Medicina Nuclear e Radioterapia

Pre-Treatment Dose Verification of Imrt Using Gafchromic Ebt3 Film and 2DArray

Abstract

Nalbant Nalbant, Donmez Kesen N and Bilge Hatice

Purpose: The present work deals with pre-treatment dosimetric verification of 10 prostate intensity-modulated radiotherapy (IMRT) plans obtained by Gafchromic EBT3 film and 2D-Array seven29 to establish quality control protocol for the delivery of prostate IMRT in our clinic.
Methods: 10 prostate patients were irradiated according to IMRT techniques with 6 MV photon beams produced by a Varian DHX linear accelerator. Dose plans were computed using Eclipse 8.9 (version8.9, Varian, Palo Alto, CA, United States) treatment planning system (TPS). Pre-treatment dosimetric verification was carried out on field-perfield and total IMRT plan basis measuring 2D dose distributions in RW3 solid water phantom (PTW-Freiburg, Germany). For 10 patient plans, the dose distribution was re-calculated with the phantom CT scan and delivered to the phantom with the original and 0 degrees gantry, collimator and table angles. Thus IMRT quality control (QC) plans were generated. Dose distribution measurements were measured with Gafchromic EBT3 film and 2D-Array seven29 (PTW-Freiburg, Germany) two dimensional ionization chamber system. Verification measurements of total IMRT plans and each individual beams were compared with expected dose maps, and differences were evaluated by Verisoft program (PTW-Freiburg, Germany). To provide comparisons of multidimensional dose distributions, dose comparison tools such as gamma dose distribution, distance- to- agreement (DTA) and dose difference (DD) have been developed. The gamma dose distribution tool was used in our study. Three different gamma criteria of dose difference (DD) and distance to agreement (DTA) (3%/3 mm, 4%/4 mm and 5%/5 mm DD / DTA) are selected. These criteria are evaluated while suppressing the dose of 5% from dose distribution. Criterion validity accepted as section with gamma value less than or equal to 1 (γ ≤ 1) to be 90%.
Results: In the comparison of dose distributions obtained from TPS and the results of PTW 2D-Array seven29 and Gafchromic EBT3 film dosimetry systems, it was showed that the compatibility of both methods were above 90% with respect to 3% DD and 3mm DTA criteria. PTW 2D-Array seven29 results compared to the results of the film was closer to the TPS data and this difference was statistically meaningful (p<0.05). If the range of criteria is increased, the compatibility increases and it reaches to 100%. It was observed that analyzing by measuring all fields which are composing IMRT plans and analyzing by measuring each individual fields at the same time, made no statistically meaningful difference (p>0.05).
Conclusions: The measurements performed with PTW 2D-Array seven29 were closer to the TPS data than film measurements and it takes less time during clinical use, so it could be preferred for routine use. The present results suggest the gamma criteria of 3%/3 mm as the most suitable criteria for prostate IMRT quality assurance.