title: Assessing the difference between planned and delivered intensity-modulated radiotherapy dose distributions based on radiobiological measures.
abstract: OBJECTIVE
  Because of the highly conformal distributions that can be obtained with intensity-modulated radiotherapy (IMRT), any discrepancy between the intended and delivered distributions would probably affect the clinical outcome. Consequently, there is a need for a measure that would quantify those differences in terms of a change in the expected clinical outcome.
  
  
  METHODS
  To evaluate such a measure, cancer of the cervix was used, where the bladder and rectum are proximal and partially overlapping with the internal target volume. A solid phantom simulating the pelvic anatomy was fabricated and a treatment plan was developed to deliver the prescribed dose to the phantom. The phantom was then irradiated with films positioned in several transverse planes. The racetrack microtron at 50 MV was used in the treatment planning and delivery processes. The dose distribution delivered was analysed based on the film measurements and compared against the treatment plan. The differences in the measurements were evaluated using both physical and biological criteria. Whereas the physical comparison of dose distributions can assess the geometric accuracy of delivery, it does not reflect the clinical effect of any measured dose discrepancies.
  
  
  RESULTS
  It is shown how small inaccuracies in delivered dose can affect the treatment outcome in terms of complication-free tumour cure.
  
  
  CONCLUSIONS
  With highly conformal IMRT, the accuracy of the patient set-up and treatment delivery are critical for the success of the treatment. A method is proposed to evaluate the precision of the delivered plan based on changes in complication and control rates as they relate to uncertainties in dose delivery.
authors.affiliation: Department of Medical Radiation Physics, Karolinska Institutet and Stockholm University, Sweden. panayiotis.mavroidis@med.uth.gr
authors.forename: P
authors.initials: P
authors.lastname: Mavroidis
authors.forename: B C
authors.initials: BC
authors.lastname: Ferreira
authors.forename: N
authors.initials: N
authors.lastname: Papanikotaou
authors.forename: R
authors.initials: R
authors.lastname: Svensson
authors.forename: C
authors.initials: C
authors.lastname: Kappas
authors.forename: B K
authors.initials: BK
authors.lastname: Lind
authors.forename: A
authors.initials: A
authors.lastname: Brahme
mesh_terms: D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D011879:Radiotherapy Dosage / Q000592:standards; D050397:Radiotherapy, Intensity-Modulated; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*