提出了一种新型基于补偿器的系统，可以使用钴-60射线进行调强放疗（IMRT），从而提高低收入和中等收入国家对先进放疗的接触率。为了使这一系统在商业治疗计划系统（TPS）中得到临床可行，以便将其纳入正在开发的放射治疗计划助手（RPA）中，以提供低收入和中等收入国家的自动化规划服务，必须进行委托和验证。所考虑的新型治疗设备采用钴-60源和九个补偿器。每个补偿器由三维打印的薄塑料模制成，然后在机器内按需用可重复使用的直径为2毫米的球形钨球填充。该系统在Eclipse TPS中进行委托，并使用Geant4应用于计算机断层发射进行百分深度剂量，平面剖面，笔集，IMRT剂量验证的蒙特卡罗验证测试。同时还进行了美国医学物理学家协会任务组119基准测试。此外，为46例头颈癌病例创建了基于补偿器的钴-60 IMRT计划，并与临床使用的线性加速器体积调节弧疗法（VMAT）计划进行比较，然后评估了剂量参数。计算了每个场的发射时间。此外，在有限环境中进行了测量，并与蒙特卡罗模拟进行了比较。Eclipse和蒙特卡罗的深度剂量和平面剖面之间的差异分别为0.65％±0.41％和1.02％±0.99％，而80％-20％笔缘在0.46±0.27毫米之内。对于任务组119验证计划，所有治疗计划目标均得到满足，并且γ通过率> 95％（3％/ 3 mm标准）。在46例临床头颈病例中，基于补偿器的钴-60 IMRT计划具有与基于线性加速器的VMAT计划类似的计划目标容量（PTV）覆盖：所有PTV的剂量值均在1.5％之内。与基于线性加速器的VMAT计划相比，器官危及剂量参数在基于补偿器的钴-60 IMRT计划中略高。脊髓，大脑和脑干的平均剂量差异分别为4.43±1.92 Gy，3.39±4.67 Gy和2.40±3.71 Gy，其余器官的平均剂量差异均<1 Gy。6MV多叶片整流器计划每个场的平均开机时间为0.42±0.10分钟，而钴-60补偿器计划在剂量速率为350和175 cGy / min时的开机时间分别为0.17±0.01和0.31±0.01分钟。测量结果与蒙特卡罗模拟之间的平面剖面之间存在良好的一致性，两种不同场的差异分别为1.34％±1.90％和0.13％±2.16％。委托了钴-60射线基于补偿器的IMRT系统，并在商业TPS中进行了验证。在所有测试案例中，该系统的计划质量与基于线性加速器的计划相当，估计的开机时间更短。该系统可靠，成本和复杂性较低，并可能对世界上服务不足的地区带来益处。这个系统正在集成到RPA中，后者是一个基于网络的自动轮廓和自动设置平台。©2023年美国医学物理学家协会。

A novel compensator-based system has been proposed which delivers intensity-modulated radiation therapy (IMRT) with cobalt-60 beams. This could improve access to advanced radiotherapy in low- and middle-income countries. For this system to be clinically viable and to be adapted into the Radiation Planning Assistant (RPA), being developed to offer automated planning services in low- and middle-income countries, it is necessary to commission and validate it in a commercial treatment planning system (TPS).The novel treatment device considered here employs a cobalt-60 source and nine compensators. Each compensator is produced by 3-D printing a thin plastic mold which is then filled on-demand within the machine with reusable 2-mm-diameter spherical tungsten balls. This system was commissioned in the Eclipse TPS and validation tests were conducted with Monte Carlo using Geant4 Application for Tomographic Emission for percentage depth dose, in-plane profiles, penumbra, and IMRT dose validation. And the American Association of Physicists in Medicine Task Group 119 benchmarking testing was performed. Additionally, compensator-based cobalt-60 IMRT plans were created for 46 head-and-neck cancer cases and compared to the linac-based volumetric modulated arc therapy (VMAT) plans used clinically, then dosimetric parameters were evaluated. Beam-on time for each field was calculated. In addition, the measurement was also performed in a limited environment and compared with the Monte Carlo simulations.The differences in percent depth doses and in-plane profiles between the Eclipse and Monte Carlo simulations were 0.65% ± 0.41% and 1.02% ± 0.99%, respectively, and the 80%-20% penumbra agreed within 0.46 ± 0.27 mm. For the Task Group 119 validation plans, all treatment planning goals were met and gamma passing rates were >95% (3%/3 mm criteria). In 46 clinical head-and-neck cases, the cobalt-60 compensator-based IMRT plans had planning target volume (PTV) coverages similar to linac-based VMAT plans: all dosimetric values for PTV were within 1.5%. The organs at risk dose parameters were somewhat higher in cobalt-60 compensator-based IMRT plans versus linac-based VMAT plans. The mean dose differences for the spinal cord, brain, and brainstem were 4.43 ± 1.92, 3.39 ± 4.67, and 2.40 ± 3.71 Gy, while those for the rest of the organs were <1 Gy. The average beam-on time per field was 0.42 ± 0.10 min for the 6 MV multi-leaf-collimator plans while those for the cobalt-60 compensator plans were 0.17 ± 0.01 and 0.31 ± 0.01 min at the dose rates of 350 and 175 cGy/min. There was a good agreement between in-plane profiles from measurements and Monte Carlo simulations, which differences are 1.34 ± 1.90% and 0.13 ± 2.16% for two different fields.A novel compensator-based IMRT system using cobalt-60 beams was commissioned and validated in a commercial TPS. Plan quality with this system was comparable to that of linac-based plans in all test cases with shorter estimated beam-on times. This system enables reliable, high-quality plans with reduced cost and complexity and may have benefits for underserved regions of the world. This system is being integrated into the RPA, a web-based platform for auto-contouring and auto-planning.© 2023 American Association of Physicists in Medicine.