title: A patient-specific quality assurance study on absolute dose verification using ionization chambers of different volumes in RapidArc treatments.
abstract: The recalculation of 1 fraction from a patient treatment plan on a phantom and subsequent measurements have become the norms for measurement-based verification, which combines the quality assurance recommendations that deal with the treatment planning system and the beam delivery system. This type of evaluation has prompted attention to measurement equipment and techniques. Ionization chambers are considered the gold standard because of their precision, availability, and relative ease of use. This study evaluates and compares 5 different ionization chambers: phantom combinations for verification in routine patient-specific quality assurance of RapidArc treatments. Fifteen different RapidArc plans conforming to the clinical standards were selected for the study. Verification plans were then created for each treatment plan with different chamber-phantom combinations scanned by computed tomography. This includes Medtec intensity modulated radiation therapy (IMRT) phantom with micro-ionization chamber (0.007 cm(3)) and pinpoint chamber (0.015 cm(3)), PTW-Octavius phantom with semiflex chamber (0.125 cm(3)) and 2D array (0.125 cm(3)), and indigenously made Circular wax phantom with 0.6 cm(3) chamber. The measured isocenter absolute dose was compared with the treatment planning system (TPS) plan. The micro-ionization chamber shows more deviations when compared with semiflex and 0.6 cm(3) with a maximum variation of -4.76%, -1.49%, and 2.23% for micro-ionization, semiflex, and farmer chambers, respectively. The positive variations indicate that the chamber with larger volume overestimates. Farmer chamber shows higher deviation when compared with 0.125 cm(3). In general the deviation was found to be <1% with the semiflex and farmer chambers. A maximum variation of 2% was observed for the 0.007 cm(3) ionization chamber, except in a few cases. Pinpoint chamber underestimates the calculated isocenter dose by a maximum of 4.8%. Absolute dose measurements using the semiflex ionization chamber with intermediate volume (0.125 cm(3)) shows good agreement with the TPS calculated among the detectors used in this study. Positioning is very important when using smaller volume chambers because they are more sensitive to geometrical errors within the treatment fields. It is also suggested to average the dose over the sensitive volume for larger-volume chambers. The ionization chamber-phantom combinations used in this study can be used interchangeably for routine RapidArc patient-specific quality assurance with a satisfactory accuracy for clinical practice.
authors.affiliation: Department of Medical Physics, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India. skppm@rediffmail.com
authors.forename: S A
authors.initials: SA
authors.lastname: Syam Kumar
authors.forename: Prabakar
authors.initials: P
authors.lastname: Sukumar
authors.forename: Padmanaban
authors.initials: P
authors.lastname: Sriram
authors.forename: Dhanabalan
authors.initials: D
authors.lastname: Rajasekaran
authors.forename: Srinu
authors.initials: S
authors.lastname: Aketi
authors.forename: Nagarajan
authors.initials: N
authors.lastname: Vivekanandan
mesh_terms: D006801:Humans; D007194:India; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000592:standards*; D011874:Radiometry / Q000295:instrumentation* / Q000592:standards*; D050397:Radiotherapy, Intensity-Modulated / Q000295:instrumentation* / Q000592:standards*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity