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Title: SU-F-T-238: Analyzing the Performance of MapCHECK2 and Delta4 Quality Assurance Phantoms in IMRT and VMAT Plans

Abstract

Purpose: Intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) have been widely investigated for use in radiotherapy and found to have a highly conformal dose distribution. Delta{sup 4} is a novel cylindrical phantom consisting of 1069 p-type diodes with true treatments measured in the 3D target volume. The goal of this study was to compare the performance of a Delta{sup 4} diode array for IMRT and VMAT planning with ion chamber and MapCHECK2. Methods: Fifty-four IMRT (n=9) and VMAT (n=45) plans were imported to Philips Pinnacle Planning System 9.2 for recalculation with a solid water phantom, MapCHECK2, and the Delta4 phantom. To evaluate the difference between the measured and calculated dose, we used MapCHECK2 and Delta{sup 4} for a dose-map comparison and an ion chamber (PTW 31010 Semiflex 0.125 cc) for a point-dose comparison. Results: All 54 plans met the criteria of <3% difference for the point dose (at least two points) by ion chamber. The mean difference was 0.784% with a standard deviation of 1.962%. With a criteria of 3 mm/3% in a gamma analysis, the average passing rates were 96.86%±2.19% and 98.42%±1.97% for MapCHECK2 and Delta{sup 4}, respectively. The student t-test of MapCHECK2/Delta{sup 4}, ion chamber/Delta{sup 4},more » and ion chamber/MapCHECK2 were 0.0008, 0.2944, and 0.0002, respectively. There was no significant difference in passing rates between MapCHECK2 and Delta{sup 4} for the IMRT plan (p = 0.25). However, a higher pass rate was observed in Delta{sup 4} (98.36%) as compared to MapCHECK2 (96.64%, p < 0.0001) for the VMAT plan. Conclusion: The Pinnacle planning system can accurately calculate doses for VMAT and IMRT plans. The Delta{sup 4} shows a similar result when compared to ion chamber and MapCHECK2, and is an efficient tool for patient-specific quality assurance, especially for rotation therapy.« less

Authors:
; ; ; ; ; ;  [1]
  1. National Taiwan University Hospital, Taipei City, Taiwan (China)
Publication Date:
OSTI Identifier:
22648854
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; CYLINDRICAL CONFIGURATION; IONIZATION CHAMBERS; PERFORMANCE; PHANTOMS; PLANNING; QUALITY ASSURANCE; RADIATION DOSE DISTRIBUTIONS; RADIOTHERAPY; RATS

Citation Formats

Lu, SH, Tsai, YC, Lan, HT, Wen, SY, Chen, LH, Kuo, SH, and Wang, CW. SU-F-T-238: Analyzing the Performance of MapCHECK2 and Delta4 Quality Assurance Phantoms in IMRT and VMAT Plans. United States: N. p., 2016. Web. doi:10.1118/1.4956378.
Lu, SH, Tsai, YC, Lan, HT, Wen, SY, Chen, LH, Kuo, SH, & Wang, CW. SU-F-T-238: Analyzing the Performance of MapCHECK2 and Delta4 Quality Assurance Phantoms in IMRT and VMAT Plans. United States. doi:10.1118/1.4956378.
Lu, SH, Tsai, YC, Lan, HT, Wen, SY, Chen, LH, Kuo, SH, and Wang, CW. 2016. "SU-F-T-238: Analyzing the Performance of MapCHECK2 and Delta4 Quality Assurance Phantoms in IMRT and VMAT Plans". United States. doi:10.1118/1.4956378.
@article{osti_22648854,
title = {SU-F-T-238: Analyzing the Performance of MapCHECK2 and Delta4 Quality Assurance Phantoms in IMRT and VMAT Plans},
author = {Lu, SH and Tsai, YC and Lan, HT and Wen, SY and Chen, LH and Kuo, SH and Wang, CW},
abstractNote = {Purpose: Intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) have been widely investigated for use in radiotherapy and found to have a highly conformal dose distribution. Delta{sup 4} is a novel cylindrical phantom consisting of 1069 p-type diodes with true treatments measured in the 3D target volume. The goal of this study was to compare the performance of a Delta{sup 4} diode array for IMRT and VMAT planning with ion chamber and MapCHECK2. Methods: Fifty-four IMRT (n=9) and VMAT (n=45) plans were imported to Philips Pinnacle Planning System 9.2 for recalculation with a solid water phantom, MapCHECK2, and the Delta4 phantom. To evaluate the difference between the measured and calculated dose, we used MapCHECK2 and Delta{sup 4} for a dose-map comparison and an ion chamber (PTW 31010 Semiflex 0.125 cc) for a point-dose comparison. Results: All 54 plans met the criteria of <3% difference for the point dose (at least two points) by ion chamber. The mean difference was 0.784% with a standard deviation of 1.962%. With a criteria of 3 mm/3% in a gamma analysis, the average passing rates were 96.86%±2.19% and 98.42%±1.97% for MapCHECK2 and Delta{sup 4}, respectively. The student t-test of MapCHECK2/Delta{sup 4}, ion chamber/Delta{sup 4}, and ion chamber/MapCHECK2 were 0.0008, 0.2944, and 0.0002, respectively. There was no significant difference in passing rates between MapCHECK2 and Delta{sup 4} for the IMRT plan (p = 0.25). However, a higher pass rate was observed in Delta{sup 4} (98.36%) as compared to MapCHECK2 (96.64%, p < 0.0001) for the VMAT plan. Conclusion: The Pinnacle planning system can accurately calculate doses for VMAT and IMRT plans. The Delta{sup 4} shows a similar result when compared to ion chamber and MapCHECK2, and is an efficient tool for patient-specific quality assurance, especially for rotation therapy.},
doi = {10.1118/1.4956378},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: Patient-specific quality assurance (QA) is necessary to accurately deliver high dose radiation to the target, especially for stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). Unlike previous 2 dimensional (D) array QA devices, Delta{sup 4} can verify the dose delivery in 3D. In this study, the difference between calculated and measured dose distribution was compared with two QA devices (MATRIXX and Delta{sup 4}) to evaluate the delivery accuracy. Methods: Twenty-seven SRS/SBRT plans with VMAT were verified with point-dose and dose-map analysis. We use an ion chamber (A1SL, 0.053cc) for point-dose measurement. For verification of the dose map, themore » differences between the calculated and measured doses were analyzed with a gamma index using MATRIXX and Delta{sup 4} devices. The passing criteria for gamma evaluation were set at 3 mm for distance-to-agreement (DTA) and 3% for dose-difference. A gamma index less than 1 was defined as the verification passing the criteria and satisfying at least 95% of the points. Results: The mean prescribed dose and fraction was 40 ± 14.41 Gy (range: 16–60) and 10 ± 2.35 fractions (range: 1–8), respectively. In point dose analysis, the differences between the calculated and measured doses were all less than 5% (mean: 2.12 ± 1.13%; range: −0.55% to 4.45%). In dose-map analysis, the average passing rates were 99.38 ± 0.96% (range: 95.31–100%) and 100 ± 0.12% (range: 99.5%–100%) for MATRIXX and Delta{sup 4}, respectively. Even using criteria of 2%/2 mm, the passing rate of Delta{sup 4} was still more than 95% (mean: 99 ± 1.08%; range: 95.6%–100%). Conclusion: Both MATRIXX and Delta{sup 4} offer accurate and efficient verification for SRS/SBRT plans. The results measured by MATRIXX and Delta{sup 4} dosimetry systems are similar for SRS/SBRT performed with the VMAT technique.« less
  • In this study we analyzed and compared the dose distribution of different IMRT and VMAT plans with the intent to provide pre-treatment quality assurance using two different tools. Materials/Methods: We have used the electronic portal imaging device EPID after calibration to dose and correction for the background offset signal and also the Delta4 phantom after en evaluation of angular sensitivity. The Delta4 phantom has a two-dimensional array with ionization chambers. We analyzed three plans for each anatomical site calculated by Eclipse treatment planning system. The measurements were analyzed using γ-evaluation method with passing criteria 3% absolute dose and 3 mm distancemore » to agreement (DTA). For all the plans the range of score has been from 97% to 99% for gantry fixed at 0° while for rotational planes there was a slightly decreased pass rates and above 95%. Point measurement with a ionization chamber were done in additional to see the accuracy of portal dosimetry and to evaluate the Delta4 device to various dose rates. Conclusions: Both Delt4 and Portal dosimetry shows good results between the measured and calculated doses. While Delta4 is more accurate in measurements EPID is more time efficient. We have decided to use both methods in the first steps of IMRT and VMAT implementation and later on to decide which of the tools to use depending on the complexity of plans, how much accurate we want to be and the time we have on the machine.« less
  • Purpose: To develop a method to verify the dose delivery in relation to the individual control points of intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) using an ionization chamber. In addition to more effective problem solving during patient-specific quality assurance (QA), the aim is to eventually map out the limitations in the treatment chain and enable a targeted improvement of the treatment technique in an efficient way. Methods: Pretreatment verification was carried out for 255 treatment plans that included a broad range of treatment indications in two departments using the equipment of different vendors. In-house developed softwaremore » was used to enable calculation of the dose delivery for the individual beamlets in the treatment planning system (TPS), for data acquisition, and for analysis of the data. The observed deviations were related to various delivery and measurement parameters such as gantry angle, field size, and the position of the detector with respect to the field edge to distinguish between error sources. Results: The average deviation of the integral fraction dose during pretreatment verification of the planning target volume dose was −2.1% ± 2.2% (1 SD), −1.7% ± 1.7% (1 SD), and 0.0% ± 1.3% (1 SD) for IMRT at the Radboud University Medical Center (RUMC), VMAT (RUMC), and VMAT at the Wellington Blood and Cancer Centre, respectively. Verification of the dose to organs at risk gave very similar results but was generally subject to a larger measurement uncertainty due to the position of the detector at a high dose gradient. The observed deviations could be related to limitations of the TPS beam models, attenuation of the treatment couch, as well as measurement errors. The apparent systematic error of about −2% in the average deviation of the integral fraction dose in the RUMC results could be explained by the limitations of the TPS beam model in the calculation of the beam penumbra. Conclusions: This study showed that time-resolved dosimetry using an ionization chamber is feasible and can be largely automated which limits the required additional time compared to integrated dose measurements. It provides a unique QA method which enables identification and quantification of the contribution of various error sources during IMRT and VMAT delivery.« less
  • Purpose: To discuss several factors surrounding the decision on when to recalibrate the ArcCHECK device as well as present a simple and efficient monthly check to evaluate ArcCHECK calibrations. Methods: ArcCheck (Sun Nuclear) calibrations were evaluated monthly by measuring a 25×25cm{sup 2} field with 100 MU. Since ArcCHECK measurements are run on an almost nightly basis, such additional square field measurements are obtained with minimal additional effort. An in-house MATLAB script compares two radial (y-direction) profiles from the top/center of the new measurement relative to a baseline measurement acquired at the last device calibration. The program automatically generates PDF profilemore » and percent difference comparisons for inspection. Recalibration is based on inspection of measurement profile shapes and percent differences from the baseline measurement. Results: The method presented here shows the utility of a simple monthly check for evaluating ArcCHECK calibrations, and in addition shows the importance of recalibrating after Linac beam steering. Our device required recalibration approximately every 8–10 months. However, for ease of scheduling, we propose a bi-annual recalibration interval. Clinics with a lighter/heavier IMRT/VMAT QA case load may require different recalibration intervals, which are easily determined using the single-field method presented. Analysis of additional square fields is also easily incorporated, if desired. We further illustrate the importance of array recalibration given that diode irradiation is not uniform over the entire device, with central diodes receiving more than 900 Gy over the course of 10 months and peripheral diodes receiving as little as 50 Gy (in our experience). Finally, we show that timely device recalibration decreases spread in clinical IMRT/VMAT QA gamma passing rates. Conclusion: Quality assurance for ArcCHECK array calibrations is important to ensure quality IMRT/VMAT QA comparisons. For many clinics, calibrations should be performed at least annually, if not more frequently, based on use of the proposed monthly check.« less
  • Purpose: To evaluate the effectiveness of using the Portal Dosimetry (PD) method for patient specific quality assurance of prostate VMAT plans. Methods: As per institutional protocol all VMAT plans were measured using the Varian Portal Dosimetry (PD) method. A gamma evaluation criterion of 3%-3mm with a minimum area gamma pass rate (gamma <1) of 95% is used clinically for all plans. We retrospectively evaluated the portal dosimetry results for 170 prostate patients treated with VMAT technique. Three sets of criterions were adopted for re-evaluating the measurements; 3%-3mm, 2%-2mm and 1%-1mm. For all criterions two areas, Field+1cm and MLC-CIAO were analysed.Tomore » ascertain the effectiveness of the portal dosimetry technique in determining the delivery accuracy of prostate VMAT plans, 10 patients previously measured with portal dosimetry, were randomly selected and their measurements repeated using the ArcCHECK method. The same criterion used in the analysis of PD was used for the ArcCHECK measurements. Results: All patient plans reviewed met the institutional criteria for Area Gamma pass rate. Overall, the gamma pass rate (gamma <1) decreases for 3%-3mm, 2%-2mm and 1%-1mm criterion. For each criterion the pass rate was significantly reduced when the MLC-CIAO was used instead of FIELD+1cm. There was noticeable change in sensitivity for MLC-CIAO with 2%-2mm criteria and much more significant reduction at 1%-1mm. Comparable results were obtained for the ArcCHECK measurements. Although differences were observed between the clockwise verses the counter clockwise plans in both the PD and ArcCHECK measurements, this was not deemed to be statistically significant. Conclusion: This work demonstrates that Portal Dosimetry technique can be effectively used for quality assurance of VMAT plans. Results obtained show similar sensitivity compared to ArcCheck. To reveal certain delivery inaccuracies, the use of a combination of criterions may provide an effective way in improving the overall sensitivity of PD. Funding provided in part by the Prostate Ride for Dad, Kitchener-Waterloo, Canada.« less