validity of the hypoth-
esis made on the electron source model. Output factors diminish
rapidly because of source occlusion effects [4] and therefore, the
accuracy of the source model is of primary importance [5–7].
Two previously published papers describe extensively the diffi-
culty for MC models to accurately predict output factors for small
fields without a measurement specific and sensitive to the electron
source model [8,9]. In the present study, however, another method,
designed for the TomoTherapy machine was chosen to quantify the
effect of source occlusion.
Following confirmation that electron source was accurately
modeled, the second objective of the work was to extend the scope
of validity of a previously published MC model called TomoPen
[10–12] to all possible jaw field widths up to 5 cm, without modi-
fying its general structure and maintaining efficiency. The model
developed here was also used as an analysis and a development
tool during the implementation of variable jaw openings in the
TomoTherapy treatment planning system (TPS). Since symmetric
jaw movement is sufficient to gain the advantages of dynamic
jaws, only symmetric fields are considered in this paper (Private
communication (Gustavo Olivera, January 2009)).

0167-8140/$ - see front matter Ó 2009 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.radonc.2009.12.018

Please cite this article in press as: Sterpin E et al. Monte Carlo-based analytical model for small and variable fields delivered by TomoTherapy. Radiother
Oncol (2010), doi:10.1016/j.radonc.2009.12.018
 ARTICLE IN PRESS
2 TomoTherapy variable jaws Monte Carlo-based model
To account for all jaw openings, the most intuitive method is to
simulate the treatment head according to the physical position of
the jaws [13]. This technique has the disadvantage of being time
consuming and it is not satisfying the various requirements for
the MC model in our case:
(1) The model has to be compatible with the structure of the
existing MC code TomoPen, which is phase-space file (PSF)
based.
(2) In the TomoTherapy convolution/superposition (C/S) [14],
the longitudinal field width and shape are determined by
measured longitudinal intensity measurements which cor-
respond to a precise and reproducible value of the jaw set-
tings. However, the physical aperture of the jaws itself is
hard to measure. The MC model must be able to handle
the same data, which make it portable from one machine
to another without additional tuning.
(3) The model must be as fast as possible, rely on a minimum of
precalculated data with no or a negligible cost in accuracy.
The methods described in this paper may be considered as a
combination of pure PSF and beam modeling approaches [15,16].
In the literature, it is proven that one can accurately reproduce
PSF data above beam modifiers by sampling global characteristics
acquired from PSF data, like an energy spectrum and fluence distri-
butions using a multiple-source model that separate the influence
of beam components such as the target, the primary collimator and
the flattening filter on the dose distributions.
To account for the specificities of TomoTherapy and the require-
ments listed above, an adapted approach was used here. It was as-
sumed that the distributions of most of the PSF characteristics of
the 5 cm field size were general enough and that one had only to
account for the direct effect of the jaws on a few variables, in an
approach inspired, but yet different, from Fippel et al. [16].
Material and methods
TomoPen
An extensive description of the TomoPen model can be found in
other papers [10–12]. In the current configuration, TomoPen is able
to calculate accurately a typical clinical procedure in about 6 h on a
single CPU (2.5 GHz) [17].
Tuning of the electron source spot size
In the TomoPen paper [12], the method used to tune the elec-
tron source spot size was: (1) match the longitudinal profiles pen-
umbra for the 5 cm field and (2) verify the obtained value by
comparing measured and calculated profiles for the two central
leaves open sequentially and simultaneously. It was observed that
a good correspondence between the ‘‘gold standard” machine and
MC was obtained for a Gaussian electron spot with a full width
half-maximum (FWHM) of 1.4 mm. However, it was hard to deter-
mine the precise value since satisfactory results were also obtained
for other values of FWHM, especially regarding the intrinsic uncer-
tainties of the measurements performed.
In this study, a completely different approach was used. Since
the measurement method itself was the subject of another paper
submitted (by Hundertmark, Sterpin and Mackie) and the validity
of a very similar method for conventional linear accelerators was
already assessed in a recent publication [18], only a very brief
explanation is given here. It consisted of measuring the dose (D) di-
vided by the field width (FW) for a cubic water phantom at 1.5 cm
depth at a source–surface distance (SSD) of 85 cm for a
10  10 cm2 field delivered by scanning a 10 cm  FW beam across
Please cite this article in press as: Sterpin E et al. Monte Carlo-based analytical model for small and variable fields delivered by TomoTherapy. Radiother
Oncol (2010), doi:10.1016/j.radonc.2009.12.018
the phantom, where FW is the longitudinal field width. The ma-
chine used for the experiment was located at Radiotherapy Clinic
of the University of Wisconsin Hospital, Madison. The values of
FW ranged from 0.4 to 5 cm. For a point source and neglecting dif-
ferences in phantom scattering, the dose would be proportional to
FW, and so the ratio of D/FW and D/5 cm would equal unity. How-
ever, because of source occlusion, it was expected that this ratio
would decrease significantly for small fields. The method was pro-
ven to be robust, i.e. it was detector independent and therefore it
could be used for testing the accuracy of the source model for
any kind of dose computation engine, including MC-based models.
The MC calculations consisted of a direct simulation of the
experimental setup. PSF calculations were performed for various
field sizes and electron source spot sizes using MC HAMMER
[10]. The resulting PSF were used thereafter in TomoPen. It is
worth mentioning that equivalent results were obtained by simu-
lating the actual experiment and by convolving a longitudinal dose
profile computed for a static field with a unit-high step function
over 10 cm (and zero elsewhere).
Arbitrary jaw settings simulation
Description of a PSF
For each field size, each particle in the PSF can be described by a
function PFS:
PFS ðKPAR; E; x; y; z; u; v ; w; WGHT; NSHIÞ ð1Þ
where FS, refers to the considered field size, KPAR is the particle
type (electron, photon, positron), E is the energy, x, y, z the coordi-
nates of the position of the particles and u, v, w are the directions
cosines, WGHT is the weight and NSHI is the primary shower coun-
ter (see the PENELOPE manual for more details [19]. The three com-
ponents of the position r of a particle traveling a distance d from an
original position r0 can be given in the form of
r ¼ ðx; y; zÞ ¼ r 0 þ dðu; v ; wÞ ¼ ðx0 ; y0 ; z0 Þ þ dðu; v ; wÞ ð2Þ
where z refers to the longitudinal direction while x and y refer to
the transverse and depth directions, respectively (see Fig. 1 for a
schematic representation of the axis system). Since contamination
electrons and positrons are removed by the transfer function meth-
od implemented into TomoPen [11], all particles are photons for all
field sizes, i.e. KPAR is not used. Moreover, we will assume that the
PSF will be simulated many times during routine simulations and
completely when PSF characteristics are determined. Therefore,
only the total number of primary showers simulated has to be
recorded.
Fig. 1. Schematic representation of the reference frame used thorough this study.
 ARTICLE IN PRESS

E. Sterpin et al. / Radiotherapy and Oncology xxx (2010) xxx–xxx 3

When the gantry is in the upright position, y will be constant

whatever the field size since it only provides the position of the
PSF plane. Moreover,

u2 þ v 2 þ w2 ¼ 1 ð3Þ
then only the behavior of two direction cosines must be analyzed. In
this case, u and w were chosen. The reasons of this choice will ap-
pear later. Therefore, let us assume that the function PFS can be sep-
arated into two functions PRFS, the phase space for a Reference Field
Size (RFS) which contains most of the information for any field size,
and FFS which corrects the weight of each particle to account for the
differences from one field size to another:
PFS ðE; x; y; z; u; v ; w; WGHT; NSHIÞ
¼ P RFS ðE; x; y; z; u; v ; w; WGHT F FS ðE; x; z; u; w; WGHTÞ; NSHIÞ
ð4Þ
It will be shown that the dependence of E, WGHT, x and u with
field size can actually be neglected and that the problem may be
reduced to
PFS ðE; x; y; z; u; v ; w; WGHT; NSHIÞ
¼ P RFS ðE; x; y; z; u; v ; w; WGHT RFS ðz; wÞ; NSHIÞ ð5Þ
where RFS is a ratio accounting for the variation of the energy flu- Fig. 2. Examples of JIF (a) and JAF (b) ratios calculated with respect to the 5 cm
ence of particles and their angular distribution along the longitudi- field.
nal direction.

Simulating an arbitrary field size from the 5 cm PSF
Two methods were employed here. The first method, called the
Jaw Angular Function (JAF) method, consisted of multiplying the
weight of each particle of the reference 5 cm field PSF by a precal-
culated ratio RFS at a given SSD:
 
IFS ðzÞ aFS ðz; wÞ
RJAF
FS;SSD ðz; wÞ ¼
I5 cm ðzÞ a5 cm ðz; wÞ SSD
where I can be either measured or calculated by integrating the
energy times the weight of each photon with a given z in a given
PSF and dividing by the total number of primary showers. The
PSF is binned along the z direction, with a resolution of around
0.8 mm. The number of bins is limited to 128, i.e. I is defined
throughout 10 cm, which is large enough to encompass the vast
majority of the photons. Outside the region of interest, the ratio
of I is assumed equal to one. a is also defined the same way, but
over the variables z and w and is only computable from MC simu-
lations. The number of bins is also 128 with a resolution of 0.002
for w, which is justified by the narrowness of a distributions. The
region of interest is large enough to encompass all the values of
a. JAF ratios for the 1 cm field with respect to the 5 cm field is
shown in Fig. 2(b). It is worth mentioning that the ratio of a is
set to conserve energy.
The JAF method is designed to use I ratios computed from mea-
surement data and interpolated a distributions determined from
PSF calculated for several jaw settings from 0 to 5 cm.
To analyze the effect of removing the dependency of angular
distribution with field size, which is the case in a C/S algorithm,
the second method, called the Jaw Intensity Function (JIF) assumed
the ratio of a equals one and therefore RFS becomes:
 
IFS ðzÞ
RJIF
FS;SSD ðzÞ ¼
I5 cm ðzÞ SSD
We can also write
 
aFS ðz; wÞ
RJAF
FS;SSD ðz; wÞ ¼ RJIF
FS;SSD ðzÞ
a5 cm ðz; wÞ SSD
An example of JIF ratios are shown in Fig. 2(a). JIF and JAF meth-
ods are strictly equivalent provided that the jaws do not contribute
to scattered radiation and that the photon source is a point source.
In the two methods, the ratios were calculated at the isocenter
plane (source–surface distance (SSD) of 85 cm). In the original
TomoPen simulation, the PSFs were recorded 45 cm above the iso-
ð6Þ center plane (SSD = 40 cm). To apply the JAF and JIF methods, the
PSFs were therefore recorded at the isocenter plane. During the
simulation, the weight of each particle is multiplied by the ratio
RFS according to the method chosen and then transported to the
same plane as the original TomoPen simulation before the simula-
tion resumes as described in Sterpin et al. [12]. The reason why the
isocenter plane was chosen is because measurements are likely
performed at that plane and are used as primary information for
tuning the C/S algorithm. Moreover, dose computed using JAF
and JIF will be more accurate to the plane where the ratios were
calculated. To minimize deviations from pure MC simulations,
positioning the PSF plane at the isocenter, the symmetry center
of the system, is the best choice.
For small fields, the method has the disadvantage of producing
a lot of particles with very small weights outside the field. To save
the time simulating particles with very small weight, Russian rou-
lette is applied with a moderate splitting factor (20) to avoid dis-
tortions due to heavy weighted particles.
It is worth emphasizing the fact that the JIF ratio accounts for
most of the modifications while the ratios of a account for modifi-
cations regarding the divergence of the beam with field size, which
is a second-order effect.
Testing the JAF and JIF methods
Two main sets of tests were performed:
ð7Þ
(1) Independence of the shape of E and x distributions. This was
verified by comparing spectral, energy fluence and dose dis-
tributions of the PSF at various positions along the longitudi-
nal direction. The invariance of the distribution of WGHT is
ð8Þ implicitly verified since it is taken into account in each
scored quantity.

Please cite this article in press as: Sterpin E et al. Monte Carlo-based analytical model for small and variable fields delivered by TomoTherapy. Radiother
Oncol (2010), doi:10.1016/j.radonc.2009.12.018
 ARTICLE IN PRESS

4 TomoTherapy variable jaws Monte Carlo-based model

(2) Equivalence of dose distributions computed with MC, JIF and

JAF methods in a water phantom (dimensions of
40  30  40 cm3, resolutions of 0.4, 0.3 and 0.1 cm in the
transverse, depth and longitudinal directions, respectively).
Two SSD were chosen, 75 cm and a more extreme 50 cm to
magnify the effects of divergence. Profiles were compared
in all the directions and at several depths.

For the sake of conciseness, the results of the first set of test are
not shown in this paper. Very good agreement was achieved for en-
ergy spectrum, which was expected according to Jeraj et al. [20]
and transverse energy fluence, within statistical uncertainties
(1%, 1 r), whatever the depth and the longitudinal position of the
acquisitions. The dose distributions in the phantom provide an
indirect verification of those results.
In the second set, two cases had to be distinguished. First JIF, JAF
and MC could be compared when I and a distributions were obtained
directly from the PSF for which dose distributions were calculated. In
this case, no interpolation was required. The second case analyzed
occurred when I and a of the considered field were obtained from
interpolation of I and a distributions computed for the closest corre-
sponding PSFs. For instance, a 0.7 cm field was calculated with a pure
MC approach but I and a distributions were interpolated between 0.6
and 0.8 cm PSFs. This test was necessary to ensure that interpolation
can be performed without a significant loss of accuracy. The only
parameter needed for the interpolation was the FWHM of the energy
fluence at the isocenter. Linear interpolation was used.
Fig. 4. Transverse dose profiles (a) and depth dose (b) comparison between the JAF
method and pure MC computations the 1 cm field at several depths.

Results Instead of a Gaussian model, other lateral distribution models

Tuning of the electron spot size
Fig. 3 shows a comparison between measured and calculated D/
FW ratios. It can be clearly observed that the ratio is very sensitive
to the electron source spot size chosen, particularly with fields
smaller than 1 cm, with the best match (within 2.5%) obtained
with the 1.1 mm FWHM electron spot. For instance, differences be-
tween the 1.4 mm and the 1.1 mm spots are up to 18% for the
0.6 cm field whereas there are within 2% for the values above
1 cm. When the best match was obtained for the 0.6 cm field,
one additional point was calculated with FWHM = 1.1 mm to verify
the 0.4 cm field with a similar agreement than the 0.6 cm field.
were calculated for a circular homogeneous electron spot. No signif-
icant differences with the Gaussian hypothesis could be observed.
Water phantom calculations
1 cm field: no interpolation
In this test, dose distributions in ‘‘absolute” values (eV/g/pri-
mary particle) for a 1 cm field obtained by the JAF, JIF and pure
MC approaches were compared. Fig. 4 displays a comparison be-
tween JAF and MC for percent depth dose and transverse profiles.
Very similar results were obtained with the JIF method. For the
sake of clarity, points of MC computations were joined by a line.
Since the uncertainty bars (<1%, 3 r) have the same height as the
points, they were not displayed. Agreement was within 1%/
0.1 mm for both JIF and JAF.
Evidently, differences were more expected in the longitudinal
plane. Fig. 5 shows a comparison of longitudinal dose profiles for
the 1 cm field PSF obtained by pure MC computations and the
JAF/JIF methods. Agreement is very good between all the profiles
at all the depths, with differences well inside statistical uncertain-
ties (within the height of each point).
Differences between JIF and JAF only appeared when dose is cal-
culated far from the isocenter. Fig. 6 compares MC, JIF and JAF for a
1 cm field with SSD of 50 cm at 2 cm depth. While JAF and MC are
still in agreement, the penumbra is underestimated by JIF, result-
ing even in an underestimation on the central axis of about 3%. This
is likely due to the fact that the JIF method assumes the longitudi-
nal divergence of the 1 cm field beam is the same as the 5 cm field.

0.7 cm field: interpolation between 0.6 and 0.8 cm fields

Fig. 3. Comparison between measured (ion chamber Exradin A1SL) and calculated
D/FW ratio for three electron spot size settings (1.4, 1.1 and 0.7 mm FWHM) and for
10  FW fields scanned over 10 cm in the longitudinal direction.
In Fig. 7, longitudinal profiles computed with MC and JAF using
interpolated data for the latter were compared. All the points agree
within 1%/0.2 mm which is very good considering the small width
of the field, the large gradients and the voxel size chosen (1 mm).

Please cite this article in press as: Sterpin E et al. Monte Carlo-based analytical model for small and variable fields delivered by TomoTherapy. Radiother
Oncol (2010), doi:10.1016/j.radonc.2009.12.018
 ARTICLE IN PRESS
E. Sterpin et al. / Radiotherapy and Oncology xxx (2010) xxx–xxx
Fig. 5. Longitudinal dose profiles comparison between the JAF (a) and JIF (b)
methods and pure MC computations for the 1 cm field at several depths
(SSD = 75 cm).
Discussion
The combination of an accurate electron spot size model and a
fast and efficient technique to simulate any jaw opening is a prere-
quisite before extending the TomoPen model to treatments involv-
ing variable jaw openings. Fig. 3 shows a clear effect of source
obscuration for sizes smaller than 1.5 cm. Since the size of the pho-
ton source is linked to the size of the electron spot [21], the exper-
iment illustrates a direct effect of the accuracy of the electron spot
size. According to Scott et al. [8,9], the sensitivity of output factors
for small fields to source occlusion is much higher than the sensi-
tivity of penumbras measurements, which depends on many other
parameters, like detector and MC voxel sizes. The results presented
in our study were compatible with the observations made in Scott
et al. [8,9] especially if one compares Fig. 10 in Ref. [8] with Fig. 3 in
the present paper.
For the modeling of the jaws, results shown in Figs. 4–7 demon-
strate the equivalence of JAF and MC but differences were found
between JIF and MC, for an extreme SSD. In general, the accuracy
Fig. 6. Longitudinal dose profiles comparison between JAF, JIF and pure MC
computations in a water phantom for a 1 cm field (SSD = 50 cm).
Please cite this article in press as: Sterpin E et al. Monte Carlo-based analytical model for small and variable fields delivered by TomoTherapy. Radiother
Oncol (2010), doi:10.1016/j.radonc.2009.12.018
5
Fig. 7. Longitudinal dose profiles comparison between JAF method and pure MC
computations for the 0.7 cm field at several depths (SSD = 75 cm). In this case, I and
a distributions were obtained from interpolations from I and a distributions of
adjacent PSFs (0.6 and 0.8 cm fields).
of the JAF method for an arbitrary field opening will rely directly
on the quality of the interpolation of the (z, w) distributions be-
tween the closest PSFs. If I(z) is given by measurements or interpo-
lated from a measurement database, then only a (z, w)
distributions have to be interpolated from PSF data. a is a sec-
ond-order correction, therefore the quality of the interpolation
on a will not interfere much with the accuracy of the results. How-
ever, the accuracy of I(z) is of primary importance and therefore it
is worth building a precise set of PSFs to minimize the errors due to
interpolations in the case of calculated I(z). Since sparse PSFs are
allowed, this is a relatively straightforward process.
One of the main objectives of the JAF and JIF methods was of
course efficiency. Calculation time between a 1 cm field calculated
from a MC PSF and a JAF PSF were compared to evaluate the poten-
tial loss in speed of the JAF method. The main sources of loss of effi-
ciency are the fact that more particle phase space data is being read
than necessary. For a fully open field, the loss of efficiency is
around 25%, which is not prohibitive considering the speed of Tom-
oPen [17]. The overall efficiency could yet be improved by allowing
TomoPen to select a PSF of another field size. For instance if the
5 cm and 2.5 cm PSF are used altogether in the system, TomoPen
could select the 2.5 cm for field smaller than 2.5 cm PSF and the
5 cm PSF for the others. This will improve the efficiency by a factor
of 2. Another solution would be to sample the distributions of E, x,
z, u, v, w and WEIGHT according to the 5 cm PSF and a (z, w) of the
considered field. The efficiency issue will be handled during the
implementation of the dynamic jaw feature into TomoPen and will
be the subject of another paper.
Conclusions
A new method for evaluating the accuracy of the electron
source model of dose calculation algorithms was tested for a MC
model of TomoTherapy, TomoPen. It was observed that for the ma-
chine used in this study, a FWHM of 1.1 mm was the best choice to
match the measurements. The method ensured that TomoPen
could be used confidently for field sizes smaller than 1 cm.
The other subject of this study was to design a new method to
account for various symmetrical jaws settings without having to
simulate each PSF independently. It was demonstrated that only
modifications of intensity and angular distributions along the axis
of the jaws (longitudinal) through a weighting factor are required
to reproduce accurately pure MC computations. This allows strong
simplifications and a simple workflow to implement dynamic jaws
into both TomoPen and into the treatment planning system of
TomoTherapy.
 ARTICLE IN PRESS
6 TomoTherapy variable jaws Monte Carlo-based model
Acknowledgements
E. Sterpin is a research fellow of the Belgian ‘Fonds National
pour la Recherche Scientifique’ (Charge de recherches du F.R.S –
FNRS FC 73512). This work was also supported by the University
of Wisconsin, Department of Medical Physics and TomoTherapy
Inc. (Madison WI). T.R. Mackie, W. Lu and G.H. Olivera have finan-
cial interest in TomoTherapy Inc.
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