Affordable compensator for IMRT delivery designed for low-and-middle income countries, a Monte Carlo study.

• Novel cost-effective compensator to deliver IMRT in low-and-middle income countries. • A reusable bead-based compensator provides dose distribution similar to a solid compensator with low cost. • The system can be used with cobalt-60 unit or linear accelerator. • Beam profiles show no significant signature of the beads relative to a solid compensator. We propose a novel cost-effective compensator that can be used to facilitate access to IMRT in low-and-middle income countries. The compensator has the advantages of simplicity, less downtime, increased reliability and less impact on treatment quality from patient motion during treatment. Moreover, the system can be used with either a cobalt-60 unit or linear accelerator. In this Monte Carlo study, the dosimetric properties of the new compensator design have been evaluated. Results were obtained for different field sizes of cobalt teletherapy machine, and the dose was scored at 0.5 cm depth in a water phantom. The effects of compensator thickness, filling material type and shape, and field size were identified. Furthermore, the percentage depth dose and beam profiles for various field sizes and at different depths were obtained. Beam profiles show no significant signature of the beads relative to a solid compensator; in addition, they exhibit a better flatness while preserving symmetry for all field sizes. A reusable bead-based compensator appears to be feasible, and provides dose distribution similar to a solid compensator with low cost and no hazards. Our results avail the ongoing efforts to expand the reach to IMRT in low- and middle-income countries. [ABSTRACT FROM AUTHOR]