Dosimetric Study on Variations of Gamma Index (GI) in Pre-Treatment Verification Procedure in Intensity Modulated Radiotherapy (IMRT) Plans with Varying Grid Sizes Using 2D Array Detectors

Abstract

Aim: The main aim of our study was to compare the variation of Gamma Index (GI) in Pre-treatment Verification Procedure in Intensity Modulated Radiotherapy (IMRT) Plans with Varying Grid Sizes Using 2D Array Detectors. Choosing an optimum grid size plays a vital role for planning in radiotherapy cases especially while treating with IMRT. A minimal change of even 1 mm of grid size can result in large variation in treatment planning and is reflected in quality assurance results also. Methods and Material: We compared IMRT plans for a total of 12 patients. Out of these 12 patients 4 were head and neck, 4 were pelvic and 4 were brain patients respectively. For each patient three plans were generated with three different grid sizes. The plan acceptance criteria were 95% of PTV to receive at least 95% of prescribed dose and dose to 1% of PTV not to exceed 107% of prescribed dose. Dose for the organs at risk were respected as per the QUANTEC guidelines. After plan acceptance corresponding Pre-treatment Verification Procedure for IMRT was executed by PTW 729 array detector. The Gamma index (GI) results of each plan were recorded for the three different grid sizes. The passing criteria were kept to be 3% Dose Difference (DD) and 3 mm Distance to Agreement (DTA) for all cases. Results: We estimated the variations in GI quality assurance results for patients undergoing IMRT planning with varying grid sizes of 3 mm, 5 mm and 10 mm respectively. We also evaluated 2% DD and 2 mm DTA, 3% DD, 3 mm DTA and 5% DD, 5 mm DTA criteria for passing result. Stastical analysis: We have calculated the average and standard Deviations (Std. Dev.) for each passing criteria for 2% DD, 2 mm DTA, 3% DD, 3 mm DTA and 5% DD, 5 mm DTA for each IMRT plans with varying grid sizes. Conclusions: Though the present results suggest the gamma criteria of 5% DD and 5 mm DTA as the most suitable criteria for IMRT quality assurance. This gamma criterion of 5% DD and 5 mm DTA favourably exceeds 95% in each case and grid sizes but it is not recommended for strict verification procedure in Intensity Modulated Radiotherapy (IMRT). The criteria of 2% DD and 2 mm DTA, and 3% DD and 3 mm DTA gamma values show below 90% for 5 mm and 10 mm grid sizes but exceeds 95% for the 3 mm grid sizes. Hence 3 mm or less grid sizes should be routinely used in pre-treatment verification procedure IMRT plans using 2D Array Detectors.