We don’t need better dose calculation, it’s doing more bad than good

Sterpin, Edmond [UCL]

Advanced dose calculation algorithms have demonstrated excellent performance against measurements for complex treatments and heterogeneous phantoms. Thus, it is natural to consider those as the best candidates for treatment planning. Because the dose calculation is more accurate, so will be the treatment and its outcome improved. This seems intuitively obvious. However, a broader view on our clinical practice may temper this conclusion. In our clinical practice, we are using dose prescriptions from past experience that was typically based on less accurate dose calculation algorithms. Also, we are using safety margins for geometrical uncertainties that are based on hypothesis that simplify considerably the physics of dose deposition, but yet seem to provide adequate coverage and safety for the majority of the patients. We will show during this debate that changing the dose calculation algorithm considering our present practice will not necessary have a positive impact for the patients. Therefore, the introduction of such algorithms in clinics should be made cautiously.