Correction factors for commissioning and patient specific quality assurance of stereotactic fields in a Monte Carlo based treatment planning system: TPS correction factors

Validation of small field dosimetry is crucial for stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT). Accurate and considered measurement of linear accelerator dose must be compared to precise and accurate calculation by the treatment planning system (TPS). Monte Carlo calculated distributions contain statistical noise, reducing the reliance that should be given to single voxel doses. The average dose to a small volume of interest (VOI) can minimise the influence of noise, but for small fields introduces significant volume averaging. Similar challenges present during measurement of composite dose from clinical plans when a small volume ionisation chamber is used. This study derived correction factors for VOI averaged TPS doses calculated for small fields, allowing correction to an isocentre dose following account for statistical noise. These factors were used to determine an optimal VOI to represent small volume ionisation chambers during patient specific quality assurance (PSQA). A retrospective comparison of 82 SRS and 28 SBRT PSQA measurements to TPS calculated doses from varying VOI was completed to evaluate the determined volumes. Small field commissioning correction factors of under 5% were obtained for field sizes of 8 mm and larger. Optimal spherical VOI with radius between 1.5 and 1.8 mm and 2.5 to 2.9 mm were determined for IBA CC01 and CC04 ionisation chambers respectively. Review of PSQA confirmed an optimal agreement between CC01 measured doses and a volume of 1.5 to 1.8 mm while CC04 measured doses showed no variation with VOI.