title: An integral quality monitoring system for real-time verification of intensity modulated radiation therapy.
abstract: OBJECTIVE
  To develop an independent and on-line beam monitoring system, which can validate the accuracy of segment-by-segment energy fluence delivery for each treatment field. The system is also intended to be utilized for pretreatment dosimetric quality assurance of intensity modulated radiation therapy (IMRT), on-line image-guided adaptive radiation therapy, and volumetric modulated arc therapy.
  
  
  METHODS
  The system, referred to as the integral quality monitor (IQM), utilizes an area integrating energy fluence monitoring sensor (AIMS) positioned between the final beam shaping device [i.e., multileaf collimator (MLC)] and the patient. The prototype AIMS consists of a novel spatially sensitive large area ionization chamber with a gradient along the direction of the MLC motion. The signal from the AIMS provides a simple output for each beam segment, which is compared in real time to the expected value. The prototype ionization chamber, with a physical area of 22 x 22 cm2, has been constructed out of aluminum with the electrode separations varying linearly from 2 to 20 mm. A calculation method has been developed to predict AIMS signals based on an elementwise integration technique, which takes into account various predetermined factors, including the spatial response function of the chamber, MLC characteristics, beam transmission through the secondary jaws, and field size factors. The influence of the ionization chamber on the beam has been evaluated in terms of transmission, surface dose, beam profiles, and depth dose. The sensitivity of the system was tested by introducing small deviations in leaf positions. A small set of IMRT fields for prostate and head and neck plans was used to evaluate the system. The ionization chamber and the data acquisition software systems were interfaced to two different types of linear accelerators: Elekta Synergy and Varian iX.
  
  
  RESULTS
  For a 10 x 10 cm2 field, the chamber attenuates the beam intensity by 7% and 5% for 6 and 18 MV beams, respectively, without significantly changing the depth dose, surface dose, and dose profile characteristics. An MLC bank calibration error of 1 mm causes the IQM signal of a 3 x 3 cm2 aperture to change by 3%. A positioning error in a single 5 mm wide leaf by 3 mm in 3 X 3 cm2 aperture causes a signal difference of 2%. Initial results for prostate and head and neck IMRT fields show an average agreement between calculation and measurement to within 1%, with a maximum deviation for each of the smallest beam segments to within 5%. When the beam segments of a prostate IMRT field were shifted by 3 mm from their original position, along the direction of the MLC motion, the IQM signals varied, on average, by 2.5%.
  
  
  CONCLUSIONS
  The prototype IQM system can validate the accuracy of beam delivery in real time by comparing precalculated and measured AIMS signals. The system is capable of capturing errors in MLC leaf calibration or malfunctions in the positioning of an individual leaf. The AIMS does not significantly alter the beam quality and therefore could be implemented without requiring recommissioning measurements.
authors.affiliation: Department of Radiation Physics, Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario M5G 2M9, Canada. islam@rmp.uhn.on.ca
authors.forename: Mohammad K
authors.initials: MK
authors.lastname: Islam
authors.forename: Bernhard D
authors.initials: BD
authors.lastname: Norrlinger
authors.forename: Jason R
authors.initials: JR
authors.lastname: Smale
authors.forename: Robert K
authors.initials: RK
authors.lastname: Heaton
authors.forename: Duncan
authors.initials: D
authors.lastname: Galbraith
authors.forename: Cary
authors.initials: C
authors.lastname: Fan
authors.forename: David A
authors.initials: DA
authors.lastname: Jaffray
mesh_terms: D006801:Humans; D011786:Quality Control; D011874:Radiometry; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods* / Q000592:standards*; D015203:Reproducibility of Results; D013997:Time Factors