title: Uncertainty estimation in intensity-modulated radiotherapy absolute dosimetry verification.
abstract: OBJECTIVE
  Intensity-modulated radiotherapy (IMRT) represents an important method for improving RT. The IMRT relative dosimetry checks are well established; however, open questions remain in reference dosimetry with ionization chambers (ICs). The main problem is the departure of the measurement conditions from the reference ones; thus, additional uncertainty is introduced into the dose determination. The goal of this study was to assess this effect systematically.
  
  
  METHODS
  Monte Carlo calculations and dosimetric measurements with five different detectors were performed for a number of representative IMRT cases, covering both step-and-shoot and dynamic delivery.
  
  
  RESULTS
  Using ICs with volumes of about 0.125 cm(3) or less, good agreement was observed among the detectors in most of the situations studied. These results also agreed well with the Monte Carlo-calculated nonreference correction factors (c factors). Additionally, we found a general correlation between the IC position relative to a segment and the derived correction factor c, which can be used to estimate the expected overall uncertainty of the treatment.
  
  
  CONCLUSIONS
  The increase of the reference dose relative standard uncertainty measured with ICs introduced by nonreference conditions when verifying an entire IMRT plan is about 1-1.5%, provided that appropriate small-volume chambers are used. The overall standard uncertainty of the measured IMRT dose amounts to about 2.3%, including the 0.5% of reproducibility and 1.5% of uncertainty associated with the beam calibration factor. Solid state detectors and large-volume chambers are not well suited to IMRT verification dosimetry because of the greater uncertainties. An action level of 5% is appropriate for IMRT verification. Greater discrepancies should lead to a review of the dosimetric procedure, including visual inspection of treatment segments and energy fluence.
authors: Radiofísica, Hospital Universitario Virgen Macarena, Sevilla, Spain. paco@us.es
authors: Francisco
authors: F
authors: Sánchez-Doblado
authors: Günther H
authors: GH
authors: Hartmann
authors: Javier
authors: J
authors: Pena
authors: Roberto
authors: R
authors: Capote
authors: Marta
authors: M
authors: Paiusco
authors: Bernhard
authors: B
authors: Rhein
authors: Antonio
authors: A
authors: Leal
authors: Juan Ignacio
authors: JI
authors: Lagares
mesh_terms: D002138:Calibration; D009010:Monte Carlo Method; D011786:Quality Control; D011874:Radiometry / Q000295:instrumentation / Q000592:standards; D011879:Radiotherapy Dosage / Q000592:standards*; D050397:Radiotherapy, Intensity-Modulated / Q000592:standards*; D012016:Reference Values; D035501:Uncertainty