Technical Note: Alternating clinical usage of the integral quality monitor transmission detector

The purpose of the study was the implementation of a method to use the integral quality monitor (IQM) transmission detector for occasional, alternating usage during patient treatment with intensity modulated radiotherapy. Due to attenuation, the transmission detector must be taken into account during the planning process. The proposed workflow is based on determining a dynamic transmission factor (dTF) required to scale the total number of MU of the original radiotherapy (RT) plan. Thus a very similar radiation therapy plan is obtained that can be used with the IQM detector.

Ten clinically applied volumetric modulated arc therapy plans were delivered at two beam qualities. A dTF is calculated from each RT plan for which a collapsed RT plan was created for verification using a two-dimensional array with and without the IQM detector. The total number of MU of the original RT plan was scaled by the inverse of the dTF to obtain the modified RT plan for clinical use with the IQM detector. Validation was performed with an electronic three-dimensional phantom and via gamma analysis using strict criteria of 1%/1 mm.

Except for one outlier, the gamma pass rate between the original RT plan without IQM and the modified RT plan with IQM was always above 99.5%. The variations of the dTF were smaller than 1% for all tested RT plans.

The results show that the proposed workflow can be used clinically. Thus the IQM transmission detector can also be used occasionally for online verification of RT plans.