Tissue classifications in Monte Carlo simulations of patient dose for photon beam tumor treatments

The purpose of this work was to study the calculated dose uncertainties induced by the material classification that determined the interaction cross-sections and the water-to-material stopping-power ratios. Calculations were made for a head- and neck-cancer patient treated with five intensity-modulated radiotherapy fields using 6 MV photon beams. The patient's CT images were reconstructed into two voxelized patient phantoms based on different CT-to-material classification schemes. Comparisons of the depth-dose curve of the anterior-to-posterior field and the dose-volume-histogram of the treatment plan were used to evaluate the dose uncertainties from such schemes. The results indicated that any misassignment of tissue materials could lead to a substantial dose difference, which would affect the treatment outcome. To assure an appropriate material assignment, it is desirable to have different conversion tables for various parts of the body. The assignment of stopping-power ratio should be based on the chemical composition and the density of the material.