Integral Quality Monitor Research Articles

Comparison of calculation algorithms to predict the IQM detector response for various modulation degrees of VMAT treatment plans on linear accelerator equipped with the HD120 MLC.

The calculation model for the integral quality monitor (IQM) system does not take into account the characteristics of the HD120 multileaf collimator (MLC), which some Varian accelerators are equipped with. Some treatment plans prepared with this collimator are characterized by a high level of modulation. The aim of the work was to prepare a model for that collimator and to determine the influence of modulation on results of the verification carried out with the use of IQM system. The short and long stabilities of the IQM detector response were verified by measuring the signal for a 6MV flattening filter-free (FFF) beam with the static field of 10×10cm2 size. The obtained results were compared with the measurements performed with the PTW Farmer chamber. Next, the signals for 35 static square fields 4×4cm2 , covering the whole field 38×20cm2 , were measured with the IQM. Based on the results of these measurements, the original calculation model has been changed in order to achieve the smallest differences between calculations and measurements. While tuning the model, the characteristics of the HD120 MLC were included. Measurements were performed for 30 clinical plans (86 arcs) prepared with 6MV FFF beams. Among those 30 plans, there were were multitarget plans with single isocenter. For each plan, the modulation complexity score (MCS) was calculated. The measurement results were compared with the calculation results performed with the original and authors' calculation model. Very good stability of the short and long stabilities of the IQM detector response was obtained. Measurements performed for 35 static fields revealed that for the manufacturer's and for the authors' models, the deviation exceeded 3% for 12 and five of the 35 static fields, respectively. The differences for the manufacturer's and authors' algorithms were in the range of ±2% for the 15 and 26 of the fields, respectively. For original and the authors' models, the differences between measured and calculated signals (starting with the segment number 40) were within the range of ±3.5% for 87.6% and 96.7% of all arcs for the respective models. For both models, the dependence of the compliance of measurements and calculations on the MCS was observed. For most of the very modulated arcs, the measured signal was at least 3% lower than the calculated one. The largest differences between measurements and calculations were obtained for single-isocenter multitarget plans. The signal predicted by an algorithm taking into account the real geometry of the collimating system of the Edge accelerator (equipped with the HD120 MLC) made it possible to obtain greater consistency between the measurements and calculations. We characterized the dependence between the MCS of each arc and the compliance of the measurements and calculations. Much worse results were obtained for single-isocenter multitarget plans.

An investigation of the IQM signal variation and error detection sensitivity for patient specific pre-treatment QA.

To evaluate the Integral Quality Monitor (IQM) as a clinical dosimetry device for detecting photon beam delivery errors in clinically relevant conditions. The IQM's ability to detect delivery errors introduced into clinical VMAT plans for two different treatment sites was assessed. This included measuring 103 nasopharynx VMAT plans and 78 lung SBRT VMAT plans with introduced errors in gantry angle (1-5°) and in MLC-defined field size and field shift (1-5mm). The IQM sensitivity was compared to ArcCheck detector performance. Signal dependence on field position for on-axis and asymmetrically offset square field sizes from 1×1cm2 to 30×30cm2 was also investigated. The IQM detected almost all introduced clinically-significant MLC field size errors, but not some small gantry angle errors or most MLC field shift errors. The IQM sensitivity was comparable to the ArcCheck for lung SBRT, but worse for the nasopharynx plans. Differences between IQM calculated/predicted and measured signals were within±2% for all on-axis square fields, but up to 60% for the smallest asymmetrically offset fields at large offsets. The IQM performance was consistent and reproducible. It showed highest sensitivity to the field size errors for these plans, but did not detect some clinically-significant introduced gantry angle errors or most MLC field shift errors. The IQM calculation model is still being developed, which should improve small offset-field performance. Care is required in IQM use for plan verification or online monitoring, especially for small fields that are off-axis in the detector gradient direction.

Comparison of pretreatment VMAT quality assurance with the integral quality monitor (IQM) and electronic portal imaging device (EPID).

The purpose of this study was to compare pretreatment volumetric modulated arc therapy (VMAT) quality assurance (QA) measurements and evaluate the multileaf collimator (MLC) error sensitivity of two detectors: the integral quality monitor (IQM) system (iRT systems IQM) and the electronic portal imaging device (EPID) (Varian PortalVision aS1200). Pretreatment QA measurements were performed for 20 retrospective VMAT plans (53 arcs). A subset of ten plans (23 arcs) was used to investigate MLC error sensitivity of each device. Eight MLC error plans were created for each VMAT plan. The errors included systematic opening/closing (±0.25, ±0.50, ±0.75 mm) of the MLC and random positional errors (1 mm) for individual/groups of leaves. The IQM was evaluated using the percent error of the measured cumulative signal relative to the calculated signal. The EPID was evaluated using two methods: a novel percent error of the measured relative to the predicted cumulative signals, and gamma (γ) analysis (1%/1 mm, 2%/2 mm, 3%/3 mm and 3%/1 mm for Stereotactic Body Radiation Therapy plans). The average change in maximum dose obtained from dose‐volume histogram (DVH) data and change in detector signals for different systematic MLC shifts was also compared. Cumulative signal differences showed similar levels of agreement between measured and expected detector signals (IQM: 1.00 ± 0.55%; EPID: 1.22 ± 0.92%). Results from γ analysis lacked specificity. Only the 1%/1 mm criteria produced data with remarkable differences. A strong linear correlation was observed between IQM and EPID cumulative signal differences with MLC error magnitude (R = 0.99). Likewise, results indicate a strong correlation between the cumulative signal for both detectors and DVH dose (RIQM = 0.99; REPID = 0.97). In conclusion, use of cumulative signal differences could be more useful for detecting errors in treatment delivery in EPID than γ analysis.

Effect of an integral quality monitor on 4-, 6-, 10-MV, and 6-MV flattening filter-free photon beams.

PurposeTo investigate the effect of an integral quality monitor (IQM; iRT Systems GmbH, Koblenz, Germany) on 4, 6, 10, and 6‐MV flattening filter‐free (FFF) photon beams.MethodsWe assessed surface dose, PDD20,10, TPR20,10, PDD curves, inline and crossline profiles, transmission factor, and output factor with and without the IQM. PDD, transmission factor, and output factor were measured for square fields of 3, 5, 10, 15, 20, 25, and 30 cm and profiles were performed for square fields of 3, 5, 10, 20, and 30 cm at 5‐, 10‐, and 30‐cm depth.ResultsThe differences in surface dose of all energies for square fields of 3, 5, 10, 15, 20, and 25 cm were within 3.7% whereas for a square field of 30 cm, they were 4.6%, 6.8%, 6.7%, and 8.7% for 4‐MV, 6‐MV, 6‐MV‐FFF, and 10‐MV, respectively. Differences in PDD20,10, TPR20,10, PDD, profiles, and output factors were within ±1%. Local and global gamma values (2%/2 mm) were below 1 for PDD beyond d max and inline/crossline profiles in the central beam region, respectively. The gamma passing rates (10% threshold) for PDD curves and profiles were above 95% at 2%/2 mm. The transmission factors for 4‐MV, 6‐MV, 6‐MV‐FFF, and 10‐MV for field sizes from 3 × 3 to 30 × 30 cm2 were 0.926–0.933, 0.937–0.941, 0.937–0.939, and 0.949–0.953, respectively.ConclusionsThe influence of the IQM on the beam quality (in particular 4‐MV X‐ray has not verified before) was tested and introduced a slight beam perturbation at the surface and build‐up region and the edge of the crossline/inline profiles. To use IQM in pre‐ and intra‐treatment quality assurance, a tray factor should be put into treatment planning systems for the dose calculation for the 4‐, 6‐, 10‐, and 6‐MV flattening filter‐free photon beams to compensate the beam attenuation of the IQM detector.

Combined Use of a Transmission Detector and an EPID-Based In Vivo Dose Monitoring System in External Beam Whole Breast Irradiation: A Study with an Anthropomorphic Female Phantom

We evaluate the combined usage of two systems, the Integral Quality Monitor (IQM) transmission detector and SoftDiso software, for in vivo dose monitoring by simultaneous detection of delivery and patient setup errors in whole breast irradiation. An Alderson RANDO phantom was adapted with silicon breast prostheses to mimic the female anatomy. Plans with simulated delivery errors were created from a reference left breast plan, and patient setup errors were simulated by moving the phantom. Deviations from reference values recorded by both monitoring systems were measured for all plans and phantom positions. A 2D global gamma analysis was performed in SoftDiso for all phantom displacements. Both IQM signals and SoftDiso R-values are sensitive to small MU variations. However, only IQM is sensitive to jaw position variations. Conversely, IQM is unable to detect patient positioning errors, and the R-value has good sensitivity to phantom displacements. A gamma comparison analysis allows one to determine alert thresholds to detect phantom shifts or relatively large rotations. The combined use of the IQM and SoftDiso allows for fast identification of both delivery and setup errors and substantially reduces the impact of error identification and correction on the treatment workflow.

Out-of-field scattering from the Integral Quality Monitor® in megavolt photon beams

PurposeTo investigate out-of-field scattered doses from the Integral Quality Monitor (IQM) transmission detector in megavoltage photon beams. Materials and methodsWe measured out-of-field point doses for 20 × 20 cm2 6–15 MV photon beams using 10 × 2 cm2 Gafchromic EBT3 film strips placed across the surfaces of 5-cm thick water-equivalent RW3 slabs. The films were placed at 10 cm intervals from the central axis (CAX) of each beam, up to 1.0 m away on opposite sides of the CAX. The measurements were conducted at 80 cm and 100 cm source-to-surface distances (SSD) without the IQM, and were repeated with the IQM in the paths of the beams. Measurements were also performed at 90 cm SSD for 20 × 20 and 30 × 30 cm2 15 MV fields. Surface dose profiles were then constructed from the measurements for each beam setup with and without the IQM to examine the differences in scattered dose off-axis. The dose profile for each beam setup was normalised to dose maximum measured on the CAX. ResultsOverall, surface dose profiles acquired with the IQM in the paths of the beams were higher than the corresponding profiles without the IQM. The out-of-field dose increased with increase in photon energy, field size, and shorter SSDs, and decreased with off-axis distance. At 80 cm SSD for the 20 × 20 cm2 field, the IQM-induced surface dose ranged from −0.6% ÷ 1.9%, −0.3% ÷ 3.0%, and 0.3% ÷ 6.8% for 6, 10, and 15 MV beams, respectively. ConclusionThe higher surface dose profiles measured with the IQM attached to the linac compared to the profiles without the IQM indicates that the device is acting as an additional source of scattered radiation.

Feasibility of using a single transmission factor for the Integral Quality Monitor ® on dynamic 15 MV photon beams

PurposeTo investigate the feasibility of using a single transmission factor (TF) to account for the attenuation of the iRT Systems Integral Quality Monitor (IQM) on dynamic 15 MV photon beams supported by Gafchromic EBT3 film measurements in a realistic pelvic prosthesis phantom. Materials and methodsIQM TFs for 2 × 2 to 20 × 20 cm2 15 MV photon beams produced by an Elekta Synergy linac were measured with a 0.6 cm3 cylindrical chamber inside RW3 phantom slabs. A Monaco treatment planning system (v. 5.00.00) that uses the X-ray voxel Monte Carlo algorithm was used to generate intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) plans in a computed tomography scanned-based model of the pelvic phantom. The phantom was irradiated according to the plans with and without the IQM mounted on the linac. In each case, the absorbed dose in the phantom was measured with EBT3 Gafchromic film. In a second step each plan was re-scaled to new monitor units (MUs) taking into account the IQM TF. The phantom was irradiated according to the plans that now have the re-scaled MUs. Again, film dosimetry was performed with the IQM mounted to the linac. Monaco dose values were compared with film measurements using percentage differences and gamma index criteria of 3%/3 mm. ResultsThe measured IQM TFs varied within 0.1% over the range of fields evaluated. For the treatment plans, inside the target area, dose differences ≥4% were found between Monaco and EBT3 film for plans with unscaled MUs with the IQM mounted. Plans delivered with unscaled MUs without the IQM as well as plans delivered with scaled MUs with the IQM showed dose differences within 2% between Monaco and film. In these cases, the corresponding gamma pass rate between Monaco and film data was ≥90%. ConclusionA single TF is sufficient to scale MUs of IMRT/VMAT plans so that the attenuation in IQM is taken into account for dynamic 15 MV photon beams. Dose differences between corrected plans and film measurements are then within 2%, as opposed to ≥4% when not taken into account.

X-Ray Beam Segment Size and Entrance Location Effects on the Integral Quality Monitor (IQM®) Signal and Usefulness in Predicting Complex Segment Output Signals.

Background: The Integral Quality Monitor (IQM®) is an independent online dosimetry device attached to the treatment machine to monitor the accuracy of radiation delivery.Objective: This study investigates the influence of beam segment size and displacement as projected onto the IQM chamber on the signals and determine how individual signals can be added to get a combined segment signal made up of smaller segments.Material and Methods: This is an experimental original research type of study. IQM response maps were generated by irradiating the IQM sensitive area with small elementary segments and measuring their corresponding signals per monitor unit (MU). The output signal/MU was measured for regular and irregular fields and compared with the predicted signal/MU obtained from decomposing the open segment into a set of smaller regular segments and summing their signals from their respective response maps. The dependence of signals on segment size, shape, location and combination was investigated. Results: Predicted signals were calculated within 95-98 % accuracy for regular fields and 90-98% for irregular fields. More uniform fluence contain distribution for larger segments was observed. Response maps were consistent with the geometrical symmetry in the chamber’s wedge shape and the symmetry in the linac fluence. Conclusion: The field decomposition method allows the pre-calculation of known segment output signals per MU within 2% error, although the accuracy drops significantly for smaller, irregular fields. A method of correcting predicted signals in smaller segments needs to be laid down to get a better match with measured signals.

External beam patient dose verification based on the integral quality monitor (IQM®) output signals

Background: The Integral Quality Monitor (IQM®) can essentially measure the integral fluence through a segment and provide real-time information about the accuracy of radiation delivery based on comparisons of measured segment signals and pre-calculated reference values. However, the present IQM chamber cannot calculate the dose in the patient. Aim: This study aims to make use of IQM field output signals to calculate the number of monitor units (MUs) delivered through an arbitrary treatment field in order to convert Monte Carlo (MC)-generated dose distributions in a patient model into absolute dose. Methods: XiO and Monaco treatment planning systems (TPSs) were used to define treatment beam portals for cervix and esophagus conformal radiotherapy as well as prostate intensity-modulated radiotherapy for the translation of patient and beam setup information from DICOM to DOSXYZnrc. The planned beams were simulated in a patient model built from actual patient CT images and each simulated integral field/segment was weighted with its MUs before summation to get the total dose in the plan. The segment beam weights (MUs) were calculated as the ratio of the open-field IQM measured signal and the calculated signal per MU extracted from chamber sensitivity maps. These are the actual MUs delivered not just MUs set. The beam weighting method was evaluated by comparing weighted MC doses with original planned doses using profile and isodose comparisons, dose difference maps, γ analysis and dose-volume histogram (DVH) data. Results: γ pass rates of up to 98% were found, except for the esophagus plan where the γ pass rate was below 45%. DVH comparisons showed good agreement for most organs, with the largest differences observed in low-density lung. However, these discrepancies can result from differences in dose calculation algorithms or differences in MUs used for dose weighting planned by the TPS and MUs calculated using IQM field output signals. To test this, a 4-field box DOSXYZnrc MC simulation weighted with planned (XiO) MUs was compared with the same simulation weighted with IQM-based MUs. Dose differences of up to 5% were found on the isocentre slice. For XiO versus MC, up to 7% dose differences were found, indicating additional error due to limitations of XiO’s superposition algorithm. Dose differences between MC Monaco and MC EGSnrc were less than 3%. Conclusions: The most valuable comparison was MC versus MC as it eliminated algorithm discrepancies and evaluated dose differences precisely according to beam weighting. For XiO TPS, care must be taken as dose differences may also arise due to limitations in XiO’s planning software, not merely due to differences in MUs. Overall, the IQM was successfully used to compute beam dose weights to accurately reconstruct the patient dose using unweighted MC beams. Our technique can be used for pre-treatment QA provided each segment output is known and an accurate linac source model is available.

An artificial neural network to model response of a radiotherapy beam monitoring system.

The integral quality monitor (IQM) is a real-time radiotherapy beam monitoring system, which consists of a spatially sensitive large-area ion chamber, mounted at the collimator of the linear accelerator (linac), and a calculation algorithm to predict the detector signal for each beam segment. By comparing the measured and predicted signals the system validates the beam delivery. The current commercial version of IQM uses an analytic method to predict the signal, which requires a semi-empirical approach to determine and optimize various calculation parameters. The process of developing the calculation model is complex and time consuming, and moreover, the model cannot be easily generalized across various beam delivery platforms with different combinations of beam energy, beam flattening, beam shaping elements, and Linac models. Therefore, as an alternative solution, we investigated the feasibility of developing a machine learning (ML) method, using an artificial neural network (ANN), to predict the ion chamber signal. In developing an ANN, it is not necessary to explicitly account for each of the elements of beam interactions with various structures in the beam path to the ion chamber. The ANN was designed with multilayer perceptron (MLP). The input layer consisted of multiple features, derived from the geometrical characteristics of beam segments. Gradient descent error backpropagation technique was used to train the ANN. The combined training dataset included 270 rectangular fields, and 801 clinical IMRT fields delivered using 6 MV beams on Varian TrueBeamTM and Elekta InfinityTM . Each of 12 different ANN configurations (3 different sets of input features×4 different sets of number of hidden nodes) was simulated 10 times with randomly selected 80% of data for training and the remaining data for validation. Artificial neural networks with one hidden layer, consisting of 10 nodes, and 10 input features provided optimum results. Once the feature sets were extracted, the time required for the network training was on the order of a few minutes, and the time required to perform an output calculation per field was only fraction of a second. More than 95% of clinical intensity-modulated radiation therapy (IMRT) segments were calculated within±3.0% modeling error for Varian Truebeam (90% and ±3.3% for Elekta Infinity). A total of 3320 volumetric-modulated arc therapy (VMAT) segments from Truebeam were calculated using the ANN trained with IMRT fields. More than 95% of the cumulative VMAT beam segments were within 3.6% modeling error, similar to the performance for IMRT segments. In general the modeling error was found to be inversely proportional to the size and intensity of the beam segment. A prototype ANN has been developed for predicting the signals of the IQM system, with substantially less efforts compared to the analytic model. The performance of the ANN was found to be at least equivalent to that of the analytic method, in terms of average and maximum error, for 6 MV beams on both Varian TrueBeam and Elekta Infinity platforms.

Integral quality monitor (IQM®) signal correction factors for small fields to predict larger irregular segment output signals

To develop a method of correcting for the inaccuracies of small adjoined field segments in their contribution to larger fields in order to get a better match between their combined signals and the measured integral quality monitor (IQM) open field signals. This would enable the pre-calculation of known irregular segment output signals per monitor unit (MU), which would be later useful for patient-based dose calculations for treatment verification during pre-treatment treatment validation using the IQM output signal per MU. Small fields exhibit source obscurity and loss of scatter, resulting in smaller signals being measured by the IQM and the subsequent underestimation of IQM output signals of larger segments obtained by combining small segment signals. Larger field segments were broken down into a set of smaller, regular, abutted segments, whose individual signals were added together to get the predicted output signal of the larger field. The signal/MU for each smaller constituent segment was extracted at its exact location from measured IQM response maps, generated by irradiating the IQM with small elementary segments ranging from 1×1cm2 -5×5cm2 , shifting each segment 1cm at a time and measuring its corresponding output signal/MU throughout the entire IQM sensitive area. The predicted signal was weighed against the IQM-measured signal of the open field to calculate a signal correction factor (CF) of each elementary segment size. The CFs were applied to known signals of each set of elementary fields before summation in order to pre-calculate signals of larger irregular fields more accurately. The dependence of CFs on elementary segment size, location of the open field, and beam energy was investigated. CFs exhibited an exponential decrease with increase in elementary segment size. CFs were also invariant with beam energy, changing by ≤1% from 6-15MV. Uncorrected signals for regular fields had relative errors of above 5% whilst signal correction reduced these errors down to ~0.4% (i.e., 99.6% accuracy). For irregular fields, signal correction reduced calculation errors from ~10% to well below 1.5%. Larger signal prediction errors were found when smaller segments were used to reconstruct the field. Open field size and location had a great impact on measured signals but virtually no significance on CFs. Results indicate that summation of small segment signals cannot sufficiently reproduce the same output given by an open field if individual elementary segment signals are not weighted with their respective CFs. This effect is particularly predominant for elementary segments 3×3cm2 and for irregular fields. The method outlined enabled the calculation of signal CFs in order to match predicted signals with measured signals to 98.5% accuracy, thus enabling the pre-calculation of irregular segment output signals/MU for future patient dose calculations.

Technical Note: Alternating clinical usage of the integral quality monitor transmission detector.

The purpose of the study was the implementation of a method to use the integral quality monitor (IQM) transmission detector for occasional, alternating usage during patient treatment with intensity modulated radiotherapy. Due to attenuation, the transmission detector must be taken into account during the planning process. The proposed workflow is based on determining a dynamic transmission factor (dTF) required to scale the total number of MU of the original radiotherapy (RT) plan. Thus a very similar radiation therapy plan is obtained that can be used with the IQM detector. Ten clinically applied volumetric modulated arc therapy plans were delivered at two beam qualities. A dTF is calculated from each RT plan for which a collapsed RT plan was created for verification using a two-dimensional array with and without the IQM detector. The total number of MU of the original RT plan was scaled by the inverse of the dTF to obtain the modified RT plan for clinical use with the IQM detector. Validation was performed with an electronic three-dimensional phantom and via gamma analysis using strict criteria of 1%/1mm. Except for one outlier, the gamma pass rate between the original RT plan without IQM and the modified RT plan with IQM was always above 99.5%. The variations of the dTF were smaller than 1% for all tested RT plans. The results show that the proposed workflow can be used clinically. Thus the IQM transmission detector can also be used occasionally for online verification of RT plans.

Sensitivity of the IQM and MatriXX detectors in megavolt photon beams.

This study focused on evaluating the sensitivity of integral quality monitoring (IQM®) system and MatriXX detectors. These two detectors are recommended for radiotherapy pre-treatment quality assurance (QA). IQM is a large wedged-shaped ionisation chamber mounted to the linear accelerator (linac) head in practice. MatriXX consists of an array of ionisation chambers also attached to the linac head. In this study, the dosimetric performance and sensitivity of MatriXX and IQM detectors were evaluated using the following characteristics: reproducibility, linearity, error detection capability and three-dimensional conformal radiotherapy (3D-CRT) plans of the head and neck, thorax and pelvic regions. This study indicates that the signal responses of the large ionisation chamber device (IQM) and the small pixel array of ionisation chambers device (MatriXX) are reproducible, linear and sensitive to MLC positional errors, backup jaw positional errors and dose errors. The local percentage differences for dose errors of 1%, 2%, and 3% were, respectively, within 0.35-8.23%, 0.78-16.21%, and 1.10-24.41% for the IQM device. While for the MatriXX detector, the ranges were between 0.24-3.19, 0.57-6.43 and 0.81-12.95, respectively. Since IQM is essentially a double wedge-shaped large ionisation chamber, its reproducibility and detection capability are competitive to that of MatriXX. In addition, the sensitivity of the two QA systems increases with an increase in escalation percentage, and the signal responses are patient plan specific. The two detectors response signals have good correlations and they are accurate for pre-treatment QA. Statistically, (P<0.05) there is a significant difference between the IQM and MatriXX response to dose errors.

Sensitivity evaluation of two commercial quality assurance systems to organ-dose variations of patient-specific VMAT plans

The purpose of this study was to assess the dose variation sensitivity of two quality assurance (QA) devices (Integral quality monitoring (IQM®) and MatriXXEvolution systems) used for radiotherapy ...

Sensitivity of the IQM transmission detector to errors of VMAT plans.

The integral quality monitor (IQM) transmission detector is a wedge-shaped large area ionization chamber that reports a position-weighted dose area product for each control point of an IMRT or VMAT plan. In this study, the accuracy of the signal prediction is verified for the Synergy Agility MLC. Tolerance criteria for VMAT plan verification with the IQM were obtained from the observed sensitivity for the detection of incorrectly delivered plans. The predicted IQM signal was compared to the measured signal recorded for a set of 30 VMAT plans for each beam quality of 6 and 10MV. The system's capability to detect incorrectly delivered plans was tested by measuring altered plans containing small, random deviations. In addition, the observed deviations were related to measurements performed with a second QA phantom. The cumulative IQM signal per arc deviated from the respective calculation on average by -0.48% (6MV) and +0.21% (10MV) with a standard deviation of 1.08% in both cases, suggesting a 2% warning and 3% action threshold as plan acceptance criteria. This choice was confirmed by the optimum threshold of 2.5% obtained via receiver operating characteristic (ROC) analysis. Reproducibility of individual control points in multiply measured plans was low (on average 7% for 1SD) and thus, segment-by-segment comparison was impractical. A suitable criterion to resolve the angular distribution of the plan was identified by binning three to five control points as a running average. While the correlation between IQM signal deviations and gamma passing rates obtained with the ArcCHECK phantom was low for clinical plans, it was apparent for erroneous plans. Binning led to even higher sensitivity to errors. The IQM was able to detect induced errors at least as reliable as the standard phantom and showed the potential to be used in pretreatment plan verification to ensure the correct plan transfer and delivery. However, there is no direct correlation between the IQM signal deviation and DVH metrics, so the IQM should be primarily used to screen for errors. Finer diagnostics should then be carried out using a different phantom.

027. - A study to determine the relationship between the integral quality monitor (IQM)® output signal and absorbed dose

027. - A study to determine the relationship between the integral quality monitor (IQM)® output signal and absorbed dose

P2. - On the sensitivity of the integral quality monitoring system to MLC positional error using BEAMnrc Monte Carlo simulation

P2. - On the sensitivity of the integral quality monitoring system to MLC positional error using BEAMnrc Monte Carlo simulation

Error detection capability of a novel transmission detector: a validation study for online VMAT monitoring

The purpose of this study was to characterize a new single large-area ionization chamber, the integral quality monitor system (iRT, Germany), for online and real-time beam monitoring.Signal stability, monitor unit (MU) linearity and dose rate dependence were investigated for static and arc deliveries and compared to independent ionization chamber measurements. The dose verification capability of the transmission detector system was evaluated by comparing calculated and measured detector signals for 15 volumetric modulated arc therapy plans. The error detection sensitivity was tested by introducing MLC position and linac output errors. Deviations in dose distributions between the original and error-induced plans were compared in terms of detector signal deviation, dose-volume histogram (DVH) metrics and 2D γ-evaluation (2%/2 mm and 3%/3 mm).The detector signal is linearly dependent on linac output and shows negligible (<0.4%) dose rate dependence up to 460 MU min−1. Signal stability is within 1% for cumulative detector output; substantial variations were observed for the segment-by-segment signal.Calculated versus measured cumulative signal deviations ranged from −0.16%–2.25%. DVH, mean 2D γ-value and detector signal evaluations showed increasing deviations with regard to the respective reference with growing MLC and dose output errors; good correlation between DVH metrics and detector signal deviation was found (e.g. PTV Dmean: R2 = 0.97). Positional MLC errors of 1 mm and errors in linac output of 2% were identified with the transmission detector system.The extensive tests performed in this investigation show that the new transmission detector provides a stable and sensitive cumulative signal output and is suitable for beam monitoring during patient treatment.

Technical note: A new wedge-shaped ionization chamber component module for BEAMnrc to model the integral quality monitoring system®

The purpose of this study was to develop a new component module (CM) namely IQM to accurately model the integral quality monitoring (IQM) system® to be used in the BEAMnrc Monte Carlo (MC) code. The IQM is essentially a double wedge ionization chamber with the central electrode plate bisecting the wedge. The IQM CM allows the user to characterize the double wedge of this ionization chamber and BEAMnrc can then accurately calculate the dose in this CM including its enclosed air regions. This has been verified against measured data.The newly created CM was added into the standard BEAMnrc CMs, and it will be made available through the NRCC website. The BEAMnrc graphical user interface (GUI) and particle ray-tracing techniques were used to validate the IQM geometry. In subsequent MC simulations, the dose scored in the IQM was verified against measured data over a range of square fields ranging from 1 × 1–30 × 30cm2.The IQM system is designed for the present day need for a device that could verify beam output in real-time during treatment. This CM is authentic, and it can serve as a basis for researchers that have an interest in real-time beam delivery checking using wedge-shaped ionization chamber based instruments like the IQM.

Influence of the Integral Quality Monitor transmission detector on high energy photon beams: A multi-centre study

PurposeThe influence of the Integral Quality Monitor (IQM) transmission detector on photon beam properties was evaluated in a preclinical phase, using data from nine participating centres: (i) the change of beam quality (beam hardening), (ii) the influence on surface dose, and (iii) the attenuation of the IQM detector. MethodsFor 6 different nominal photon energies (4 standard, 2 FFF) and square field sizes from 1×1cm2 to 20×20cm2, the effect of IQM on beam quality was assessed from the PDD20,10 values obtained from the percentage dose depth (PDD) curves, measured with and without IQM in the beam path. The change in surface dose with/without IQM was assessed for all available energies and field sizes from 4×4cm2 to 20×20cm2. The transmission factor was calculated by means of measured absorbed dose at 10cm depth for all available energies and field sizes. Results(i) A small (0.11–0.53%) yet statistically significant beam hardening effect was observed, depending on photon beam energy. (ii) The increase in surface dose correlated with field size (p<0.01) for all photon energies except for 18MV. The change in surface dose was smaller than 3.3% in all cases except for the 20×20cm2 field and 10MV FFF beam, where it reached 8.1%. (iii) For standard beams, transmission of the IQM showed a weak dependence on the field size, and a pronounced dependence on the beam energy (0.9412 for 6MV to 0.9578 for 18MV and 0.9440 for 6MV FFF; 0.9533 for 10MV FFF). ConclusionsThe effects of the IQM detector on photon beam properties were found to be small yet statistically significant. The magnitudes of changes which were found justify treating IQM either as tray factors within the treatment planning system (TPS) for a particular energy or alternatively as modified outputs for specific beam energy of linear accelerators, which eases the introduction of the IQM into clinical practice.