This study aims at a method that employs deformable dose accumulation for the evaluation of the results of intensity-modulated radiation therapy (IMRT) in pelvic cases. Each fraction dose was derived from the planning dose through rigid transformation accounting for setup corrections. Daily cone-beam CT (CBCT) images were used to deform the daily fraction dose to a reference geometry, which in our study was the first fraction geometry. A commercial software system, MIMvista, was used to perform deformable image registration, dose deformation, and dose accumulation. The differences in distributions of accumulated dose and planned dose were observed. The application of deformable dose accumulation is particularly useful in final accumulated dose evaluation throughout radiotherapy treatment, especially for the cases where there are significant deformations of planning target volume (PTV) and organs at risk (OARs).

Purposes/Objective: Image-Guided Radiation Therapy has been shown to significantly decrease setup errors and correct for organ motions (by patient repositioning, referred to as shift here), thus allowing the use of a tight treatment margin. The objective of the present work is to show that our evidenced-based patient positioning technique (isocenter shift) can effectively reduce the overall setup error for the majority of prostate patients.

Methods and Materials: We reviewed and analyzed the pre-treatment CT scans of 87 prostate patients treated from 2005-2007. Each patient received 10-15 image-guided fractions in the first phase of the treatment course. By systematically analyzed the imaging data and comparing to the planning CT, the isocenter positioning in both the left-right and anterior-posterior directions in the second phase of the treatment course can be predicted, along with the selection of a patient specific posterior margin.

Results: For 90% of the patients, the isocenter correction can be predicted to within 95% confidence. 90% of the patients in the study have a posterior margin in the range 5-8 mm for the second phase of treatment. The outliers in the frequency distributions of the iso-shifts for both the left-right and anterior-posterior directions seems to indicate that more frequent image-guided sessions are required in order to improve the setup accuracy.

Conclusions: An adequate number of image-guided treatments provide a semi-pattern recognition approach for patient repositioning. This, together with the inclusion of a quasi-adaptive margin can accommodate the daily variance of the prostate positions and affords a 95% confidence limit for tumor coverage. Our evidence-based method can effectively reduce the systematic setup error which potentially could modify the cumulative dose distribution. The use of adaptive strategy as proposed in this work reduces the overall setup error.

There are a number of codes, reports and protocols by national and international organizations, including IAEA, which provide physicists with a systematic approach to dosimetry of photon beams. Most of these dosimetry recommendations have explicitly recognized the advantages of using cylindrical ionization chambers for dosimetry of therapeutic beams, especially for photon beams with energies from kilo voltage (kV) to megavoltage (MV) x-ray. A commercial cylindrical ionization chamber (W-30001) was used as the reference chamber for compare measurements. The homemade 0.6cc ionization chamber (CC1) have been designed, fabricated, tested and calibrated. Measurements were made using a Farmer type 2670 electrometer together with these chambers. Leakage current, short-term stability, cable effect, repeatability and angular dependence of the CC1 and W-30001 were all tested and found to be in consistence with the international standard IEC 60731. Ion collection efficiency and polarity effect were determined during calibration of the chambers in Co-60. According to the preliminary test results the CC1 homemade chamber is found to be in consistence with the international standard IEC 60731. An advantage of CC1 chamber is a very low leakage current i.e. its specific insulation design and material.