Objective: Purpose of this work was to study the dose perturbation within the target volume of a external MV radiation therapy when using metal fiducials.
Methods: We developed a Monte Carlo simulation in Geant4 of a cylindrical fiducial made either of gold or of steel and simulated the photon irradiation beam originating from a medical Linac operating at 6, 10 or 15 MV. For each energy, two different irradiation schemes were simulated: a single 5 × 5-cm square field in the -x direction, and five 5 × 5-cm fields at 0°, 80°, 165°, 195° and 280°.
Results: In a single beam irradiation scheme, we observed a dose reduction behind fiducials varying from -20% for gold at 6 MV to -5% for steel at 15 MV, and a dose increment in front of the fiducial ranging from +33% for gold at 15 MV to +10% for steel at 6 MV. When five beams were employed, a dose increment ranging from +28% to +46% has been found around gold. Around a steel fiducial, an average increment of +17% was found, irrespective of the photon energy.
Conclusions: When using a single beam, the decrement of dose behind both steel and gold markers increases with the photon energy. This effect vanishes when a multifield treatment is delivered; in this instance there is a dose increment around fiducials, according to both fiducial material and photon energy, with lower values for steel and 6 MV. This energy represents the best choice when fiducial markers are present inside the irradiated volume.
Keywords: Monte Carlo; Radiotherapy; dose; fiducial marker x-rays.