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Epson GT-X970


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Accuracy study QA strategy for VMAT at Juntendo University Hospital, Tokyo, Japan

Institution: purpose:

Juntendo University, Tokyo, Japan, To evaluate the new rotational IMRT delivery technique from Elekta, which is called volumetric modulated arc therapy (VMAT), in terms of treatment planning procedure and QA of planned dose distribution, we report the patient specific QA for prostate treatment at Juntendo University Hospital. First published as a poster at ESTRO 2009
QA Strategy for VMAT at Juntendo University Hospital, Tokyo, Japan
Shuichi Ozawa1, Motohiro Kawashima1, Tomohisa Furuya1, Yutaka Tsutsumi1, Akira Isobe1, Takayuki Fujita1, Chie Kurokawa1, Satoru Sugimoto1, 2, Chie Toramatsu1, 3, Kana Itoh1, Kumiko Karasawa1
Juntendo University, Tokyo, Japan, University of Florida, Gainesville, FL, USA University of Florida Proton Therapy Institute, Jacksonville, FL, USA

Materials and methods

The CT image sets are transferred to RTPS (Philips Pinnacle3), as shown in figure 1. After target and OAR delineation, these images are exported to another RTPS (ERGO++) to optimize the VMAT plan. Although ERGO++ converts the 73 fixed beams (each five degrees, single arc delivery) to VMAT sequences, planar dose calculation for a phantom delivery is calculated by Pinnacle3 with data from the 73 fixed beams imported from ERGO++.
Figure 1: flowchart of VMAT procedure no one needs to have new skills except the physicists.
A tough water phantom (Kyoto Kagaku) 40 x 40 x 20cm in size was used for the phantom irradiation (figure 2a). The absolute dose to the center of the phantom was measured by a Farmer chamber. The planar dose distribution was measured by Gafchromic EBT or EBT2 films. Films(1) were placed in several coronal planes of the phantom, for example, source-to-film distances (SFDs) of 98, 100, and 102cm. Planar dose calculations were performed at 3 mm depths of each SFD with 1mm intervals. Thus, each film data point had seven calculation results to be compared. Comparison of the planar dose measurement with multiple depth calculations enables us to consider the 2.5 dimensional DTA(2). The exposed films were scanned by an Epson scanner (GT-X970; figure 2b).

Figure 2a: QA set-up

Figure 2b: EPSON GTX970 scanner (A4 size).
The films were analyzed using the MapCHECK software (Sun Nuclear Corporation(3)), which uses the red channel for film analysis. Figure 3 shows a screen shot of film analysis by MapCHECK.
Figure 3: film analysis. 3%/3mm gamma analysis with relative dose comparison normalization point is CAX. (screen shot of MapCHECK software).
Table 1: VMAT QA report at Juntendo University Hospital.


Document No. 0843 10:Elekta. All mentioned trademarks and registered trademarks are the property of the Elekta Group. All rights reserved. No part of this document may be reproduced in any form without written permission from the copyright holder. Specifications subject to change without notice.
1 2 WILKO F.A.R. VERBAKEL , et al, Int. J. Radia Oncol Biol Phys, Vol. 74, No. 1, pp. 252 259,


The difference in the absolute dose to the isocenter was around 1%. When the measured planar dose distribution has at least one calculated planar dose that has a pass rate of more than 90% with a 3%/3mm criterion, the measurement was determined as passed. The film dosimetry in the phantom agreed well with the plans, and all film results have passed so far.


The entire patient-specific QA for VMAT showed very satisfactory results. We found that film analysis with multiple planar dose calculation was a useful method for VMAT QA.

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Abstract ID: 15725 Title: Evaluation of Radiation Dosimetry of Bolus Electron Conformal Therapy (ECT)
Purpose:To evaluate the radiation dosimetry of bolus electron conformal therapy (ECT) using new commercially available bolus fabrication software. Methods: A customized electron bolus was designed using 3D planning system (TPS) Eclipse Ver.8.6.15 (Varian) and p.d ECT (.decimal) software. Computed tomography (CT) images of tough water was obtained and the planning target volume (PTV) was assumed. The proximal surface of the bolus was designed to conform to the 90% isodose line to the distal surface of the PTV using p.d ECT. Dose was calculated with a pencil beam algorithm for review with TPS. Based on structure set from TPS, bolus was fabricated using a computer-controlled milling machine. To evaluate the dose distribution, CT images with the bolus on the tough water were acquired and final dose distribution was computed. Gafchromic EBT 2 film (Lot A09171002, ISP) were sandwiched between tough water at 1, 2 and 3 cm depth from the bottom of bolus and irradiated at same geometry with planning. Film was scanned by EPSON GTX970 scanner and that 2D dose distribution is compared with calculation. Results: 2D dose distribution showed qualitative agreement between calculation and measurement, absolute dose value is corresponded within 3% in the region of PTV. The pass rates of the gamma test were greater than 90% at 3 cm depth. Conclusions: In this study the dose distribution for bolus ECT was measured by EBT 2 film. The 3D electron bolus which is fabricated by p.d ECT software reproduce the accurate dose distribution that is calculated with TPS.



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