In this paper we describe a concept for dosimetric treatment plan verification using two-dimensional ionization chamber arrays. Two different versions of the 2D-ARRAY (PTW-Freiburg, Germany) will be presented, a matrix of 16 x 16 chambers (chamber cross section 8 mm x 8 mm; the distance between chamber centers, 16 mm) and a matrix of 27 x 27 chambers (chamber cross section 5 mm x 5 mm; the distance between chamber centers is 10 mm). The two-dimensional response function of a single chamber is experimentally determined by scanning it with a slit beam. For dosimetric plan verification, the expected two-dimensional distribution of the array signals is calculated via convolution of the planned dose distribution, obtained from the treatment planning system, with the two-dimensional response function of a single chamber. By comparing the measured two-dimensional distribution of the array signals with the expected one, a distribution of deviations is obtained that can be subjected to verification criteria, such as the gamma index criterion. As an example, this verification method is discussed for one sequence of an IMRT plan. The error detection capability is demonstrated in a case study. Both versions of two-dimensional ionization chamber arrays, together with the developed treatment plan verification strategy, have been found to provide a suitable and easy-to-handle quality assurance instrument for IMRT.

The spatial resolution of 2D detector arrays equipped with ionization chambers or diodes, used for the dose verification of IMRT treatment plans, is limited by the size of the single detector and the centre-to-centre distance between the detectors. Optimization criteria with regard to these parameters have been developed by combining concepts of dosimetry and pattern analysis. The 2D-ARRAY Type 10024 (PTW-Freiburg, Germany), single-chamber cross section 5 x 5 mm(2), centre-to-centre distance between chambers in each row and column 10 mm, served as an example. Additional frames of given dose distributions can be taken by shifting the whole array parallel or perpendicular to the MLC leaves by, e.g., 5 mm. The size of the single detector is characterized by its lateral response function, a trapezoid with 5 mm top width and 9 mm base width. Therefore, values measured with the 2D array are regarded as sample values from the convolution product of the accelerator generated dose distribution and this lateral response function. Consequently, the dose verification, e.g., by means of the gamma index, is performed by comparing the measured values of the 2D array with the values of the convolution product of the treatment planning system (TPS) calculated dose distribution and the single-detector lateral response function. Sufficiently small misalignments of the measured dose distributions in comparison with the calculated ones can be detected since the lateral response function is symmetric with respect to the centre of the chamber, and the change of dose gradients due to the convolution is sufficiently small. The sampling step width of the 2D array should provide a set of sample values representative of the sampled distribution, which is achieved if the highest spatial frequency contained in this function does not exceed the 'Nyquist frequency', one half of the sampling frequency. Since the convolution products of IMRT-typical dose distributions and the single-detector lateral response function have no or very small frequency contributions beyond 0.1 mm(-1), the mathematical approach introduced by Nyquist and Shannon shows that the sampling frequency of 0.2 mm(-1) is appropriate. Overall it is shown that the spatial resolution of the 2D-ARRAY Type 10024 is appropriate for the dose verification of IMRT plans. The insights obtained are also applied in the discussion of other available two-dimensional detector arrays.

BackgroundThe removal of the flattening filter (FF) leads to non-uniform fluence distribution with a considerable increase in dose rate. It is possible to adapt FFF beams (flattening-filter-free) in 3D conformal radiation therapy (3D CRT) by using field in field techniques (FiF). The aim of this retrospective study is to clarify whether the quality of 3D CRT plans is influenced by the use of FFF beams.MethodThis study includes a total of 52 CT studies of RT locations that occur frequently in clinical practice. Dose volume targets were provided for the PTV of breast (n=13), neurocranium (n=11), lung (n=7), bone metastasis (n=10) and prostate (n=11) in line with ICRU report 50/62. 3D CRT planning was carried out using FiF methods. Two clinically utilized photon energies are used for a Siemens ARTISTE linear accelerator in FFF mode at 7MVFFF and 11MVFFF as well as in FF mode at 6MVFF and 10MVFF. The plan quality in relation to the PTV coverage, OAR (organs at risk) and low dose burden as well as the 2D dosimetric verification is compared with FF plans.ResultsNo significant differences were found between FFF and FF plans in the mean dose for the PTV of breast, lung, spine metastasis and prostate. The low dose parameters V5Gy and V10Gy display significant differences for FFF and FF plans in some subgroups. The DVH analysis of the OAR revealed some significant differences. Significantly more fields (1.9 – 4.5) were necessary in the use of FFF beams for each location (p<0.0001) in order to achieve PTV coverage. All the tested groups displayed significant increases (1.3 – 2.2 times) in the average number of necessary MU with the use of FFF beams (p<0.001).ConclusionsThis study has shown that the exclusive use of a linear accelerator in FFF mode is feasible in 3D CRT. It was possible to realize RT plans in comparable quality in typical cases of clinical radiotherapy. The 2D dosimetric validation of the modulated fields verified the dose calculation and thus the correct reproduction of the characteristic FFF parameters in the planning system that was used.

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Purpose: IMRT requires a more specified quality assurance program than the conventional techniques. In this work we present our solution for a full IMRT quality assurance program with two‐dimensional ionization chamber arrays (2D‐ARRAY, PTW‐Freiburg) containing daily checks and individual dosimetric plan verifications. Method and Materials: The used array (type 10024) has 27 × 27 ionization chambers arranged in a plane, with an entrance window of 5 mm × 5 mm each. The centers of the 729 single chambers are positioned at 10 mm distance from each other. Results: Our quality assurance program is divided into two parts: On a daily basis, as a morning check, the dose at the central axis, the flatness and symmetry as well as the MLC calibration and light/radiation field congruence are evaluated by a single measurement. For a patient specific IMRT plan verification, the calculated dose distribution of the patient is exported to a CT containing the phantom set‐up with the 2D‐ARRAY. The corresponding IMRT sequence is exported to the linear accelerator. The values calculated for the plane of the 2D‐ARRAY and the values measured with it are then compared. Conclusion: The daily QA program has been extensively tested. All important field parameters can be obtained in a single measurement per energy. Furthermore MLC misalignments can be detected with an accuracy of less then 1.0 mm, allowing an early warning for a necessary MLC recalibration. The described program for IMRT plan verification has been proved to be very useful for an easy and fast pre‐treatment quality assurance. The error detection capabilities will be discussed in detail and shown to be sufficient for standard IMRT plans. Conflict of Interest: This work was performed in collaboration with PTW‐Freiburg Dr. Pychlau GmbH, Freiburg, Germany.