Vol 27, No 2 (2022)
Research paper
Published online: 2022-03-09

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Comparison of pre-treatment and in-vivo dosimetry for advanced radiotherapy of prostate cancer

Agnieszka Bartnikowska12, Grzegorz Cieślik1, Mateusz Młodzik1, Miguel Garcia-Argibay3
Rep Pract Oncol Radiother 2022;27(2):189-197.


Background: The usage of advanced radiotherapy techniques requires validation of a previously calculated dose with the precise delivery with a linear accelerator. This study aimed to review and evaluate new verification methods of dose distribution. Moreover, our purpose was to define an internal protocol of acceptance for in-vivo measurements of dose distribution.

Materials and methods: This study included 43 treatment plans of prostate cancer calculated using the Monte Carlo algorithm. All plans were delivered using the Volumetric Modulated Arc Therapy (VMAT) technique of advanced radiotherapy by the linear accelerator Elekta VersaHD. The dose distribution was verified using: MatriXX, iViewDose, and in-vivo measurements. The verification also included recalculation of fluence maps of quality assurance plans in another independent algorithm.

Results: The acceptance criterion of 95% points of dose in agreement was found for pre-treatment verification using MatriXX; the average γ value was 99.09 ± 0.93 (SD) and 99.64 ± 0.35 (SD) for recalculation in the Collapse Cone algorithm. Moreover, using the second algorithm in the verification process showed a positive correlation ρ = 0.58, p < 0.001. However, verification using iViewDose in a phantom and in-vivo did not meet this γ-pass rate.

Conclusions: Evaluation of gamma values for in-vivo measurements utilizing iViewDose software was helpful to establish an internal dosimetry protocol for prostate cancer treatments. We assumed  value at a minimum of 50% points of the dose in agreement with the 3%/3 mm criterion as an acceptable compliance level. The recalculated dose distribution of QA plans in regard to the Collapse Cone algorithm in the other treatment planning system can be used as a pre-treatment verification method used by a medical physicist in their daily work. The effectiveness of use in iViewDose software, as a pre-treatment tool, is still debatable, unlike the MatriXX device.

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  1. International Agency for Research on Cancer, World Health Organization, Latest global cancer data 2018. https://www.who.int/cancer/PRGlobocanFinal.pdf.
  2. Levitt S, Khan F, Potish R, Perez CA. Technological Basis of radiation therapy. Clinical Applications. Williams & Wilkins 1999: 128–133.
  3. Ryu JK, Winter K, Michalski JM, et al. Interim report of toxicity from 3D conformal radiation therapy (3D-CRT) for prostate cancer on 3DOG/RTOG 9406, level III (79.2 Gy). Int J Radiat Oncol Biol Phys. 2002; 54(4): 1036–1046.
  4. Dursun P, Taşkın Z, Altınel İ. The determination of optimal treatment plans for Volumetric Modulated Arc Therapy (VMAT). Eur J Oper Res. 2019; 272(1): 372–388.
  5. Wilkins A, Mossop H, Syndikus I, et al. Hypofractionated radiotherapy versus conventionally fractionated radiotherapy for patients with intermediate-risk localised prostate cancer: 2-year patient-reported outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncol. 2015; 16(16): 1605–1616.
  6. Studenski MT, Shen X, Yu Y, et al. Intensity-modulated radiation therapy and volumetric-modulated arc therapy for adult craniospinal irradiation--a comparison with traditional techniques. Med Dosim. 2013; 38(1): 48–54.
  7. Herman TD, Schnell E, Young J, et al. Dosimetric comparison between IMRT delivery modes: Step-and-shoot, sliding window, and volumetric modulated arc therapy - for whole pelvis radiation therapy of intermediate-to-high risk prostate adenocarcinoma. J Med Phys. 2013; 38(4): 165–172.
  8. Matulewicz Ł. Wpływ parametrów kolimatora i techniki napromieniania na rozkład dawki. Inz Fiz Med. 2015; 4(6): 332.
  9. Mężeński P, Gałecki J, Zawadzka A, et al. Porównanie metod 3D-CRT i IMRT w napromienianiu chorych na raka piersi po operacji oszczędzającej bez i z objęciem węzłów chłonnych nadobojczykowo-pachowych. Now J Oncol. 2012; 62(6): 423–430.
  10. Arnold E. Basic clinical radiobiology for Radiation Oncologists. Edward Arnold Publishers 1993: 2–7.
  11. Boutoleau B, Boissonnade O, Garcia Al. Integration of geometric data recorded during irradiation sessions for post-treatment dosimetry calculation in external radiotherapy. Phys Med. 2013; 29: e6.
  12. Matulewicz Ł. Dokładność algorytmów obliczeń rozkładu dawki w systemie planowania radioterapii. Inz Fiz Med. 2015; 4(2): 84–85.
  13. Bleuse O, Rakotomalala R. Alara approach: Imaging optimization in radiotherapy. Phys Med. 2013; 29: e6.
  14. Schneider U, Hälg R, Besserer J. Concept for quantifying the dose from image guided radiotherapy. Radiat Oncol. 2015; 10: 188.
  15. Ahnesjö A. Collapsed cone convolution of radiant energy for photon dose calculation in heterogeneous media. Med Phys. 1989; 16(4): 577–592.
  16. Kumar S, Singh RR, Godson HF, et al. In-vivo dose measurements with MOSFET dosimeters during MV portal imaging. Rep Pract Oncol Radiother. 2021; 26(1): 93–100.
  17. Woźniak K. Dosimetric verification of dynamic radiotherapy treatment planning VMAT. Inz Fiz Med. 2015; 4(3): 147.
  18. Szczurek L, Juszkat R, Szczurek J, et al. Pre-treatment 2D and 3D dosimetric verification of volumetric arc therapy. A correlation study between gamma index passing rate and clinical dose volume histogram. PLoS One. 2019; 14(8): e0221086.
  19. Hussein M, Adams EJ, Jordan TJ, et al. A critical evaluation of the PTW 2D-ARRAY seven29 and OCTAVIUS II phantom for IMRT and VMAT verification. J Appl Clin Med Phys. 2013; 14(6): 4460.
  20. Van Esch A, Clermont C, Devillers M, et al. On-line quality assurance of rotational radiotherapy treatment delivery by means of a 2D ion chamber array and the Octavius phantom. Med Phys. 2007; 34(10): 3825–3837.
  21. Song JHo, Shin HJ, Kay CS, et al. Dosimetric verification by using the ArcCHECK system and 3DVH software for various target sizes. PLoS One. 2015; 10(3): e0119937.
  22. Aristophanous M, Suh Y, Chi PC, et al. Initial clinical experience with ArcCHECK for IMRT/VMAT QA. J Appl Clin Med Phys. 2016; 17(5): 20–33.
  23. Jodda A, Piotrowski T, Kruszyna-Mochalska M, et al. Impact of different optimization strategies on the compatibility between planned and delivered doses during radiation therapy of cervical cancer. Rep Pract Oncol Radiother. 2020; 25(3): 412–421.
  24. Gray A, Bawazeer O, Arumugam S, et al. Evaluation of the ability of three commercially available dosimeters to detect systematic delivery errors in step-and-shoot IMRT plans. Rep Pract Oncol Radiother. 2021; 26(5): 793–803.
  25. Barbeiro AR, Ureba A, Baeza JA, et al. 3D VMAT Verification Based on Monte Carlo Log File Simulation with Experimental Feedback from Film Dosimetry. PLoS One. 2016; 11(11): e0166767.
  26. Mans A, Remeijer P, Olaciregui-Ruiz I, et al. 3D Dosimetric verification of volumetric-modulated arc therapy by portal dosimetry. Radiother Oncol. 2010; 94(2): 181–187.
  27. Delaby N, Bouvier J, Jouyaux F, et al. 40. Validation of a transit EPID device for a clinical use: application to iViewDose (Elekta). Phys Med. 2017; 44: 19–20.
  28. Wendling M, Louwe RJW, McDermott LN, et al. Accurate two-dimensional IMRT verification using a back-projection EPID dosimetry method. Med Phys. 2006; 33(2): 259–273.
  29. Biltekin F, Yedekci Y, Ozyigit G. Feasibility of novel in vivo EPID dosimetry system for linear accelerator quality control tests. Australas Phys Eng Sci Med. 2019; 42(4): 995–1009.
  30. Osewski W, Konefał A. Rekonstrukcja rozkładu dawki w technikach dynamicznych: IMRT i VMAT. Uniwersytet Śląski, Wydz Mat Fiz Chem 2013.
  31. Low D. Gamma Dose Distribution Evaluation Tool. J Phys: Conf Ser. 2010; 250: 012071.
  32. Spezi E, Lewis DG. Gamma histograms for radiotherapy plan evaluation. Radiother Oncol. 2006; 79(2): 224–230.

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