title: A quantitative evaluation of IMRT dose distributions: refinement and clinical assessment of the gamma evaluation.
abstract: OBJECTIVE
  Although intensity modulated radiotherapy (IMRT) is a step forward in comparison to conventional, static beam delivery, quality assurance is more complex and labour intensive, demanding detailed two-dimensional dosimetric verification. Regardless of the technique used for measuring the dose distribution, what is essential to the implementation of routine verification of IMRT fields is the efficient and accurate comparison of the measured versus desired dose distribution. In order to achieve a fast, yet accurate quantitative measure of the correspondence between measured and calculated dose, the theoretical concept of the gamma evaluation method presented by Low et al. (Med. Phys., 25 (1998) 656) was converted into a calculation algorithm, taking into account practical considerations related to the discrete nature of the data.
  
  
  METHODS
  A filter cascade of multiple levels was designed to obtain fast and accurate comparison of the two dose distributions under evaluation. The actual comparison consists of classification into accepted or rejected datapoints with respect to user-defined acceptance criteria (dose difference and distance to agreement). The presented algorithm was tested on dosimetric images calculated and/or acquired by means of a liquid filled portal imaging device during the course of intensity modulated treatments of prostate cancer, including pre-treatment verification as well as verification during treatment. To assess its ability to intercept possible errors in dose delivery, clinically relevant errors were deliberately introduced into the dose distributions.
  
  
  RESULTS
  The developed gamma filter method proves successful in the efficient comparison of calculated versus measured IMRT dose distribution. Secondly, intercomparison of dosimetric images acquired during different treatment sessions illustrate its potential to highlight variations in the dosimetric images. The simulated errors were unmistakably intercepted.
  
  
  CONCLUSIONS
  The readily obtained gamma evaluation images are an easy tool for quality control of IMRT fields. To reduce the artefacts related to the discrete nature and limited resolution of the data, a fast and accurate filter cascade was developed, offering the possibility to use the gamma method for day to day evaluation of patient dosimetric portal images with or without comparison to a predicted portal dose distribution.
authors.affiliation: Department of Oncology, Division Radiation Physics, University Hospital Gasthuisberg, Herestraat 49, B-3000, Leuven, Belgium.
authors.forename: Tom
authors.initials: T
authors.lastname: Depuydt
authors.forename: Ann
authors.initials: A
authors.lastname: Van Esch
authors.forename: Dominique Pierre
authors.initials: DP
authors.lastname: Huyskens
mesh_terms: D000465:Algorithms; D005720:Gamma Rays; D006801:Humans; D008962:Models, Theoretical; D011829:Radiation Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012015:Reference Standards