Treatment Planning Systems:

Vendors TPS Algorithms

1 BrainLab iPlan 1.4 Pencil Beam (PB)
Monte Carlo (MC)
2 Varian Eclipse Modified Batho Power Law (MBPL)
3 Varian CADPlan PLUS Equivalent TAR
4 Elekta XiO Superposition
5 Elekta Monaco X-Ray Voxel Monte Carlo(XVMC)
6 Philips Pinnacle Collapsed Cone Convolution(CCC)
Clarkson
7 TMS Helax Pencil Beam
Collapsed Cone (CC)
Convolution-superposition
8 DOSIsoft Penelope MC

1) The treatment planning system BrainLab, iPlan 1.4 uses Monte Carlo and Pencil Beam
algorithms. The iPlan Monte Carlo can perform dose calculations within seconds for
conformal beam and dynamic arc treatments and within minutes for complex IMRT
cases.1 The iPlan uses dose calculation integration with advanced calculation method that
eliminates treatment area restrictions of conventional dose calculation algorithms for
highly precise treatment delivery to inhomogeneous regions including lung and head and
neck.1 Monte Carlo algorithm is for photon beam radiation delivery.1 Based on the
XVMC (X-Ray Voxel Monte Carlo) algorithm, iPlan MC was developed to provide high-
precision treatment in everyday clinical practice and has been verified using
measurements and research studies.1 iPlan MC takes into consideration of a linac head
geometry, secondary electron dose effects and tissue inhomogeneities, providing
clinicians with faster and more accurate dose calculation for SBRT.1 MC simulates the
transport of millions of photons and particles through a medium.5 Each photon and
scattered electron is tracked from the source through all the linac components to calculate
photon fluence.5 A random number is generated to determine if and when the photon will
interact with other particles in its path. Similarly the photon interactions are simulated in
the patient.5 For a given photon, dose is a result of its interaction with matter (Coherent,
Photoelectric, Compton, pair production) and the likelihood of each event depends on
photon energy.5 And the contribution of each interaction for the photon is summed to
calculate dose/photon fluence.5
Pencil Beam algorithm in iPlan takes an incident beam and is divided into many
pencil beams.5 For each beam, a kernel (dose distribution) is applied. The heterogeneity
corrections applied along length direction.5 PB dose distributions is a incident beam
formed by summing the dose distribution for each pencil beam kernel.5

2) Varian, Eclipse treatment planning system uses Modified Batho Power Law. As the
radiation beam travels through the patient’s body, it interacts with tissues of different
densities.2 The conventional method to predict dose to a patient is to assume patient’s
body as a homogeneous water medium.2 Objects of different densities (tissue
heterogeneities) are then accounted for analytically with improved algorithms to reduce
uncertainties in absolute dose.2 The dose is thus calculated in a water equivalent material
and multiplied by a tissue heterogeneity correction factor.2 The correction factor is
generated from an electron density matrix derived from a CT value matrix since CT value
and electron density has a linear relationship.2 To obtain a correction factor, the (Varian
Medical Systems, Palo Alto, CA) uses tissue heterogeneity correction algorithm known
as, Modified Batho Power Law (MBPL).2 Batho has been an empirical correction factor
method, which uses tissue maximum ratios (TMR), to a power that depends on the
medium’s electron density relative to water.2 It was originally developed for dose
calculations in water below a single slab of lung tissue.2 MBPL method differs from the
original Batho in its definition of depth.2 In high-energy photon beams has a buildup
region that can be several centimeters thick in which the TMR values are not valid.2 The
MBPL method uses only the descending part of the TMR curves by adding to the depth,
the depth of maximum dose.2

3)Varian Medical Systems (VMS) of Palo Alto, California, is a manufacturer of medical

devices and software for treating cancer and other medical conditions with radiotherapy,
radiosurgery, proton therapy, and brachytherapy. The company supplies informatics
software for managing comprehensive cancer clinics, radiotherapy centers and medical
oncology practices. Varian is a premier supplier of tubes and digital detectors for X-ray
imaging in medical, scientific, and industrial applications and also supplies X-ray
imaging products for cargo screening and industrial inspection. CADPlan PLUS™
treatment planning system, is one of many treatment planning systems that has been
copyrighted through Varian. It was used in research study to help compare Equivalent
TAR dose calculation method. It is also known as the Equivalent Tissue-Air Ratio
Method.8 In this method the use of water-equivalent depth is corrects for the primary
component of dose.8 However, the change in scattered dose is not correctly predicted
because the effect of scattering structures depends on the geometric arrangement of the
patients.8 There is also a weighting factor that is used to calculate the Compton scatter of
the cross sections and integration scatter over the entire irradiated volume for each point
of dose calculation.8 This type of algorithm and planning system is not used often in
present day due to the outdated method of calculating dose.

4) In Elekta, XiO treatment planning system uses superposition algorithm. As for the
superposition algorithm uses two main components to calculate dose and they are
primary and secondary scatter effects.4 The total scatter from a broad beam of radiation
reaches a calculation point, within a patient.5 The scatter contributions come from various
sub-volumes of different shapes and can, however, be isolated if enough data are
available for a variety of depths and field sizes.5 However, superposition can determine
the contributions from regions in the form of a slab pencil beam or point.3 The term
“Scatter kernel” is known as the pattern of spread of energy.3 The kernels can be
interpreted from two points of view: (1) as iso-contributions from upstream scattering
points to a destination point of interest or (2) as the energy spread from a scattering point
to downstream voxels.3 During the execution of a dose algorithm, the dose at a point is
calculated by summing the effects from scattering elements.3 The level of summation
required, however, is dictated by the problem and boundary conditions at hand.3 If the
incident radiation is changing in only one direction (e.g., wedged photon field), then there
are speed advantages to using a slab kernel and performing only a one-dimensional
superposition.3 If the incident beam intensity is intentionally varied in two directions
using tissue compensators or intensity modulation, then the pencil beam approach is more
suitable.3 If the beam fluence is also changing in a complex way throughout the absorber,
then the point kernel must be known and a full 3-D integration is necessary.3
Mathematically the dose distribution, where F is proportional to the primary source
fluence incident upon the surface of each scatter kernel, and K can be either a point,
pencil, or slab kernel.3 In this general discussion, the kernels are not assumed identical
for each combination of scattering element (x¢,y¢,z¢) and dose point (x,y,z), i.e., the
kernels are not assumed to be invariant throughout the irradiated volume.3 In
heterogeneous tissue, these equations allow for local changes in pimary fluence, F, as
well as changes in the spread of energy due to local scattering conditions.3 This general
approach is known as the superposition principle.3

5) Elekta, Monaco uses X-Ray Voxel Monte Carlo (XVMC).4 In Monaco planning
system XVMC dose engine is used during the segment shape and weight optimization
phase.4 It is consider the most accurate dose calculation currently available by Elekta.
Monaco also uses a fast pencil beam dose engine during “ideal” fluence optimization that
was created specifically for IMRT.4

6) Philips, Pinnacle uses Collapsed Cone Convolution (CCC) and Clarkson algorithm.
Pinnacle³’s Collapsed Cone Convolution Superposition (CCCS) algorithm is the
industry’s most accurate, true 3D dose calculation algorithm.6 The Model Based
Segmentation (MBS) software includes an anatomical library of 3D patient organ
structures models, which reduce the time oncologists spend manually drawing contours.
IGRT workflow is enhanced with our (MBS) software by allowing clinicians to
propagate organs to alternate 4D datasets to determine the extent of tumor movement
within the patient.6 In Pinnacle CCC dose calculation, to account for inhomogeneity, the
kernels are density-scaled during superposition that is performed by using "collapsed
cones", which refer to the modeling of a cone in space using a single ray corresponding to
the central axis of the cone.6
Clarkson Method is based on the principle that the scattered component of the
depth dose, which depends on the field size and shape, can be calculated separately from
the primary component, which is independent of the field size and shape.8 A special
quantity, SAR, is used to calculate the scattered dose.8 The history of Clarkson method is
that it was developed by Cunningham at the Princess Margaret Hospital, Toronto, and
was published in 1970.8 Another program, based on the same principle, was developed by
Khan at the University of Minnesota.8 It was originally written for the CDV-3300
computer using SARs and later rewritten for the Artronix PC-12 and PDP 11/34-
computers.8 The later version use SMRs instead of SARs.8 The following data that are
permanently stored in this computer algorithm: a) a table of SMRs as functions of radii of
circular fields and b) the off-axis ratios Ksp derived form dose profiles at selected
depths.8 These data are then stored in the form of a table of Kp as a function of 1/L
where l is the lateral distance of a point from the central axis and L is the distance along
the same line to the geometric edge of the beam.8 Usually larger fields are used for these
measurements. 8
7) The Helax-TMS Pencil Beam from the Helax-TMS (Nucletron) TPS. The convolution-
superposition algorithm was the Collapsed Cone implemented in the Helax-TMS. The
principles of the algorithm are same as mentioned before.

8) DOSIsoft, Penelope uses Monte Carlo algorithm.7 Full integration of MC algorithms in

the TPS: co-existence with other conventional calculation models (beam library structure,
pooled dose distribution evaluation tools, possibility of mixed processing MC and
specific features associated to MC simulation for routine clinical planning.

References:

1) Expanding Treatment Possibilities: iPlan Monte Carlo Dose Calculation.

BrainLab Oncology Solutions. Available at:
www.brainlab.com/download/pdf/MonteCarlo_Flyer_F_091008.pdf. Accessed
on; August 22, 2012.
2) Herman TL, Gabrish H, Herman TS, et al. Impact of tissue heterogeneity
corrections in stereotactic body radiation therapy treatment plans for lung cancer.
J Med Phys. 2010;35(3):170-173.
3) Dyk JV, Barnett RB, Battista JJ. The modern technology of radiation oncology: a
compendium for medical physicists and radiation oncologists. Medical Physics
Pub. 1999: 236-241.
4) Bring Monaco into Your Clincal Practice. Elekta. 2012. Available at:
http://www.elekta.com/healthcare-professionals/products/elekta-software/treatment-
planning.html. Accessed on: August 22, 2012.
5) Sethi A, Dose Calculation Algorithms Radiation Therapy [power point
prensetation]. Loyola University Medical Center. August 26, 2011.
6) Pinnacle3. Philips. 2012. Available at:
http://www.healthcare.philips.com/us_en/products/ros/products/pinnacle3/index.wpd
#&&/wEXAQUOY3VycmVudFRhYlBhdGgFEERldGFpbHM6T3ZlcnZpZXevJDkbbr7L4JQhtIIK
6OD4k8mA3Q==. Accessed on: August 22, 2012.
7) Husson F. Penelope Monte Carlo Code in Iosgray treatment planning system.
2008. Available at: www.maestro-research.org/IDF-Maestro/Monte.../05.Husson.pdf.
Accessed on: August 22, 2012.
8) Khan F.M. The Physics of Radiation Therapy. 4th ed. Philadelphia, PA: Lippincott
Williams and Wilkins; 2010: 154-166,221-224.