Impact of amalgam dental filling on radiotherapy of head and neck cancer: In vivo dosimetry and dose calculation using AAA and Acuros algorithms

High-density dental materials cause significant dose perturbations in the oral cavity during head and neck radiotherapy. In our clinical IMRT setup, the AAA algorithm demonstrated closer agreement with in vivo film measurements compared to AXB, despite the theoretical and literature-reported superiority of AXB in heterogeneous conditions. This discrepancy underscores that algorithm performance depends on clinical technique, dosimetric methodology, and dose reporting mode. Additionally, each dental filling was associated with earlier mucositis onset.