Multi-dimensional dosimetric verification of stereotactic radiotherapy for uveal melanoma using radiochromic EBT film.

Since 1997, linac based stereotactic radiotherapy (SRT) of uveal melanoma has been continuously developed at the Department of Radiotherapy, Medical University Vienna. The aim of the present study was (i) to test a new type of radiochromic film (Gafchromic EBT) for dosimetric verification of class solutions for these treatments and (ii) to verify treatment plan acceptance criteria, which are based on gamma values statisitcs. An EPSON Expression 1680 Pro flat bed scanner was utilized for film reading. To establish a calibration curve, films were cut in squares of 2 x 2 cm2, positioned at 5 cm depth in a solid water phantom and were irradiated with different dose levels (0.5 and 5 Gy) in a 5 x 5 cm2 field at 6 MV. A previously developed solid phantom (polystyrene) was used with overall dimensions corresponding to an average human head. EBT films were placed at four different depths (10, 20, 25 and 30 mm) and all films were irradiated simultaneously. Four different treatment plans were verified that resemble typical clinical situations. These plans differed in irradiation technique (conformal mMLC or circular arc SRT) and in tumour size (PTV of 1 or 2.5 cm3). In-house developed software was applied to calculate gamma (gamma) index values and to perform several statistical operations (e.g. gamma-area histograms). At depths of 10 mm gamma1%, (gamma-value where 1% of the points have an equal or higher value in the region of interest) were between 1-3 and maximum gamma > 1 (% of gamma-values > 1 in the region of interest) areas were almost 30%. At larger depths, i.e. more close to the isocenter, gamma 1% was < 1 and gamma > 1 areas were mostly < 5%. Average gamma values were about 0.5. Besides the compromised accuracy in the buildup region, previously defined IMRT acceptance criteria [Stock et al., Phys. Med Biol. 50 (2005) 399-411] could be applied as well to SRT. Radiochromic EBT films, in combination with a flat-bed scanner, were found to be an ideal multidimensional dosimetric tool for treatment plan quality assurance. EBT films are a suitable and reliable dosimetric tool that could replace traditionally used radiographic films. The presented acceptance criteria for SRT treatment plans might be used as a benchmarking data-set for other stereotactic applications and/or other equipment (planning system and delivery hardware) combinations.