# Clinical test cases for commissioning, QA, and benchmarking of model‐based dose calculation algorithms in 1⁹2Ir HDR gynecologic tandem and ring brachytherapy

## TL;DR

This paper creates realistic test cases for evaluating dose calculation algorithms in HDR brachytherapy, using real patient data and Monte Carlo simulations.

## Contribution

The paper introduces a framework for commissioning and benchmarking model-based dose calculation algorithms using clinically relevant datasets and simulations.

## Key findings

- Monte Carlo simulations showed agreement within statistical uncertainty.
- Commercial TPS MBDCAs had both advantages and limitations compared to MC simulations.
- The datasets and methodology can be used for benchmarking and quality assurance in HDR brachytherapy.

## Abstract

To develop clinically relevant test cases for commissioning Model‐Based Dose Calculation Algorithms (MBDCAs) for 192Ir High Dose Rate (HDR) gynecologic brachytherapy following the workflow proposed by the TG‐186 report and the WGDCAB report 372.

Two cervical cancer intracavitary HDR brachytherapy models were developed based on a real patient, using either uniformly structured regions or realistic segmentation. The patient's computed tomography (CT) images were processed, converted to a series of digital imaging and communications in medicine (DICOM) CT images, and imported into two treatment planning systems (TPSs), the Oncentra Brachy and BrachyVision. The original segmentation of the clinical case was augmented to enable a thorough dosimetric analysis. The actual clinical treatment plan was generally maintained, with the source replaced by a generic 192Ir HDR source. Dose to medium in medium calculations were performed using the MBDCA option of each TPS, and three different Monte Carlo (MC) simulation codes. MC results demonstrated agreement within statistical uncertainty, while comparisons between the commercial TPS MBDCAs and a general‐purpose MC code highlighted both the advantages and limitations of the studied MBDCAs, suggesting potential approaches to overcome the challenges.

The datasets for the developed cases are available online at https://doi.org/10.5281/zenodo.15720996. The DICOM files include the treatment plan for each case, TPS, and the corresponding reference MC dose data. The package also contains a TPS‐ and case‐specific user guide for commissioning the MBDCAs, as well as files necessary to replicate the MC simulations.

The provided datasets and proposed methodology can serve as a commissioning framework for TPSs that employ MBDCAs, as well as a benchmark for brachytherapy researchers using MC methods and MBDCA developers. They also facilitate intercomparisons of MBDCA performance and provide a quality assurance resource for evaluating future TPS software updates.