The Impact of Dose Calculation Algorithm for SBRT Lung Cancer Radiotherapy Treatment

Document Type : Original Paper


1 Kafr Ash shaykh military oncology center, Egypt

2 Menoufia University, faculty of science, department of Physics, Egypt

3 Hermitage Medical Clinic, Physics department, Dublin, Ireland

4 Al Azhar University, faculty of medicine, Oncology department, Egypt


Introduction: The study aimed to provide the dose accuracy effects between the Anisotropic Analytical Algorithm (AAA) and the deterministic solver Acuros XB (AXB) that are available on Eclipse TPS (Varian Medical Systems, Palo Alto, CA) treatment planning system (TPS).  The purpose is to investigate the difference between the AAA and Acuros XB Algorithm, The difference is due to the electron transport difference in the case of small fields.
Material and Methods: For the study of non-small cell lung cancer (NSCLC) patient Computed tomography (CT) scans are used to do retrospective stereotactic body radiosrgery (SBRT) plans via AAA and recalculated by AXB dose calculation algorithms using the Eclipse treatment planning system. The main dosimetric comparison parameters are Conformity index (CI), Homogeneity Index (HI), Gradient Index (GI), Target mean dose, and calculation time. The Statistical analysis done by the gamma index comparison.
Results: Based on the results, the CI is (1.45±0.55) to (1.85±0.7) (P<0.05). The HI are (0.15±0.07) and (0.13±0.08) (P<0.05), the GI for AAA was (4.8±2.6) and for AXB reaches (7.4±3.8) (P<0.05) and the maximum dose for Planning target volume (PTV) is differed about 2.3% to 4.5%, mean dose is differed about 2.4% to 3.8% and the calculation time 153±43sec and 185±76sec for AAA and AXB respectively.
Conclusion: The findings using the deterministic solver AXB in the calculation for the case of low density like lung cases is more accurate than AAA calculation Algorithm in SBRT treatment.


Main Subjects

  1. Timmerman RD, Park C, Kavanagh BD. The North American experience with stereotactic body radiation therapy in non-small cell lung cancer. Journal of Thoracic Oncology, 2007; 2(7): S101-12.‏
  2. Pizzutiello R, Svatos M. SU‐A‐BRE‐01: AAPM Medical Physics Student Meeting. Medical Physics. 2014; 41(6Part2):89.‏
  3. SRS SR. Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT).
  4. Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, Gomi K, et al. Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage I non-small cell lung cancer: updated results of 257 patients in a Japanese multi-institutional study. Journal of thoracic oncology. 2007; 2)7(: S94-100.‏
  5. Partridge M, Ramos M, Sardaro A, Brada M. Dose escalation for non-small cell lung cancer: analysis and modelling of published literature. Radiotherapy and Oncology. 2011; 99)1(: 6-11.‏
  6. Wulf J, Baier K, Mueller G, Flentje MP. Dose-response in stereotactic irradiation of lung tumors. Radiotherapy and oncology. 2005; 77(1): 83-7.‏
  7. Bezjak A, Paulus R, Gaspar LE, Timmerman RD, Straube WL, Ryan WF, et al. Primary study endpoint analysis for NRG Oncology/RTOG 0813 trial of stereotactic body radiation therapy (SBRT) for centrally located non-small cell lung cancer (NSCLC). International Journal of Radiation Oncology Biology• Physics. 2016; 94(1): 5-6.‏
  8. Sievinen J, Ulmer W, Kaissl W. AAA Photon Dose Calculation Model in Eclipse. 2005;118:2894.
  9. Krabch ME, Chetaine A, Nourreddine A, Er-Radi FZ, Baddouh L. Comparative study between Acuros XB algorithm and Anisotropic Analytical Algorithm in the case of heterogeneity for the treatment of lung cancer. Polish Journal of Medical Physics and Engineering.2018; 24(3):115-9.‏
  10. Alghamdi S, Tajaldeen A. Evaluation of dose calculation algorithms using different density materials for in-field and out-of-field conditions. Exp oncol. 2019; 41(1): 46-52.‏
  11. Menzel Hans-Georg. International commission on radiation units and measurements. Journal of the ICRU. 2014;14(2):1-2.
  12. Fogliata A, Nicolini G, Clivio A, Vanetti E, Cozzi L. Dosimetric evaluation of Acuros XB Advanced Dose Calculation algorithm in heterogeneous media. Radiation oncology, 2011; 6)1(: 1-15.‏
  13. Kan MW, Leung LH, So RW, Yu PK. Experimental verification of the Acuros XB and AAA dose calculation adjacent to heterogeneous media for IMRT and RapidArc of nasopharygeal carcinoma. Medical physics, 2013; 40(3): 031714.‏
  14. Tillikainen L, Siljamäki S, Helminen H, Alakuijala J, Pyyry J. Determination of parameters for a multiple-source model of megavoltage photon beams using optimization methods. Physics in Medicine & Biology, 2007; 52(5): 1441.‏
  15. Tillikainen L, Helminen H, Torsti T, Siljamäki S, Alakuijala J, Pyyry J, et al. A 3D pencil-beam-based superposition algorithm for photon dose calculation in heterogeneous media. Physics in Medicine & Biology, 2008; 53(14): 3821.‏
  16. Alagar AG, Mani GK, Karunakaran K. Percentage depth dose calculation accuracy of model based algorithms in high energy photon small fields through heterogeneous media and comparison with plastic scintillator dosimetry. Journal of applied clinical medical physics, 2016;17(1):132-42.‏
  17. Mishra P, Li R, Mak RH, Rottmann J, Bryant JH, Williams CL, et al. An initial study on the estimation of time‐varying volumetric treatment images and 3D tumor localization from single MV cine EPID images. Medical physics, 2014; 41(8Part1): 081713.‏
  18. Tajaldeen A, Ramachandran P, Alghamdi S, Geso M. On the use of AAA and AcurosXB algorithms for three different stereotactic ablative body radiotherapy (SABR) techniques: Volumetric modulated arc therapy (VMAT), intensity modulated radiation therapy (IMRT) and 3D conformal radiotherapy (3D-CRT). Reports of Practical Oncology and Radiotherapy. 2019; 24(4):399-408.‏
  19. Tsuruta Y, Nakata M, Nakamura M, Matsuo Y, Higashimura K, Monzen H, et al. Dosimetric comparison of Acuros XB, AAA, and XVMC in stereotactic body radiotherapy for lung cancer. Medical physics, 2014; 41(8Part1): 081715.‏
  20. Vassiliev ON, Wareing TA, McGhee J, Failla G, Salehpour MR, Mourtada F. Validation of a new grid-based Boltzmann equation solver for dose calculation in radiotherapy with photon beams. Physics in Medicine & Biology. 2010; 55(3): 581.‏
  21. Fogliata A, Lobefalo F, Reggiori G, Stravato A, Tomatis S, Scorsetti M, et al. Evaluation of the dose calculation accuracy for small fields defined by jaw or MLC for AAA and Acuros XB algorithms. Medical physics. 2016; 43(10): 5685-94.‏
  22. Krishna GS, Srinivas V, Reddy PY. Clinical implications of Eclipse analytical anisotropic algorithm and Acuros XB algorithm for the treatment of lung cancer. Journal of medical physics. 2016;41(4):219.
  23. Aristophanous M, Rottmann J, Court LE, Berbeco RI. EPID‐guided 3D dose verification of lung SBRT. Medical physics. 2011;38(1): 495-503.‏
  24. Wilke L, Andratschke N, Blanck O, Brunner TB, Combs SE, Grosu AL, et al. ICRU report 91 on prescribing, recording, and reporting of stereotactic treatments with small photon beams. Strahlentherapie und Onkologie. 2019; 195(3): 193-8.
  25. Lomax NJ, Scheib SG. Quantifying the degree of conformity in radiosurgery treatment planning. International Journal of Radiation Oncology* Biology* Physics, 2003; 55(5):1409-19.‏
  26. ICRU report 83: Prescribing, Recording and Reporting Photon-Beam Intensity Modulated Radiation Therapy (IMRT). Journal of the ICRU. 2010;10(1):1-3
  27. Vassiliev ON, Kry SF, Wang HC, Peterson CB, Chang JY, Mohan R. Radiotherapy of lung cancers: FFF beams improve dose coverage at tumor periphery compromised by electronic disequilibrium. Physics in Medicine & Biology.2018; 63(19): 195007.‏
  28. Paddick I, Lippitz B. A simple dose gradient measurement tool to complement the conformity index. Journal of neurosurgery. 2006; 105(Supplement):194-201
  29. Kan MW, Leung LH, Yu PK. Dosimetric impact of using the Acuros XB algorithm for intensity modulated radiation therapy and RapidArc planning in nasopharyngeal carcinomas. Int J Radiat Oncol Biol Phys. 2013;85(1):e73-80.
  30. Do Park, Kim TG, Kim JE. Dosimetric impact of intermediate dose calculation for optimization convergence error. Oncotarget. 2016; 7(25):37589.‏
  31. Rana S, Rogers K, Pokharel S, Lee T, Reed D, Biggs C.Acuros XB algorithm vs. anisotropic analytical algorithm: a dosimetric study using heterogeneous phantom and computed tomography (CT) data sets of esophageal cancer patients. Journal of Cancer Therapy. 2013; 4(1):138-44.
  32. Liu HW, Nugent Z, Clayton R, Dunscombe P, Lau H, Khan R. Clinical impact of using the deterministic patient dose calculation algorithm Acuros XB for lung stereotactic body radiation therapy. Acta Oncologica. 2014; 53(3):324-9.‏




Volume 19, Issue 5
September and October 2022
Pages 290-295
  • Receive Date: 03 April 2021
  • Revise Date: 31 August 2021
  • Accept Date: 15 September 2021