A Pilot Rotational Radiotherapy Audit: Is a 2D array suitable to replace film and ionisation chambers?

Catharine Clark1,2, Mohammad Hussein2, Yat Tsang3, David Maughan1 Julia Snaith1, Russell Thomas1, Clare Gouldstone1, Steve Bolton4,5
1

National Physical Laboratory, 2Royal Surrey County Hospital, 3Mount Vernon Cancer Centre, 4The Christie Hospital and 5IPEM

Introduction
The National Physical Laboratory, in collaboration with Royal Surrey County Hospital, the Institute for Physics and Engineering in Medicine [IPEM] and the Radiotherapy Trials QA group (RTTQA) has carried out a pilot audit of rotational intensity modulated radiotherapy (IMRT). Rotational radiotherapy is treatment where radiation is delivered whilst the linac machine continuously rotates around the patient and hence this complex method of treatment requires advanced dosimetry methods. There has been a fast uptake in hospitals of rotational treatments due to the speed of delivery and hence an assessment of measurement technique for carrying out an audit of this treatment approach has been undertaken, with a view to assessing a suitable approach for a national audit. The aim of the audit was to: Assess suitability of 2D array for future audits Compare with standard use of ionisation chambers and film Calibrate and characterise the semiflex ionisation chambers Determine potential use of alanine in complex dose distributions Validate a rotational IMRT credentialing module (3DTPS) Determine appropriate tolerances for rotational IMRT audit Decide on best way to do a national rotational IMRT audit

3DTPS test

3DTPS plan
Based on the UK IMRT credentialing module and the American Association Physicists in Medicine tests for IMRT in multi-institutions [AAPM TG119]. There are 5 targets which are treated to different dose levels and one organ-at-risk which is designed to be avoided. This provides a standardised plan for all centres with measurement points at standard positions. The centre may also choose a treatment plan from a clinical trial to be measured as well.

CENTRE The London Clinic RMH London Ipswich The Christie Clatterbridge UCH London RMH Sutton Newcastle Middlesbrough Addenbrookes Guildford

MODALITY RapidArc RapidArc RapidArc VMAT RapidArc RapidArc VMAT Tomotherapy Tomotherapy Tomotherapy RapidArc

AUDIT DATE 15th March 16th June 25th June 30th June/1st July 2nd July 8th July 9th July 23rd July 24th July 30th July 13th August

Results
Results show that the 2D array can provide dosimetric information which is comparable with ion chambers and alanine in terms of point dose measurement (the majority of dose measurement points for all three measurement techniques were within 3% of the calculation) and give sufficient spatial information to be a replacement for film.
2D array Semiflex

National Audit
The phantom and 2D array combination has also been used to offer an audit to all UK centres with rotational radiotherapy in clinical use. This work has been carried out in collaboration with RTTQA and IPEM. Individual centre results have been reported and an overall analysis of data is in progress.

Equipment

One of the goals was to verify whether a 2D array of ion chambers could be used to replace film and single ion chambers for a future national audit. Inserts were designed to position the different detectors in the same positions within the phantom.

 The NCRI Radiotherapy Clinical Trials Quality Assurance (RTTQA) Group. RTTQA IMRT credentialing program. http://www.rttrialsqa.org.uk  Ezzell et al. IMRT commissioning: Multiple institution planning and dosimetry comparisons, a report from AAPM Task Group 119. Medical Physics 2009: 36: 53595373

www.npl.co.uk

Queens Printer and Controller of HMSO, 2011.

Alanine

Gafchromic film

 International Commission on Radiation Units and Measurements (ICRU). ICRU Report No 83: Prescribing, Recording, and Reporting Photon Beam Intensity-Modulated Radiation Therapy (IMRT). Journal of the ICRU Volume 10 No 1 2010

9792/0911

References