Clinical introduction of a linac head-mounted 2D detector array based quality assurance system in head and neck IMRT.

IMRT QA is commonly performed in a phantom geometry but the clinical interpretation of the results in a 2D phantom plane is difficult. The main objective of our work is to move from film measurement based QA to 3D dose reconstruction in a patient CT scan. In principle, this could be achieved using a dose reconstruction method from 2D detector array measurements as available in the COMPASS system (IBA Dosimetry). The first step in the clinical introduction of this system instead of the currently used film QA procedures is to test the reliability of the dose reconstruction. In this paper we investigated the validation of the method in a homogeneous phantom with the film QA procedure as a reference. We tested whether COMPASS QA results correctly identified treatment plans that did or did not fulfil QA requirements in head and neck (H&N) IMRT. A total number of 24 treatments were selected from an existing database with more than 100 film based H&N IMRT QA results. The QA results were classified as either good, just acceptable or clinically rejected (mean gamma index <0.4, 0.4-0.5 or >0.5, respectively with 3%/3mm criteria). Film QA was repeated and compared to COMPASS QA with a MatriXX detector measurement performed on the same day. Good agreement was found between COMPASS reconstructed dose and film measured dose in a phantom (mean gamma 0.83±0.09, 1SD with 1%/1mm criteria, 0.33±0.04 with 3%/3mm criteria). COMPASS QA results correlated well with film QA, identifying the same patients with less good QA results. Repeated measurements with film and COMPASS showed changes in delivery after a modified MLC calibration, also visible in a standard MLC check in COMPASS. The time required for QA reduced by half by using COMPASS instead of film. Agreement of COMPASS QA results with film based QA supports its clinical introduction for a phantom geometry. A standard MLC calibration check is sensitive to <1mm changes that could be significant in H&N IMRT. These findings offer opportunities to further investigate the method based on a 2D detector array to 3D dose reconstruction in a patient anatomy.

Korevaar EW ，Wauben DJ ，van der Hulst PC ，Langendijk JA ，Van't Veld AA ... -  《-》

Monte Carlo simulations to replace film dosimetry in IMRT verification.

Patient-specific verification of intensity-modulated radiation therapy (IMRT) plans can be done by dosimetric measurements or by independent dose or monitor unit calculations. The aim of this study was the clinical evaluation of IMRT verification based on a fast Monte Carlo (MC) program with regard to possible benefits compared to commonly used film dosimetry. 25 head-and-neck IMRT plans were recalculated by a pencil beam based treatment planning system (TPS) using an appropriate quality assurance (QA) phantom. All plans were verified both by film and diode dosimetry and compared to MC simulations. The irradiated films, the results of diode measurements and the computed dose distributions were evaluated, and the data were compared on the basis of gamma maps and dose-difference histograms. Average deviations in the high-dose region between diode measurements and point dose calculations performed with the TPS and MC program were 0.7 ± 2.7% and 1.2 ± 3.1%, respectively. For film measurements, the mean gamma values with 3% dose difference and 3mm distance-to-agreement were 0.74 ± 0.28 (TPS as reference) with dose deviations up to 10%. Corresponding values were significantly reduced to 0.34 ± 0.09 for MC dose calculation. The total time needed for both verification procedures is comparable, however, by far less labor intensive in the case of MC simulations. The presented study showed that independent dose calculation verification of IMRT plans with a fast MC program has the potential to eclipse film dosimetry more and more in the near future. Thus, the linac-specific QA part will necessarily become more important. In combination with MC simulations and due to the simple set-up, point-dose measurements for dosimetric plausibility checks are recommended at least in the IMRT introduction phase.

Goetzfried T ，Rickhey M ，Treutwein M ，Koelbl O ，Bogner L ... -  《-》

Patient-specific 3D pretreatment and potential 3D online dose verification of Monte Carlo-calculated IMRT prostate treatment plans.

Fast and reliable comprehensive quality assurance tools are required to validate the safety and accuracy of complex intensity-modulated radiotherapy (IMRT) plans for prostate treatment. In this study, we evaluated the performance of the COMPASS system for both off-line and potential online procedures for the verification of IMRT treatment plans. COMPASS has a dedicated beam model and dose engine, it can reconstruct three-dimensional dose distributions on the patient anatomy based on measured fluences using either the MatriXX two-dimensional (2D) array (offline) or a 2D transmission detector (T2D) (online). For benchmarking the COMPASS dose calculation, various dose-volume indices were compared against Monte Carlo-calculated dose distributions for five prostate patient treatment plans. Gamma index evaluation and absolute point dose measurements were also performed in an inhomogeneous pelvis phantom using extended dose range films and ion chamber for five additional treatment plans. MatriXX-based dose reconstruction showed excellent agreement with the ion chamber (<0.5%, except for one treatment plan, which showed 1.5%), film (∼100% pixels passing gamma criteria 3%/3 mm) and mean dose-volume indices (<2%). The T2D based dose reconstruction showed good agreement as well with ion chamber (<2%), film (∼99% pixels passing gamma criteria 3%/3 mm), and mean dose-volume indices (<5.5%). The COMPASS system qualifies for routine prostate IMRT pretreatment verification with the MatriXX detector and has the potential for on-line verification of treatment delivery using T2D.

Boggula R ，Jahnke L ，Wertz H ，Lohr F ，Wenz F ... -  《-》

Volumetric-modulated arc therapy: effective and efficient end-to-end patient-specific quality assurance.

To explore an effective and efficient end-to-end patient-specific quality-assurance (QA) protocol for volumetric modulated arc radiotherapy (VMAT) and to evaluate the suitability of a stationary radiotherapy QA device (two-dimensional [2D] ion chamber array) for VMAT QA. Three methods were used to analyze 39 VMAT treatment plans for brain, spine, and prostate: ion chamber (one-dimensional absolute, n = 39), film (2D relative, coronal/sagittal, n = 8), and 2D ion chamber array (ICA, 2D absolute, coronal/sagittal, n = 39) measurements. All measurements were compared with the treatment planning system dose calculation either via gamma analysis (3%, 3- to 4-mm distance-to-agreement criteria) or absolute point dose comparison. The film and ion chamber results were similarly compared with the ICA measurements. Absolute point dose measurements agreed well with treatment planning system computed doses (ion chamber: median deviation, 1.2%, range, -0.6% to 3.3%; ICA: median deviation, 0.6%, range, -1.8% to 2.9%). The relative 2D dose measurements also showed good agreement with computed doses (>93% of pixels in all films passing gamma, >90% of pixels in all ICA measurements passing gamma). The ICA relative dose results were highly similar to those of film (>90% of pixels passing gamma). The coronal and sagittal ICA measurements were statistically indistinguishable by the paired t test with a hypothesized mean difference of 0.1%. The ion chamber and ICA absolute dose measurements showed a similar trend but had disparities of 2-3% in 18% of plans. After validating the new VMAT implementation with ion chamber, film, and ICA, we were able to maintain an effective yet efficient patient-specific VMAT QA protocol by reducing from five (ion chamber, film, and ICA) to two measurements (ion chamber and single ICA) per plan. The ICA (Matrixx®, IBA Dosimetry) was validated for VMAT QA, but ion chamber measurements are recommended for absolute dose comparison until future developments correct the ICA angular dependence.

O'Daniel J ，Das S ，Wu QJ ，Yin FF ... -  《-》

Reconstruction of high-resolution 3D dose from matrix measurements: error detection capability of the COMPASS correction kernel method.

Godart J ，Korevaar EW ，Visser R ，Wauben DJ ，Van't Veld AA ... -  《-》