[Output factor calculations for intensity modulation radiation therapy as dosimetry quality assurance]

Because intensity-modulated radiation therapy (IMRT) is complicated by many small, irregular, and off-center fields, dosimetry quality assurance (QA) is extremely important. QA is performed with verifications of both dose distributions and some arbitrary point doses. In most institutes, verifications are carried out in comparison with dose values generated from radiation treatment planning systems (RTPs) and actually measured doses. However, the estimation of arbitrary point doses without RTPs should be feasible in order to perform IMRT delivery more safely and accurately in terms of the clinical aspect. In this paper, we propose a new algorithm for calculating output factors at the center point of the collimations in an IMRT field with step and shoot delivery machines in which the lower jaws were replaced with multileaf collimators (MLC). We assumed that output is independently affected by collimator scatter and total scatter according to the position of the upper jaws and each of the MLC leaves (lower jaws). Then, the two scatter factors are accurately measured when changing their position. Thus, the output factor for an irregular field could be calculated with the new algorithm. We adopted this technique for some irregular fields and actual IMRT fields for head-and-neck cancer and found that the differences between calculated and measured output values were both small and acceptable. This study suggests that our methods and this algorithm are useful for dosimetry quality assurance.