title: Comparison of film dosimetry techniques used for quality assurance of intensity modulated radiation therapy.
abstract: OBJECTIVE
  Accurate dosimetry is essential to ensure the quality of advanced radiation treatments, such as intensity modulated radiation therapy (IMRT). Therefore, a comparison study was conducted to assess the accuracy of various film dosimetry techniques that are widely used in clinics.
  
  
  METHODS
  A simulated IMRT plan that produced an inverse pyramid dose distribution in a perpendicular plane of the beam axis was designed with 6 MV x rays to characterize the large contribution of scattered photons to low dose regions. Three film dosimetry techniques, EDR2, EDR2 with low-energy photon absorption lead filters (EDR2 WF), and GafChromic EBT, were compared to ionization chamber measurements as well as Monte Carlo (MC) simulations. The accuracy of these techniques was evaluated against the ionization chamber data. Two-dimensional comparisons with MC simulation results were made by computing the gamma index (gamma) with criteria ranging from 2% of dose difference or 2 mm of distance to agreement (2%/2 mm) to 4%/4 mm on the central vertical plane (20 x 20 cm2) of a square solid water phantom. Depth doses and lateral profiles at depths of 5, 10, and 15 cm were examined to characterize the deviation of film measurements and MC predictions from ionization chamber measurements.
  
  
  RESULTS
  In depth dose comparisons, the deviation between the EDR2 films was 9% in the low dose region and 5% in high dose region, on average. With lead filters, the average deviation was reduced to -1.3% and -0.3% in the low dose and high dose regions, respectively. EBT film results agreed within 1.5% difference on average with ionization chamber measurements in low and high dose regions. In two-dimensional comparisons with MC simulation, EDR2 films passed gamma tests with a 2%/2 mm criterion only in the high dose region (gamma < or = 1, total of 63.06% of the tested region). In the low dose region, EDR2 films passed gamma tests with 3%/3 mm criterion (gamma < or = 1, total of 98.4% of the tested region). For EDR2 WF and GafChromic EBT films, gamma tests with a 2% /2 mm criterion (gamma < or = 1) in the tested area was 97.3% and 96.8% of the tested region, respectively.
  
  
  CONCLUSIONS
  The EDR2 film WF and GafChromic EBT film achieved an average accuracy level of 1.5% against an ionization chamber. These two techniques agreed with the MC prediction in 2%/2mm criteria evaluated by the gamma index, whereas EDR2 without filters achieved an accuracy level of 3%/3 mm with the decision criteria of agreement greater than 95% of the tested region. The overall results will provide a useful quantitative reference for IMRT verifications.
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center Sungkyunkwan University School of Medicine, #50 Ilwon-dong, Kangnam-ku, Seoul 135-710, Korea.
authors.forename: Sang Gyu
authors.initials: SG
authors.lastname: Ju
authors.forename: Youngyih
authors.initials: Y
authors.lastname: Han
authors.forename: Oyeon
authors.initials: O
authors.lastname: Kum
authors.forename: Kwang-Ho
authors.initials: KH
authors.lastname: Cheong
authors.forename: Eun Hyuk
authors.initials: EH
authors.lastname: Shin
authors.forename: Jung Suk
authors.initials: JS
authors.lastname: Shin
authors.forename: Jin Sung
authors.initials: JS
authors.lastname: Kim
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Ahn
mesh_terms: D019544:Equipment Failure Analysis / Q000379:methods / Q000592:standards; D005373:Film Dosimetry / Q000295:instrumentation* / Q000592:standards*; D038622:Internationality; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000592:standards*; D020266:Radiotherapy, Conformal / Q000295:instrumentation* / Q000592:standards*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity