title: Performance analysis of a film dosimetric quality assurance procedure for IMRT with regard to the employment of quantitative evaluation methods.
abstract: A system for dosimetric verification of intensity-modulated radiotherapy (IMRT) treatment plans using absolute calibrated radiographic films is presented. At our institution this verification procedure is performed for all IMRT treatment plans prior to patient irradiation. Therefore clinical treatment plans are transferred to a phantom and recalculated. Composite treatment plans are irradiated to a single film. Film density to absolute dose conversion is performed automatically based on a single calibration film. A software application encompassing film calibration, 2D registration of measurement and calculated distributions, image fusion, and a number of visual and quantitative evaluation utilities was developed. The main topic of this paper is a performance analysis for this quality assurance procedure, with regard to the specification of tolerance levels for quantitative evaluations. Spatial and dosimetric precision and accuracy were determined for the entire procedure, comprising all possible sources of error. The overall dosimetric and spatial measurement uncertainties obtained thereby were 1.9% and 0.8 mm respectively. Based on these results, we specified 5% dose difference and 3 mm distance-to-agreement as our tolerance levels for patient-specific quality assurance for IMRT treatments.
authors.affiliation: Department of Radiation Oncology, University Medical School, Auenbruggerplatz 32, 8036 Graz, Austria. peter.winkler@meduni-graz.at
authors.forename: Peter
authors.initials: P
authors.lastname: Winkler
authors.forename: Brigitte
authors.initials: B
authors.lastname: Zurl
authors.forename: Helmuth
authors.initials: H
authors.lastname: Guss
authors.forename: Peter
authors.initials: P
authors.lastname: Kindl
authors.forename: Georg
authors.initials: G
authors.lastname: Stuecklschweiger
mesh_terms: D019985:Benchmarking / Q000379:methods / Q000592:standards; D019544:Equipment Failure Analysis / Q000379:methods* / Q000592:standards; D005373:Film Dosimetry / Q000295:instrumentation* / Q000379:methods / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000592:standards; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D020266:Radiotherapy, Conformal / Q000379:methods* / Q000592:standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity