Intensity Modulated Radiation Therapy Verification Research Articles

Quantifying the Effect of 4-Dimensional Computed Tomography–Based Deformable Dose Accumulation on Representing Radiation Damage for Patients with Locally Advanced Non-Small Cell Lung Cancer Treated with Standard-Fractionated Intensity-Modulated Radiation Therapy

The aim of this study was to investigate the dosimetric and clinical effects of 4-dimensional computed tomography (4DCT)-based longitudinal dose accumulation in patients with locally advanced non-small cell lung cancer treated with standard-fractionated intensity-modulated radiation therapy (IMRT). Sixty-seven patients were retrospectively selected from a randomized clinical trial. Their original IMRT plan, planning and verification 4DCTs, and ∼4-month posttreatment follow-up CTs were imported into a commercial treatment planning system. Two deformable image registration algorithms were implemented for dose accumulation, and their accuracies were assessed. The planned and accumulated doses computed using average-intensity images or phase images were compared. At the organ level, mean lung dose and normal-tissue complication probability (NTCP) for grade ≥2 radiation pneumonitis were compared. At the region level, mean dose in lung subsections and the volumetric overlap between isodose intervals were compared. At the voxel level, the accuracy in estimating the delivered dose was compared by evaluating the fit of a dose versus radiographic image density change (IDC) model. The dose-IDC model fit was also compared for subcohorts based on the magnitude of NTCP difference (|ΔNTCP|) between planned and accumulated doses. Deformable image registration accuracy was quantified, and the uncertainty was considered for the voxel-level analysis. Compared with planned doses, accumulated doses on average resulted in <1-Gy lung dose increase and <2% NTCP increase (up to 8.2 Gy and 18.8% for a patient, respectively). Volumetric overlap of isodose intervals between the planned and accumulated dose distributions ranged from 0.01 to 0.93. Voxel-level dose-IDC models demonstrated a fit improvement from planned dose to accumulated dose (pseudo-R2 increased 0.0023) and a further improvement for patients with ≥2% |ΔNTCP| versus for patients with <2% |ΔNTCP|. With a relatively large cohort, robust image registrations, multilevel metric comparisons, and radiographic image-based evidence, we demonstrated that dose accumulation more accurately represents the delivered dose and can be especially beneficial for patients with greater longitudinal response.

Comparison of ArcCHECK and portal dosimetry in dose verification for intensity modulated radiotherapy plan for craniospinal irradiation

BackgroundTo study the performance of ArcCHECK system and Portal Dosimetry (PD) used for dose verification in intensity-modulated radiotherapy (IMRT) plan of the craniospinal irradiation (CSI). Materials and MethodsA total of 12 IMRT verification plans were produced for patients who underwent CSI treatment. Each verification plan consists of three isocenter plans corresponding to head and neck (H&N), thorax, and abdomen. With different analysis criterion, ArcCHECK and PD were used for verification, and differences in the γ passing rate of verification system were evaluated using paired-samples t-test/Wilcoxon matched-pairs signed rank test. ResultsWith the criterion of 3%/3 mm, there was no significant difference in the average γ passing rates between H&N and abdomen (P > 0.05), but there was statistically significant difference in the average γ passing rate of the thorax (P < 0.05); With the criterion of 3%/2 mm, there was no significant difference in the passing rate (P > 0.05), but there was statistically significant difference in the passing rates of thorax, abdomen and pelvis(P < 0.05). When the 2%/2 mm criterion was used, the difference in the passing rates of the H&N/thorax/abdomen was statistically significant (P < 0.05). ConclusionsBoth ArcCHECK and PD can be used for the dose verification of the craniospinal irradiation plan. The PD method is superior to ArcCHECK in the verification efficiency and verification accuracy. It is recommended to use the criterion of 3%/3 mm or 3%/2 mm for ArcCHECK, and 3%/2 mm or 2%/2 mm criterion for Portal Dosimetry.

2D and 3D dose analysis of PRESAGE® dosimeter using a prototype 3DmicroHD-OCT imaging system

The purpose of this study was to investigate the two dimensional (2D) and three dimensional (3D) radiotherapy dosimetric properties of PRESAGE® dosimeter using an in-house optical computed tomography (OCT) imaging system known as 3DmicroHD-OCT. Dosimetric properties for verification of intensity-modulated radiation therapy (IMRT) treatment technique were studied including dose linearity, dose integration, dose rate dependence and the percentage depth dose analysis. Nine cylindrical PRESAGE® of 5 cm diameter × 5 cm height were irradiated at 6 MV photon beam with different field geometry for the dose range of 0.1–15 Gy. We also irradiated PRESAGE® in the cuvette for UV–Vis analysis for the same dose range to verify the optical density value measured by the 3DmicroHD-OCT imaging system. The irradiation was repeated with EBT film dosimetry for the 2D analysis validation. The study shows that the optical density change increases as dose deposition increases on PRESAGE®, with R2 value better than 0.988. The same response was also recorded when multiple beam was integrated for the dose range investigated. The dose linearity result is consistent with the results obtained from UV–Vis spectrometry. It was also found that the dose rate variation does not affect the optical density change over the dose range investigated. PDD analysis of the PRESAGE® dosimeter investigated shows a good agreement with the ion chamber measurement. In summary, the study shows accurate 3D and 2D measurements of PRESAGE® and EBT film dosimeter were obtained using the 3DmicroHD-OCT imaging system. It shows potential for intensity-modulated radiation therapy (IMRT) treatment verification.

Design and fabrication of indigenous multi-rotational thorax phantom for patient-specific quality assurance of IMRT and VMAT

Intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) are commonly used treatment modalities in external beam radiotherapy. Precise quality assurance is required for the clinical implementation of IMRT and VMAT to ensure the correct treatment delivery. Square slab phantom is used commonly in developing countries to measure the pre-treatment point dose measurements. The limitation of the slab phantom was that the detector was positioned on the central axis of the beam which caused difficulty in positioning of the chamber at off-axis of the beam and peripheral regions. The new indigenously multi-purpose multi-rotational phantom was fabricated with various chamber provisions in order to address the above challenge. Innovative devices always play a crucial role in radiotherapy to bring significant technological advancement to the field. The quality assurance Multi-Rotational Thorax (MRT) Phantom designing involved slice-wise modelling of an average adult thorax using Poly-methyl methacrylate (PMMA) to perform point dose absolute dosimetry using an ionization chamber and Radio-Photo-Luminescence Glass Dosimeter (RPLGD). The phantom consisted of 35 slices of PMMA material in an axial direction. Each slice had a dimension of 1 cm thickness, 35 cm length and 20 cm height. The phantom had provisions in the target region and multiple provisions in the lungs, heart, surface and spine. The unique manual rotation system was provided on the lungs as well as in the heart. The provisions were capable of holding the detectors such as ionization chambers and RPLGD. The response of the phantom to open the beam in various gantry angles was initially accessed with multiple gantry angles and then pre-treatment verification of IMRT and VMAT plans was also checked. The results showed that the MRT phantom had good capabilities for absolute point dosimetry. In the case of an open beam, multiple gantry angles, the maximum variations for both the detectors were within −1.9% when compared with the TPS dose. The maximum percentage variation on isocentre (T) for IMRT and VMAT between TPS and Semiflex chamber was 1.85%. Similarly, the maximum percentage variation was 1.92% between TPS and RPLGD on isocentre. For Semiflex chamber, maximum percentage variation on peripheral region was 2.68%. Similarly, for RPLGD maximum percentage variation was 2.76%. The overall difference between the measured values for both the detectors were less than 3%. The present dosimetric study concluded that the MRT phantom with a RPLGD and Semiflex chamber was suitable for routine IMRT and VMAT patient-specific QA purposes.

DOSIMETRIC VERIFICATION OF INTENSITY MODULATED RADIOTHERAPY (IMRT) TREATMENT PLANS FOR PROSTATE CANCER PATIENTS.

Intensity modulated radiotherapy (IMRT) has become widely used as a standard radiation therapy technique for the treatment of localized prostate cancer. The transition from conformal radiotherapy (3D CRT) to a more complex IMRT technique triggered the need for more thorough verification of the accuracy in the dose delivery. In this work we present the clinical workflow and the results of patient specific quality assurance (PSQA) procedures for 40 prostate cancer patients who have been treated with step and shot IMRT ever since its implementation in our routine clinical practice. PSQA procedures include dosimetric verification of each treatment plan with dedicated rotational phantom and high-resolution matrix detector system Octavius 4D (PTW Freiburg) that allows three-dimensional comparison of the calculated and delivered radiation dose distribution. Our results proved the compliance with the universal tolerance limits recommended for those procedures (1), assuring the safety of the treatment and providing the possibility for the adoption of more stringent constraints in the future.

Utility of Point Dose Verification Using Measured Ionization Amount Ratio of Reference Irradiation to Volumetric Modulated Arc Therapy

In the point dose verification of intensity-modulated radiation therapy (IMRT), we compared the commonly used method of measuring absolute dose (absolute method) with the measurement method by the American Association of Physicists in Medicine Task Group 119, which describes the point dose verification for IMRT using the ratio of reference irradiation and measured ionization. The target was 66 plans for head and neck cancer, 46 plans for lung cancer with 6 MV X-ray, and 31 plans for prostate cancer with 10 MV X-ray. They were treated with volumetric-modulated arc therapy (VMAT). Each plan was evaluated by the absolute method and the TG119 method using 3D-array. The average and 2SD of the verification results for head and neck cancer, lung cancer, and prostate cancer were 0.129±2.185%, 0.963±2.125%, and 0.259±2.019% by the absolute method, and 0.952±2.039%, 1.704±2.080%, and 0.524±1.274% by the TG119 method. The ratio between the average of the TG119 method and the absolute method corresponded to the error of reference irradiation dose. Considering that the measurement method is simple, the TG119 method enables more stable point dose verification of VMAT.

Comparison of gamma analysis with using different dosimetric systems for pre-treatment verification of intensity-modulated radiation therapy

The evaluation of the agreement between calculated and measured dose plays an essential role in the quality assurance procedures of intensity-modulated radiation therapy (IMRT). This study aimed to compare gamma analysis using portal dosimetry (PD), Epiqa, and 2D array detector for dose verification of radiotherapy treatment plans. Five field step-and-shoot IMRT plan was performed for 20 prostate IMRT patients using the dual-energy DHX linear accelerator (Varian Medical System, Palo Alto, Calif., USA). The treatment plans were created using Varian DHX Eclipse treatment planning system (TPS) version 15.1. All measurements were performed by aS500 EPID integrated into Varian DHX linear accelerator and 2D array detector. The dose distribution was evaluated with gamma area histograms (GAHs) generated using different γ criteria (1%/1 mm, 2%/2 mm, 3%/2 mm, and 3%/3 mm) for dose agreement and distance to agreement parameters. Statistical analyses were evaluated by using Mann–Whitney U test and Kruskal–Wallis test, and p-value of p &lt; 0.01 was considered to be significant. The average pass rate for 20 IMRT plans was above 95 for all devices with 2%/2 mm, 3%/2 mm, and 3%/3 mm. The mean and standard deviation pass rates (γ ≤ 1) were found to be 99.80 ± 0.19, 99.35 ± 0.34, and 97.53 ± 0.71 for PD, Epiqa, and 2D array, respectively. All IMRT plans passed 2%/2 mm, 3%/2 mm, and 3%/3 mm gamma by more than 95 of three dosimetric systems. They are all in good agreement with the literature. All three devices are acceptable for quality control of IMRT. Due to the simplicity and fast evaluation process, PD can be preferred for quality control.

Verification system for intensity-modulated radiation therapy with scintillator.

In the preparation of intensity-modulated radiation therapy (IMRT), patient-specific verification is widely employed to optimize the treatment. To accurately estimate the accumulated dose and obtain the field-by-field or segment-by-segment verification, an original IMRT verification tool using scintillator light and an analysis workflow was developed in this study. The raw light distribution was calibrated with respect to the irradiated field size dependency and light diffusion in the water. The calibrated distribution was converted to dose quantity and subsequently compared with the results of the clinically employed plan. A criterion of 2-mm dose-to-agreement and 3% dose difference was specified in the gamma analysis with a 10% dose threshold. By applying the light diffusion calibration, the maximum dose difference was corrected from 7.7cGy to 3.9cGy around the field edge for a 60cGy dose, 7 × 7 cm2 irradiation field, and 10 MV beam energy. Equivalent performance was confirmed in the chromodynamic film. The average dose difference and gamma pass rate of the accumulated dose distributions in six patients were 0.8 ± 4.5cGy and 97.4%, respectively. In the field-by-field analysis, the average dose difference and gamma pass rate in seven fields of Patient 1 were 0.2 ± 1.2cGy and 93.9%, respectively. In the segment-by-segment analysis, the average dose difference and gamma pass rate in nine segments of Patient 1 and a 305° gantry angle were - 0.03 ± 0.2cGy and 93.9%, respectively. This system allowed the simultaneous and independent analysis of each field or segment in the accumulated dose analysis.

Verification of IMRT and RapidArc Localized Prostate Cancer Treatment Plans Using EPID and Delta4 in vivo Dosimetry Methods

Background: Quality assurance for intensity modulated radiation therapy (IMRT) depends on the type of dosimetry system and its evaluation procedure. We can check both the intensity and distribution of each field as the required pretreatment verification with dosimetry systems. Method: Treatment verification for different plans (IMRT and RapidArc) applied on localized prostate cancer patients was done with electronic portal imager device (EPID), Delta4). The EPID used was Varian aS1000 mounted on Varian (TrueBeam) Linac with gamma criteria set to ΔD=3% and Δd=3mm. RapidArc plans were designed by arcs (179.0o CCW to 181.0o and 181.0o CW to 179.0o) under the same gamma criteria of (ΔD=3%, DTA=3mm and γ-index ≤1) while the threshold dose was 20%. Results: Evaluation analysis is passed for IMRT prostate plans with the area gamma ˂1.0 which equaled 99.1% (99.1% of the pixels had gamma˂1) within a tolerance of 95.0%, area gamma ˃0.8 (was equal to 2.1%) / area gamma ˃1.2 (was equal to 0.3%) and the average dose difference was 0.42CU. Delta4 dosimetry system was assessed with RapidArc plan; the agreement between the measured and planned doses was ±1% and gamma analysis resulted in 100% data points with the same agreement conditions. Conclusion: Portal dosimetry provided a good verification of the treatment unit ability to deliver doses according to plan. For an IMRT field comprised of several subfields, it could give rise to much more errors. RapidArc plans were verified using Delta4 system, which generated excellent dosimetry results. Periodic calibration was recommended for Delta4 dosimetry system; radiation damage affected sensitivity by ˃1% every 1kGy.

PSEUDO-3D IMRT VERIFICATION WITH EBT3 RADIOCHROMIC FILM

This work proposes a new method for pseudo-3D verification of intensity-modulated radiation therapy (IMRT) dose distributions. Unlike commercial solutions, it uses measured doses only for gamma evaluation. Its resolution is far better than with electronic detectors within the measured plane and comparable in other directions. It is readily available at clinics because it uses existing resources-a slab phantom and EBT3 films. The method was tested on six IMRT clinical cases. An in-house code for 2D and pseudo-3D gamma analysis was written in MATLAB and compared to OmniPro I'mRT.

A Method to Enhance the Spatial Resolution of the Two-dimensional Detector Arrays for the Precise Dose Assessment of Intensity Modulated Radiation Therapy

Two-dimensional (2D) detector arrays are widely used in the patient-specific quality assurance of intensity modulated radiation therapy (IMRT). One of the disadvantages of the 2D detector arrays is the low spatial resolution. We proposed a new method to enhance the spatial resolution of the 2D detector arrays. We showed that this method also reduced the volume effect of a detector element. To demonstrate the method we evaluated one field of an IMRT verification plan with the 2D ion chamber array. An open field was measured and its penumbra width was evaluated to show the reduction of the volume effect of the detector. Using the proposed method, the distance between measurement points was reduced from 7.62 mm to 6.00 mm and the penumbral width was also reduced.

222. Optimization of pretreatment IMRT dose distribution verification: Bidimensional gaussian kernel implementation

Purpose Intensity modulated radiation therapy (IMRT) is a widely used technique delivering a highly conformal dose to the target together with a better sparing of organs at risk with respect to conventional irradiation techniques. Quality assurance (QA) of the generated IMRT treatment plan is of most importance to ensure that the patient receives the planned dose; a two-dimensional array of ionization chambers in a solid phantom can be used for the verification. Different methods exist for comparison of dose distributions and the gamma evaluation is the most commonly used. The aim of this work is to convolve the calculated dose distributions in order to optimize the comparison with the measured data obtained with the MatriXX ionization chamber detector arrays (IBA Dosimetry, Germany). Methods In this study a bidimensional gaussian kernel, which addresses the ionization chamber volume averaging effect, has been implemented to optimize the comparison of dose distributions for pretreatment patient-specific IMRT QA. It was determined by scanning a single chamber with a slit beam. A point spread function was reconstructed with a Gaussian function obtained with a MATLAB script. The kernel has been tested on head&neck and prostate treatment plans. Results It has been found that the convolution of the kernel with the treatment planning system calculated dose distribution can improve the comparison respect to the conventional method of IMRT verification. The gamma index passing rate values found with convolution method are higher in all considered clinical cases. Conclusions Intensity modulated radiation therapy (IMRT) is a widely used technique delivering a highly conformal dose to the target together with a better sparing of organs at risk with respect to conventional irradiation techniques. Quality assurance (QA) of the generated IMRT treatment plan is of most importance to ensure that the patient receives the planned dose; a two-dimensional array of ionization chambers in a solid phantom can be used for the verification. Different methods exist for comparison of dose distributions and the gamma evaluation is the most commonly used. The aim of this work is to convolve the calculated dose distributions in order to optimize the comparison with the measured data obtained with the MatriXX ionization chamber detector arrays (IBA Dosimetry, Germany). In this study a bidimensional gaussian kernel, which addresses the ionization chamber volume averaging effect, has been implemented to optimize the comparison of dose distributions for pretreatment patient-specific IMRT QA. It was determined by scanning a single chamber with a slit beam. A point spread function was reconstructed with a Gaussian function obtained with a MATLAB script. The kernel has been tested on head&neck and prostate treatment plans. It has been found that the convolution of the kernel with the treatment planning system calculated dose distribution can improve the comparison respect to the conventional method of IMRT verification. The gamma index passing rate values found with convolution method are higher in all considered clinical cases.

Simple index for validity of the evaluation point for dosimetric verification results of intensity-modulated radiation therapy using a Farmer-type ionization chamber.

Based on a retrospective analysis, this study aims to develop a simple index for validity of the evaluation point for the dosimetric verification of intensity-modulated radiation therapy (IMRT). The results for the dosimetric verifications of a total of 69 IMRT plans were analyzed in this study. A Farmer-type ion chamber was used as a dose detector, and a solid water-equivalent phantom was used. Index values were obtained by dividing the difference between the maximum and minimum dosages by the mean dosage of the 69 plans, and the values were classified into five groups with index value <4, 4-8, 8-12, 12-16, and >16. A t-test was used to assess the statistical significance of the mean differences of the absolute values of the relative errors among these groups. We found that there was no significant difference between the groups with index value <4 and 4-8 (p = 0.152); however, there were significant differences between the other groups (p < 0.01). In addition, when the index values were smaller than 8, the pass ratio of 3% tolerance was 96.2% and the pass ratio of 5% tolerance was 99.9%. We observed that the smaller the index value, the smaller the uncertainty of the dose measurement. The results obtained in this study may prove to be useful for accurate dosimetric verifications of IMRTs when ion chambers are used.

Variations in Tomotherapy Beam Outputs: A Multiple-Institutional Investigation

This study aimed to determine variations in tomotherapy beam outputs at multiple institutions. Measurements were obtained at 22 radiotherapy institutions. The first parameter was the absolute dose to water (Dfmsrw, Qmsr) in the machine-specific reference field (fmsr), which indicated a static field in the tomotherapy reference conditions defined by the International Atomic Energy Agency (IAEA) study group. The second measured parameter was the difference between the measured and the planed doses in the intensity modulated radiotherapy (IMRT) verification plans, which were created using a solid phantom by the vendor during tomotherapy apparatus installation to adjust the beam output. The IMRT verification plan error at each institution was defined as the systematic error of the beam output; Dfmsrw, Qmsr was subsequently modified. The Dfmsrw, Qmsr values of four institutions with a modified energy fluence per ideal open time (EFIOT) were lower than the values at other institutions. The mean value of all institutions except those four was 0.994 ± 0.013 Gy (range: 0.974 Gy, 1.017 Gy). When the Dfmsrw, Qmsr value was corrected by the IMRT verification error, this variation decreased. In addition, the mean IMRT verification errors in the TomoDirectTM and TomoHelicalTM modes with the TomoEDGETM mode were 1.2% ± 0.8% (range: -0.6%, 1.8%) and 0.2% ± 0.5% (range: -0.6%, 0.9%), respectively (p p

A comparative analysis of Matrixx and EPID for dosimetric verification of intensity-modulated radiotherapy

Objective To compare the dosimetric verification results of Varian Portal Dosimetry and Matrixx, and to assess the reliability of the clinical application of electronic portal imaging device (EPID) verification. Methods Varian TrueBeam linear accelerator, which was equipped with a 120-leaf multileaf collimator and an amorphous silicon EPID, as well as portal dose prediction software. IBA I′mRT Matrixx ion chamber array was used. EPID algorithm configuration, dose calibration, and testing before use were performed. The sliding-window protocol was used. There were 77 patients with tumors involving the head and neck (mainly nasopharyngeal carcinoma), mediastinum, abdomen, and pelvic cavity were selected. The verification plan of the portal dose was created with a source-detector distance of 100 cm, and the gantry angle was kept the same as the treatment plan. The verification plan was carried out in the TrueBeam machine, and the data were collected at the same time by EPID. Comparison between the measured and calculated dose images was performed, and the evaluation standard was gamma index (3%/3 mm). The paired t-test was used for difference analysis. Results For the 77 patients, the Gamma passing rates of both methods were above 97%. Except for head and neck carcinoma were a significant difference between the results of dosimetric results using EPID and Matrixx in intensity-modulated radiotherapy (P=0.018) other remaining all P> 0.05. Conclusions The dosimetric verification results of EPID are consistent with those of Matrixx. EPID can be used for dosimetric verification, and Matrixx ion chamber array can be used only in case of a low Gamma passing rate. Key words: Dosimetric verification; Portal dosimetry; Matrixx

Preliminary study of clinical application on IMRT three-dimensional dose verification-based EPID system.

The three‐dimensional dose (3D) distribution of intensity‐modulated radiation therapy (IMRT) was verified based on electronic portal imaging devices (EPIDs), and the results were analyzed. Thirty IMRT plans of different lesions were selected for 3D EPID‐based dose verification. The gamma passing rates of the 3D dose verification‐based EPID system (Edose, Version 3.01, Raydose, Guangdong, China) and Delta4 measurements were then compared with treatment planning system (TPS) calculations using global gamma criteria of 5%/3 mm, 3%/3 mm, and 2%/2 mm. Furthermore, the dose–volume histograms (DVHs) for planning target volumes (PTVs) as well as organs at risk (OARs) were analyzed using Edose. For dose verification of the 30 treatment plans, the average gamma passing rates of Edose reconstructions under the gamma criteria of 5%/3 mm, 3%/3 mm, and 2%/2 mm were (98.58 ± 0.93)%, (95.67 ± 1.97)%, and (83.13 ± 4.53)%, respectively, whereas the Delta4 measurement results were (99.14% ± 1.16)%, (95.81% ± 2.88)%, and (84.74% ± 7.00)%, respectively. The dose differences between Edose reconstructions and TPS calculations were within 3% for D95%, D98%, and Dmean in each PTV, with the exception that the D98% of the PTV‐clinical target volume (CTV) in esophageal carcinoma cases was (3.21 ± 2.33)%. However, the larger dose deviations in OARs (such as lens, parotid gland, optic nerve, and spinal cord) can be determined based on DVHs. The difference was particularly obvious for OARs with small volumes; for example, the maximum dose deviation for the lens reached (−6.12 ± 5.28)%. A comparison of the results obtained with Edose and Delta4 indicated that the Edose system could be applied for 3D pretreatment dose verification of IMRT. This system could also be utilized to evaluate the gamma passing rate of each treatment plan. Furthermore, the detailed dose distributions of PTVs and OARs could be indicated based on DVHs, providing additional reliable data for quality assurance in a clinic setting.

The Clinical Applications of Polymer Gel Dosimetry Using MRI.

Polymer gel dosimeters are devices that utilize the radiation-induced polymerization reactions of vinyl monomers in a gel to store information of radiation dose. They have some advantages over other dosimeters as the visual conformation and the direct read-out of three-dimensional (3D) radiation dose information for the dosimetric verification of intensity modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), and stereotactic radiotherapy (SRT) with steep dose gradients. In this report, the dosimetric uncertainties and potential for clinical applications of polymer gel dosimetry by the in-house developed 3D dose verification system for IMRT and VMAT QA is outlined.

Feasibility Study of Patient Specific Quality Assurance Using Transit Dosimetry Based on Measurement with an Electronic Portal Imaging Device

This study was designed to measure transit dose with an electronic portal imaging device (EPID) in eight patients treated with intensity modulated radiotherapy (IMRT), and to verify the accuracy of dose delivery to patients. The calculated dose map of the treatment planning system (TPS) was compared with the EPID based dose measured on the same plane with a gamma index method. The plan for each patient was verified prior to treatment with a diode array (MapCHECK) and portal dose image prediction (PDIP). To simulate possible patient positioning errors during treatment, outcomes were evaluated after an anthropomorphic phantom was displaced 5 and 10 mm in various directions. Based on 3%/3 mm criteria, the mean±SD passing rates of MapCHECK, PDIP (pre-treatment QA) for 47 IMRT were 99.8±0.1%, 99.0±0.7%, and, respectively. Besides, passing rates using transit dosimetry was 90.0±1.5% for the same condition. Setup errors of 5 and 10 mm reduced the mean passing rates by 1.3% and 3.0% (inferior to superior), 2.2% and 4.3% (superior to inferior), 5.9% and 10.9% (left to right), and 8.9% and 16.3% (right to left), respectively. These findings suggest that the transit dose-based IMRT verification method using EPID, in which the transit dose from patients is compared with the dose map calculated from the TPS, may be useful in verifying various errors including setup and/or patient positioning error, inhomogeneity and target motions.

Changes in Patterns of Intensity-modulated Radiotherapy Verification and Quality Assurance in the UK

AimsBetween 2012 and 2014 the number of patients treated in the UK with intensity-modulated radiotherapy (IMRT) techniques increased significantly. One reason for this was the radiotherapy innovation fund for the centres in England. Before the announcement of the fund, a survey of radiotherapy centres was carried out in 2012 which collected data on IMRT uptake, obstacles to implementation, equipment used, delivery techniques and verification methods. A repeat survey was carried out in 2014 to identify key changes to IMRT quality assurance and verification practices. Materials and methodsAn online questionnaire was sent out to all 65 UK radiotherapy centres in the summer of 2012 and again in the summer of 2014. Questions covered background and equipment, machine tolerance and quality assurance, machine-based verification, software-based verification and future plans. ResultsThere have been significant changes in the delivery techniques used for IMRT, with more than twice as many centres reporting the use of volumetric-modulated arc therapy techniques in 2014 compared with 2012. This has been combined with an increase in Monte Carlo-based algorithms in treatment planning systems. In 2012 all centres reported the need to carry out machine-based measurements for IMRT plan verification, dropping to 93% in 2014. Nineteen per cent of centres now report making only one measurement per month for prostate plans and 8% of breast plans never have physical measurements. Most centres use detector arrays for quality assurance measurement (86% in 2012 and 91% in 2014), but a significant number still use film and/or ionisation chambers (51% and 41%). In the analysis of these measurements there has been an increase in the use of tighter criteria. There has been a significant increase in the use of software for verification from 63% in 2012 to 95% in 2014. All centres reported that they needed further resources in order to efficiently achieve the quality assurance required for the number of patients planned to be treated in their centre. ConclusionsThe increased numbers of patients being treated with IMRT has meant that there have been significant changes in the way that quality assurance is carried out. These have been mainly in the reduction of measurements and the increase in software-based verification. However, quality assurance is still a significant burden and still has an effect on the numbers of patients who can be treated with IMRT.

強度変調放射線治療の線量分布検証における線量分布の高解像度評価

強度変調放射線治療（IMRT）において，治療の精度を保証するためにフィルムや2次元検出器を用いた線量分布の検証がある．2次元検出器による検証は，フィルムと比較して即時に測定の評価ができ取扱いも簡便であるという利点があるが，得られる線量分布が低解像度であるという問題がある．線量分布の高解像度化はIMRT事前検証に有用で，本論文では，2次元検出器で得た線量分布の分解能を改善するために，一枚超解像法を用いて線量分布を高解像度化して評価する手法を提案する．この高解像度化した線量分布と参考指標とする治療計画装置から得た線量分布との比較評価の結果，提案法により得た高解像度線量分布は，従来法によって高解像度化した線量分布より，臨床評価において重要な標的と正常臓器の境界にあたるエッジの情報がぼけず良く復元でき，ガンマ解析による臨床評価においてもより正確に評価できる可能性があることを示す．