Are cold spots on an external beam plan due to prostate fiducials concerning?

The dosimetry around fiducials is complex, with both some minimal shielding and increased dose due to scatter coming into play. Honestly, I'm not sure how accurate the planning system algorithms are in determining dose in the immediate vicinity around the typical tiny fiducial. On balance, I think t...

We recently looked into this with our physics team. I fully agree with Dr. @Dr. First Last about the difficulties in knowing how accurate the planning systems are around the tiny fiducials.

When using Acuros in Eclipse, we noticed that the optimizer appears to compensate for the cold spots by forcin...