Intensity-modulated radiation therapy dose verification using fluence and portal imaging device

Patient-specific quality assurance for intensity-modulated radiation therapy (IMRT) dose verification is essential. The aim of this study is to provide a new method based on the relative error distribution by comparing the fluence map from the treatment planning system (TPS) and the incident fluence deconvolved from the electronic portal imaging device (EPID) images. This method is validated for 10 head and neck IMRT cases. The fluence map of each beam was exported from the TPS and EPID images of the treatment beams were acquired. Measured EPID images were deconvolved to the incident fluence with proper corrections. The relative error distribution between the TPS fluence map and the incident fluence from the EPID was created. This was also created for a 2D diode array detector. The absolute point dose was measured with an ionization chamber, and the dose distribution was measured by a radiochromic film. In three cases, MLC leaf positions were intentionally changed to create the dose error as much as 5% against the planned dose and our fluence-based method was tested using gamma index. Absolute errors between the predicted dose of 2D diode detector and of our method and measure­ments were 1.26% ± 0.65% and 0.78% ± 0.81% respectively. The gamma passing rate (3% global / 3 mm) of the TPS was higher than that of the 2D diode detector (p< 0.02), and lower than that of the EPID (p < 0.04). The gamma passing rate (2% global / 2 mm) of the TPS was higher than that of the 2D diode detector, while the gamma passing rate of the TPS was lower than that of EPID (p < 0.02). For three modified plans, the predicted dose errors against the measured dose were 1.10%, 2.14%, and -0.87%. The predicted dose distributions from the EPID were well matched to the measurements. Our fluence-based method provides very accurate dosimetry for IMRT patients. The method is simple and can be adapted to any clinic for complex cases

Robust plan optimization using edge-enhanced intensity for intrafraction organ deformation in prostate intensity-modulated radiation therapy.

This study evaluated a method for prostate intensity-modulated radiation therapy (IMRT) based on edge-enhanced (EE) intensity in the presence of intrafraction organ deformation using the data of 37 patients treated with step-and-shoot IMRT. On the assumption that the patient setup error was already accounted for by image guidance, only organ deformation over the treatment course was considered. Once the clinical target volume (CTV), rectum, and bladder were delineated and assigned dose constraints for dose optimization, each voxel in the CTV derived from the DICOM RT-dose grid could have a stochastic dose from the different voxel location according to the probability density function as an organ deformation. The stochastic dose for the CTV was calculated as the mean dose at the location through changing the voxel location randomly 1000 times. In the EE approach, the underdose region in the CTV was delineated and optimized with higher dose constraints that resulted in an edge-enhanced intensity beam to the CTV. This was compared to a planning target volume (PTV) margin (PM) approach in which a CTV to PTV margin equivalent to the magnitude of organ deformation was added to obtain an optimized dose distribution. The total monitor units, number of segments, and conformity index were compared between the two approaches, and the dose based on the organ deformation of the CTV, rectum, and bladder was evaluated. The total monitor units, number of segments, and conformity index were significantly lower with the EE approach than with the PM approach, while maintaining the dose coverage to the CTV with organ deformation. The dose to the rectum and bladder were significantly reduced in the EE approach compared with the PM approach. We conclude that the EE approach is superior to the PM with regard to intrafraction organ deformation

Radiobiological parameters used to calculate the generalized equivalent uniformed dose, tumor control probability, and normal tissue complication probability.

<p>Radiobiological parameters used to calculate the generalized equivalent uniformed dose, tumor control probability, and normal tissue complication probability.</p

Magnitudes of intrafraction organ deformation in the three directions for the clinical target volume (CTV), rectum, and bladder.

<p>Magnitudes of intrafraction organ deformation in the three directions for the clinical target volume (CTV), rectum, and bladder.</p

The treatment planning process for dose evaluation as applied in the edge-enhanced and planning target volume (PTV)-margin approaches.

<p>For the edge-enhanced approach, dose optimization to the clinical target volume (CTV) with no spatial margin was applied, followed by the creation of blurred dose distribution. The underdose region within the CTV was calculated, and the manual delineation was performed on the TPS according to the region. Re-optimization was performed to create the edge-enhanced dose distribution. In contrast, for the PTV-margin approach, dose optimization to the PTV with margin was applied. Finally, the two planned dose distributions derived from the edge-enhanced and PTV-margin approaches were blurred and compared for evaluation.</p

Dose–volume parameters and radiobiological indices for the edge-enhanced approach and PTV-margin approach under intrafraction organ deformation.

<p>Dose–volume parameters and radiobiological indices for the edge-enhanced approach and PTV-margin approach under intrafraction organ deformation.</p