Development and evaluation of an end-to-end test for head and neck IMRT with a novel multiple-dosimetric modality...

A comprehensive end-to-end test for head and neck IMRT treatments was developed using a custom phantom designed to utilize multiple dosimetry devices. Initial end-to-end test and custom H&N phantom were designed to yield maximum information in anatomical regions significant to H&N plans with respect to: (i) geometric accuracy, (ii) dosimetric accuracy, and (iii) treatment reproducibility. The phantom was designed in collaboration with Integrated Medical Technologies. The phantom was imaged on a CT simulator and the CT was reconstructed with 1 mm slice thickness and imported into Varian's Eclipse treatment planning system. OARs and the PTV were contoured with the aid of Smart Segmentation. A clinical template was used to create an eight-field IMRT plan and dose was calculated with heterogeneity correction on. Plans were delivered with a TrueBeam equipped with a high definition MLC. Preliminary end-to-end results were measured using film, ion chambers, and optically stimulated luminescent dosimeters (OSLDs). Ion chamber dose measurements were compared to the treatment planning system. Films were analyzed with FilmQA Pro using composite gamma index. OSLDs were read with a MicroStar reader using a custom calibration curve. Final phantom design incorporated two axial and one coronal film planes with 18 OSLD locations adjacent to those planes as well as four locations for IMRT ionization chambers below inferior film plane. The end-to-end test was consistently reproducible, resulting in average gamma pass rate greater than 99% using 3%/3 mm analysis criteria, and average OSLD and ion chamber measurements within 1% of planned dose. After initial calibration of OSLD and film systems, the end-to-end test provides next-day results, allowing for integration in routine clinical QA. Preliminary trials have demonstrated that our end-to-end is a reproducible QA tool that enables the ongoing evaluation of dosimetric and geometric accuracy of clinical head and neck treatments.