• Progress in Medical Physics
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• v.28 no.3
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• pp.111-121
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• 2017

Verification of dose distribution is an essential part of ensuring the treatment planning system's (TPS) calculated dose will achieve the desired outcome in radiation therapy. Each measurement have uncertainty associated with it. It is desirable to reduce the measurement uncertainty. A best approach is to reduce the uncertainty associated with each step of the process to keep the total uncertainty under acceptable limits. Point dose patient specific quality assurance (QA) is recommended by American Association of Medical Physicists (AAPM) and European Society for Radiotherapy and Oncology (ESTRO) for all the complex radiation therapy treatment techniques. Relative and absolute point dose measurement methods are used to verify the TPS computed dose. Relative and absolute point dose measurement techniques have a number of steps to measure the point dose which includes chamber cross calibration, electrometer reading, chamber calibration coefficient, beam quality correction factor, reference conditions, influences quantities, machine stability, nominal calibration factor (for relative method) and absolute dose calibration of machine. Keeping these parameters in mind, the estimated relative percentage uncertainty associated with the absolute point dose measurement is 2.1% (k=1). On the other hand, the relative percentage uncertainty associated with the relative point dose verification method is estimated to 1.0% (k=1). To compare both point dose measurement methods, 13 head and neck (H&N) IMRT patients were selected. A point dose for each patient was measured with both methods. The average percentage difference between TPS computed dose and measured absolute relative point dose was 1.4% and 1% respectively. The results of this comparative study show that while choosing the relative or absolute point dose measurement technique, both techniques can produce similar results for H&N IMRT treatment plans. There is no statistically significant difference between both point dose verification methods based upon the t-test for comparing two means.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.248-251
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• 2002

The intensity modulated radiation therapy (IMRT) with a multileaf collimator (MLC) requires the conversion of a radiation fluence map into a leaf sequence file that controls the movement of the MLC during radiation treatment of patients. Patient dose verification is clinically one of the most important parts in the treatment delivery of the radiation therapy. The three dimensional (3D) reconstruction of dose distribution delivered to the target helps to verify patient dose and to determine the physical characteristics of beams used in IMRT. A new method is presented for the pretreatment dosimetric verification of two dimensional distributions of photon intensity by means of Beam Intensity Scanner System (BISS) as a radiation detector with a custom-made software for dose calculation of fluorescence signals from scintillator. The scintillator is used to produce fluorescence from the irradiation of 6MV photons on a Varian Clinac 21EX. The BISS reproduces 3D- relative dose distribution from the digitized fluoroscopic signals obtained by digital video camera-based scintillator(DVCS) device in the IMRT. For the intensity modulated beams (IMBs), the calculations of absorbed dose are performed in absolute beam fluence profiles which are used for calculation of the patient dose distribution. The 3D-dose profiles of the IMBs with the BISS were demonstrated by relative measurements of photon beams and shown good agreement with radiographic film. The mechanical and dosimetric properties of the collimating of dynamic and/or step MLC system alter the generated intensity. This is mostly due to leaf transmission, leaf penumbra and geometry of leaves. The variations of output according to the multileaf opening during the irradiation need to be accounted for as well. These phenomena result in a fluence distribution that can be substantially different from the initial and calculative intensity modulation and therefore, should be taken into account by the treatment planning for accurate dose calculations delivered to the target volume in IMRT.

• Progress in Medical Physics
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• v.27 no.4
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• pp.213-219
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• 2016

The position verification of the radiation source utilized in brachytherapy forms a critical factor in determining the therapeutic efficiency. Currently, films are used to verify the source position; however, this method is encumbered by the lengthy time interval required from film scanning to analysis, which makes real-time position verification difficult. In general, the source position accuracy is usually tested in a monthly quality assurance check. In this context, this study investigates the feasibility of the real-time position verification of the radiation source in high dose rate (HDR) brachytherapy with the use of scintillating fibers. To this end, we construct a system consisting of scintillating fibers and a silicon photomultiplier (SiPM), optimize the dosimetric software setup and radiation system characteristics to obtain maximum measurement accuracy, and determine the relative ratio of the measured signals dependent upon the position of the scintillating fiber. According to the dosimetric results based on a treatment plan, in which the dwell time is set at 30 and 60 s at two dwell positions, the number of signals is 31.5 and 83, respectively. In other words, the signal rate roughly doubles in proportion to the dwell time. The source position can also be confirmed at the same time. With further improvements in the spatial resolution and scintillating fiber array, the source position can be verified in real-time in clinical settings with the use of a scintillating fiber-based system.

• Progress in Medical Physics
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• v.24 no.4
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• pp.213-219
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• 2013

This review paper deals with the current statues of pre-treatment quality assurance conducted for Intensity modulated radiation therapy. Focusing on the issues relevant to two-dimensional verification of absorbed dose distribution, review was made for the papers published during the last 3~4 years. Lastly, the future development direction was projected.

• Journal of the Institute of Electronics Engineers of Korea SC
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• v.43 no.6 s.312
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• pp.68-75
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• 2006

During cancer therapy by using high energy radiation, it is possible to improve the radiation therapy efficiency by performing a precise radiation therapy after verification of generated setup errors. In this paper, the video based electronic portal imaging device (EPID) which could display the portal image with near real time was developed to verify treatment position errors in radiation therapy instead of an analog typed portal film. This EPID system for applying QA tool of radiation therapy machine was consisted of a metal/fluorescent screen, $45^{\circ}$mirror, camera and image grabber. Radiation field verification has been performed to check quality assurance of the treatment machine itself by using this EPID system. The radiation field error was easily observed by edge detection of irradiated field size on EPID image when $0.6^{\circ}$ shift of collimator angle was generated. So, this implemented EPID system could be used as a radiation QA tool.

• Progress in Medical Physics
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• v.32 no.4
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• pp.116-121
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• 2021

Purpose: To investigate the effects of dose rate on intensity-modulated radiation therapy (IMRT) quality assurance (QA). Methods: We performed gamma tests using portal dose image prediction and log files of a multileaf collimator. Thirty treatment plans were randomly selected for the IMRT QA plan, and three verification plans for each treatment plan were generated with different dose rates (200, 400, and 600 monitor units [MU]/min). These verification plans were delivered to an electronic portal imager attached to a Varian medical linear accelerator, which recorded and compared with the planned dose. Root-mean-square (RMS) error values of the log files were also compared. Results: With an increase in dose rate, the 2%/2-mm gamma passing rate decreased from 90.9% to 85.5%, indicating that a higher dose rate was associated with lower radiation delivery accuracy. Accordingly, the average RMS error value increased from 0.0170 to 0.0381 cm as dose rate increased. In contrast, the radiation delivery time reduced from 3.83 to 1.49 minutes as the dose rate increased from 200 to 600 MU/min. Conclusions: Our results indicated that radiation delivery accuracy was lower at higher dose rates; however, the accuracy was still clinically acceptable at dose rates of up to 600 MU/min.

• Progress in Medical Physics
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• v.29 no.4
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• pp.137-142
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• 2018

This study aimed to evaluate and verify a process for correcting the extended source-to-imager distance (SID) in portal dosimetry (PD). In this study, eight treatment plans (four volumetric modulated arc therapy and four intensity-modulated radiation therapy plans) at different treatment sites and beam energies were selected for measurement. A Varian PD system with portal dose image prediction (PDIP) was used for the measurement and verification. To verify the integrity of the plan, independent measurements were performed with the MapCHECK device. The predicted and measured fluence were evaluated using the gamma passing rate. The output ratio was defined as the ratio of the absolute dose of the reference SID (100 cm) to that of each SID (120 cm or 140 cm). The measured fluence for each SID was absolutely and relatively compared. The average SID output ratios were 0.687 and 0.518 for 120 SID and 140 SID, respectively; the ratio showed less than 1% agreement with the calculation obtained by using the inverse square law. The resolution of the acquired EPIDs were 0.336, 0.280, and 0.240 for 100, 120, and 140 SID, respectively. The gamma passing rates with PD and MapCHECK exceeded 98% for all treatment plans and SIDs. When autoalignment was performed in PD, the X-offset showed no change, and the Y-offset decreased with increasing SID. The PD-generated PDIP can be used for extended SID without additional correction.

• Progress in Medical Physics
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• v.12 no.2
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• pp.177-184
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• 2001

The goal of radiation treatment is to deliver a prescribed radiation dose to the target volume accurately while minimizing dose to normal tissues. Due to inaccurate placement of field and shielding block and patient's movement, there could be displacement errors between the planed and treatment regions. In order to verify the location of radiation treatment, we in this study developed the registration algorithm of the x-ray simulator images and portal images and quantified the inaccuracy in terms of shift, scale and rotation. The algorithm for registration of pairs of radiation fields consists of the alignment of pairs of radiation images by points matching and field displacement analysis by field boundary matching. In the first step, paired surface landmarks are matched to calculate the transformation parameters (scale, rotation and shift) using the corresponding line pairs which are created by connecting two landmarks of each image. In the next step, portal field boundary is extracted and then the two field boundaries are matched by the $\rho$-$\theta$ technique. Applying the phantom portal images, detection errors were calculated to be less than 2mm in translation, 1$^{\circ}$ in rotation and 1% in scale. In conclusion, we quantitatively analyzed the displacement error of x-ray simulator images and portal images. The present results could contribute to the study of the radiation treatment verification.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.3
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• pp.985-989
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• 2012

Objective: To make sure the feasibility with $^{18F}FDG$ PET/CT to guided dynamic intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma patients, by dosimetric verification before treatment. Methods: Chose 11 patients in III~IVA nasopharyngeal carcinoma treated with functional image-guided IMRT and absolute and relative dosimetric verification by Varian 23EX LA, ionization chamber, 2DICA of I'mRT Matrixx and IBA detachable phantom. Drawing outline and making treatment plan were by different imaging techniques (CT and $^{18F}FDG$ PET/CT). The dose distributions of the various regional were realized by SMART. Results: The absolute mean errors of interest area were $2.39%{\pm}0.66$ using 0.6cc ice chamber. Results using DTA method, the average relative dose measurements within our protocol (3%, 3 mm) were 87.64% at 300 MU/min in all filed. Conclusions: Dosimetric verification before IMRT is obligatory and necessary. Ionization chamber and 2DICA of I'mRT Matrixx was the effective dosimetric verification tool for primary focal hyper metabolism in functional image-guided dynamic IMRT for nasopharyngeal carcinoma. Our preliminary evidence indicates that functional image-guided dynamic IMRT is feasible.

• The Journal of Korean Society for Radiation Therapy
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• v.33
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• pp.117-125
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• 2021

Purpose: To purpose of this study is to find the correlation of the Set-up error according to the couch rotation and suggest additional margin setting for the GTV. Target and Method: Each scenario treatment plan was created by making the frequency of non-coplanar beams different among all beams. The set-up error value was measured by using the Exact System and the dose accuracy was evaluated by creating a re-treatment plan. Results: When the couch was rotated by 30°, 45°, 60°, and 90°, the mean of the X-axis values was measured to be 0.29 mm, 0.26 mm, 0.51 mm, and 0.08 mm, respectively. The mean of the Y-axis values was measured to be 0.75 mm, 0.5mm, 0.35 mm, and 0.29 mm, respectively. The mean of the Z-axis values was measured to be 0.5 mm, 0.28 mm, 0.22 mm, and 0.1 mm, respectively. There were dose reductions of 0.1%, 3.1%, 1.9% in D99 for 1-NC VMAT, 2-NC VMAT, and 3-NC VMAT, respectively. Conclusion: When treating with 50% or more of non-coplanar beams among total beams, image verification is required. And it is considered to make the treatment plan by adding a 1.5 mm margin to the GTV.