title: Overestimation of low-dose radiation in intensity-modulated radiotherapy with sliding-window technique.
abstract: OBJECTIVE
  To analyze different control-system limitations on the measured dose distributions in low-dose regions of simplified intensity fields with an electronic portal imaging device to ascertain the optimal settings for the control-system limitations in the planning system.
  
  
  METHODS
  The authors created one field with an "optimal fluence" of intensity 1.0 (full dose) and one field with intensity 0.0 (no dose) in the central part of the field. The influence of different dose rates (DRs) and maximum leaf speeds (LS) on the calculated and measured dose and dose profiles were analyzed.
  
  
  RESULTS
  Good agreement between calculated and measured dose in the case of a field of intensity 1.0 was found. For the field with intensity 0.0, the measured dose was 20-60% lower than the dose calculated by the "actual fluence". The results were found dependent on the DR and LS.
  
  
  CONCLUSIONS
  The overestimation in regions of optimal intensity 0.0 by the planning system cannot be resolved by the user. Taking the measured dose in the region of desired intensity 1.0 and other technical limitations (like beam hold interrupts or spikes in the cross and longitudinal profiles) into consideration, the application of an LS of 2.5 cm/s and a DR of 500 MU/min is recommended in order to minimize radiation dose applied to organs at risk, which are located in regions of low intensity, like, for example, the spinal cord.
authors.affiliation: Department of Radiotherapy and Radiooncology, University Hospital Göttingen, Göttingen, Germany. h.vorwerk@med.uni-goettingen.de
authors.forename: Hilke
authors.initials: H
authors.lastname: Vorwerk
authors.forename: Daniela
authors.initials: D
authors.lastname: Wagner
authors.forename: Björn
authors.initials: B
authors.lastname: Seitz
authors.forename: Hans
authors.initials: H
authors.lastname: Christiansen
authors.forename: Hendrik A
authors.initials: HA
authors.lastname: Wolff
authors.forename: Clemens F
authors.initials: CF
authors.lastname: Hess
mesh_terms: D000465:Algorithms; D006801:Humans; D011832:Radiation Injuries / Q000517:prevention & control; D011874:Radiometry; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000295:instrumentation*; D050397:Radiotherapy, Intensity-Modulated / Q000295:instrumentation*; D012542:Scattering, Radiation