Treatment planning systems with highly accurate dose calculation algorithms such as Monte-Carlo method and linear Boltzmann transport equation are becoming popular thanks to a development of the computer technology. These algorithms use new concepts, dose-to-medium and dose-to-water. However, introducing these concepts can cause confusion in clinical sites. Basic knowledges about Monte-Carlo simulation and other corresponding algorithms were explained in this article such as the principles, the parameters and words of caution.

Conversion from CT value to density is essential to a radiation treatment planning system. Generally CT value is converted to the electron density in photon therapy. In the energy range of therapeutic photon, interactions between photons and materials are dominated with Compton scattering which the cross-section depends on the electron density. The dose distribution is obtained by calculating TERMA and kernel using electron density where TERMA is the energy transferred from primary photons and kernel is a volume considering spread electrons. Recently, a new method was introduced which uses the physical density. This method is expected to be faster and more accurate than that using the electron density. As for particle therapy, dose can be calculated with CT-to-stopping power conversion since the stopping power depends on the electron density. CT-to-stopping power conversion table is also called as CT-to-water-equivalent range and is an essential concept for the particle therapy.

Recently, for medical imaging, digital radiography systems are widely used in clinical practices. However, a study in the past reported that a patient radiation exposure level by digital radiography is in fact not lower than that by analog radiography system. High level of attention needs to be paid for over-exposure when using the conventional analog radiography with a screen and a film, as it results in high density of the film. However, for digital radiography systems, since the automatic adjusting function of image density is equipped with them, no attention for radiation dose need to be paid. Thus technologists tend to be careless and results in higher chance for over-exposure. Current digital radiography systems are high-performance in the image properties and capable of patient dose reduction. Especially, the image quality of the flat panel detector system is recognized, higher than that of the computed radiography system by imaging plates, in both objective and subjective evaluations. Therefore, we technologists are responsible for optimizing the balance between the image quality of the digital radiogram and the radiation dose required for each case. Moreover, it is also required for us as medical technologists to make effective use of such evaluation result of medical images for patients.