Background: Radiation therapy techniques as Intensity Modulated Radiotherapy (IMRT), rapid arc have been used for treatment of cancer with high accuracy. Objective: Verification of planned and delivered dose distribution is important, therefore current study aims to analyse quality assurance (QA) results of IMRT by Electronic Portal Imaging Device (EPID) and IMatriXX in head and neck Carcinoma (Ca H&N) patients. Material and Methods: In this experimental study, performance of an EPID and IMatriXX was assessed with dose measurements using ionization chamber. Calibrated IMatriXX and EPID are used for pre-treatment patient specific quality assurance (PSQA), for 122 patients’ plans of Ca H&N with IMRT treatment technique on linear accelerator. Dose images were acquired and compared with gamma evaluation (3% / 3 mm) and three scalar parameters, named average γ (γavg), maximum γ (γmax) and area gamma <1, were analyzed in the region of interest. Results: The γ correlation comparisons yielded average correlation of 0.990 and 0.982 for IMatriXX and EPID respectively. Maximum value of gamma is 0.998, while minimum gamma is 0.872 for IMatriXX and 0.953 for EPID. For students, unpaired ‘t’ test analysis is applied for comparison to two data sets. P-value was set at 0.005 which, for this study, was computed 0.001, showing good correlation between measured data with IMatriXX and EPID. Conclusion: The EPID and IMatriXX have significantly improved dosimetric properties, resulting in more sensitive, accurate measurements before actual treatment. The result shows EPID can be replaced with other dosimetry method and ionization chamber measurements. Portal imager is an efficient, accurate and sensitive dosimetry tool and is also the basis of pre-treatment quality assurance protocol. |
- El-Mohri Y, Antonuk LE, Yorkston J, Jee KW, et al. Relative dosimetry using active matrix flat-panel imager (AMFPI) technology. Med Phys. 1999;26(8):1530-41. doi: 10.1118/1.598649. PubMed PMID: 10501053.
- McCurdy BM, Luchka K, Pistorius S. Dosimetric investigation and portal dose image prediction using an amorphous silicon electronic portal imaging device. Med Phys. 2001;28(6):911-24. doi: 10.1118/1.1374244. PubMed PMID: 11439488.
- Grein EE, Lee R, Luchka K. An investigation of a new amorphous silicon electronic portal imaging device for transit dosimetry. Med Phys. 2002;29(10):2262-8. doi: 10.1118/1.1508108. PubMed PMID: 12408300.
- Greer PB, Popescu CC. Dosimetric properties of an amorphous silicon electronic portal imaging device for verification of dynamic intensity modulated radiation therapy. Med Phys. 2003;30(7):1618-27. doi: 10.1118/1.1582469. PubMed PMID: 12906179.
- Warkentin B, Steciw S, Rathee S, Fallone BG. Dosimetric IMRT verification with a flat-panel EPID. Med Phys. 2003;30(12):3143-55. doi: 10.1118/1.1625440. PubMed PMID: 14713081.
- McDermott LN, Louwe RJ, Sonke JJ, Van Herk MB, Mijnheer BJ. Dose-response and ghosting effects of an amorphous silicon electronic portal imaging device. Med Phys. 2004;31(2):285-95. doi: 10.1118/1.1637969. PubMed PMID: 15000614.
- Louwe RJ, McDermott LN, Sonke JJ, et al. The long-term stability of amorphous silicon flat panel imaging devices for dosimetry purposes. Med Phys. 2004;31(11):2989-95. doi: 10.1118/1.1803751. PubMed PMID: 15587651.
- Reiner BI, Siegel EL, Siddiqui K. Evolution of the digital revolution: a radiologist perspective. J Digit Imaging. 2003;16(4):324-30. doi: 10.1007/s10278-003-1743-y. PubMed PMID: 14747936. PubMed PMCID: PMC3044070.
- Georg D, Kroupa B, Winkler P, Pötter R. Normalized sensitometric curves for the verification of hybrid IMRT treatment plans with multiple energies. Med Phys. 2003;30(6):1142-50. doi: 10.1118/1.1576951. PubMed PMID: 12852539.
- Stock M, Kroupa B, Georg D. Interpretation and evaluation of the gamma index and the gamma index angle for the verification of IMRT hybrid plans. Phys Med Biol. 2005;50(3):399-411. doi: 10.1088/0031-9155/50/3/001. PubMed PMID: 15773719.
- Jursinic PA, Nelms BE. A 2-D diode array and analysis software for verification of intensity modulated radiation therapy delivery. Med Phys. 2003;30(5):870-9. doi: 10.1118/1.1567831. PubMed PMID: 12772995.
- Létourneau D, Gulam M, Yan D, Oldham M, Wong JW. Evaluation of a 2D diode array for IMRT quality assurance. Radiother Oncol. 2004;70(2):199-206. doi: 10.1016/j.radonc.2003.10.014. PubMed PMID: 15028408.
- Wiezorek T, Banz N, Schwedas M, et al. Dosimetric quality assurance for intensity-modulated radiotherapy feasibility study for a filmless approach. Strahlenther Onkol. 2005;181(7):468-74. doi: 10.1007/s00066-005-1381-z. PubMed PMID: 15995841.
- Childress NL, Bloch C, White RA, Salehpour M, Rosen II. Detection of IMRT delivery errors using a quantitative 2D dosimetric verification system. Med Phys. 2005;32(1):153-62. doi: 10.1118/1.1829171. PubMed PMID: 15719966.
- Steciw S, Warkentin B, Rathee S, Fallone BG. Three-dimensional IMRT verification with a flat-panel EPID. Med Phys. 2005;32(2):600-12. doi: 10.1118/1.1843471. PubMed PMID: 15789607.
- Wendling M, Louwe RJ, McDermott LN, Sonke JJ, et al. Accurate two-dimensional IMRT verification using a back-projection EPID dosimetry method. Med Phys. 2006;33(2):259-73. doi: 10.1118/1.2147744. PubMed PMID: 16532930.
- Low DA, Harms WB, Mutic S, Purdy JA. A technique for the quantitative evaluation of dose distributions. Med Phys. 1998;25(5):656-61. doi: 10.1118/1.598248. PubMed PMID: 9608475.
- Kim YL, Chung JB, Kim JS, Lee JW, Choi KS. Comparison of the performance between portal dosimetry and a commercial two-dimensional array system on pretreatment quality assurance for volumetric-modulated arc and intensity-modulated radiation therapy. Journal of the Korean Physical Society. 2014;64(8):1207-12. doi: 10.3938/jkps.64.1207.
- Winkler P, Zurl B, Guss H, Kindl P, Stuecklschweiger G. Performance analysis of a film dosimetric quality assurance procedure for IMRT with regard to the employment of quantitative evaluation methods. Phys Med Biol. 2005;50(4):643-54. doi: 10.1088/0031-9155/50/4/006. PubMed PMID: 15773625.
- Van Zijtveld M, Dirkx ML, De Boer HC, Heijmen BJ. Dosimetric pre-treatment verification of IMRT using an EPID; clinical experience. Radiotherapy and Oncology. 2006;81(2):168-75. doi: 10.1016/j.radonc.2006.09.008.
- Budgell GJ, Perrin BA, Mott JH, Fairfoul J, Mackay RI. Quantitative analysis of patient-specific dosimetric IMRT verification. Phys Med Biol. 2005;50(1):103-19. doi: 10.1088/0031-9155/50/1/009. PubMed PMID: 15715426.
- Partridge M, Symonds-Tayler JR, Evans PM. IMRT verification with a camera-based electronic portal imaging system. Phys Med Biol. 2000;45(12):N183-96. doi: 10.1088/0031-9155/45/12/402. PubMed PMID: 11131208.
- Louwe RJ, Damen EM, Van Herk M, et al. Three-dimensional dose reconstruction of breast cancer treatment using portal imaging. Med Phys. 2003;30(9):2376-89. doi: 10.1118/1.1589496. PubMed PMID: 14528960.
- Miften M, Olch A, Mihailidis D, Moran J, et al. Tolerance limits and methodologies for IMRT measurement-based verification QA: Recommendations of AAPM Task Group No. 218. Med Phys. 2018;45(4):e53-83. doi: 10.1002/mp.12810. PubMed PMID: 29443390.
- Herzen J, Todorovic M, Cermers F, et al. Dosimetric evaluation of a 2D pixel ionization chamber for implementation in clinical routine. Phys Med Biol. 2007;52(4):1197-208. doi: 10.1088/0031-9155/52/4/023.
- Chang J, Ling CC. Using the frame averaging of aS500 EPID for IMRT verification. J Appl Clin Med Phys. 2003;4(4):287-99. doi: 10.1120/jacmp.v4i4.2499. PubMed PMID: 14604418. PubMed PMCID: PMC5724460.
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