Effects of bone- and air-tissue inhomogeneities on the dose   distributions of the Leksell Gamma Knife$^{\circledR}$ calculated with   PENELOPE
  Monte Carlo simulation with PENELOPE (v.~2003) is applied to calculate Leksell Gamma Knife$^{\circledR}$ dose distributions for heterogeneous phantoms. The usual spherical water phantom is modified with a spherical bone shell simulating the skull and an air-filled cube simulating the frontal or maxillary sinuses. Different simulations of the 201 source configuration of the Gamma Knife have been carried out with a simplified model of the geometry of the source channel of the Gamma Knife recently tested for both single source and multisource configurations. The dose distributions determined for heterogeneous phantoms including the bone- and/or air-tissue interfaces show non negligible differences with respect to those calculated for a homogeneous one, mainly when the Gamma Knife isocenter approaches the separation surfaces. Our findings confirm an important underdosage ($\sim$10%) nearby the air-tissue interface, in accordance with previous results obtained with PENELOPE code with a procedure different to ours. On the other hand, the presence of the spherical shell simulating the skull produces a few percent underdosage at the isocenter wherever it is situated. 
Feras M.O. Al-Dweri, E. Leticia Rojas and Antonio M. Lallena