Three‐dimensional dose prediction based on two‐dimensional verification measurements for IMRT

Dose verifications for intensity-modulated radiation therapy (IMRT) are generally performed once before treatment. A 39-fraction treatment course for prostate cancer delivers a dose prescription of 78 Gy in eight weeks. Any changes in multileaf collimator leaf position over the treatment course may affect the dosimetry. To evaluate the magnitude of deviations from the predicted dose over an entire treatment course with MLC leaf calibrations performed every two weeks, we tracked weekly changes in relative dose error distributions measured with two-dimensional (2D) beam-by-beam analysis. We compared the dosimetric results from 20 consecutive patient-specific IMRT quality assurance (QA) tests using beam-by-beam analysis and a 2D diode detector array to the dose plans calculated by the treatment planning system (TPS). We added back the resulting relative dose error measured weekly into the original dose grid for each beam. To validate the prediction method, the predicted doses and dose distributions were compared to the measurements using an ionization chamber and film. The predicted doses were in good agreement, within 2% of the measured doses, and the predicted dose distributions also presented good agreement with the measured distributions. Dose verification results measured once as a pretreatment QA test were not completely stable, as results of weekly beam-by-beam analysis showed some variation. Because dosimetric errors throughout the treatment course were averaged, the overall dosimetric impact to patients was small.