Optimizing Quality Assurance in Breast IMRT Treatment Plans: A Comparative Study of Point Dose and 2D Dose Verification

S. Herwiningsih, J. A. E. Noor, C. S. Widodo, D. Y. B. Munthe, F. K. Hentihu

Abstract


Intensity-Modulated Radiation Therapy (IMRT) requires rigorous dose verification to ensure accurate radiation delivery. This study evaluates point dose verification and 2D dose verification techniques in detecting dose discrepancies due to isocenter shifts in IMRT treatment for post-mastectomy breast cancer cases. Five post-mastectomy breast IMRT plans were retrospectively analyzed, with phantom-based measurements compared against Treatment Planning System (TPS) calculations. The results indicate that point dose verification provides reliable absolute dose measurements, but lacks spatial resolution, whereas 2D verification captures dose variations more effectively. Dose discrepancies remained within acceptable limits for shifts up to ±3 mm, but shifts of ±5 mm or more resulted in clinically significant deviations. Gamma Passing Rates (GPR) decreased substantially beyond ±5 mm shifts, underscoring the importance of precise patient positioning. These findings support the integration of both verification methods to improve IMRT quality assurance, particularly in resource-limited settings. Future advancements in AI-driven dosimetry and real-time in vivo monitoring may further optimize dose verification, enhancing treatment accuracy and patient safety.

Keywords


Breast cancer; Intensity-Modulated Radiation Therapy (IMRT); Dose verification; Quality assurance; Isocenter shift; Radiation therapy

Full Text:

PDF

References


F. Bray, M. Laversanne, H. Sung et al., CA Cancer. J. Clin. 74 (2024) 229.

J. Ferlay, M. Ervik, F. Lam et al., Global cancer observatory: cancer today. https://gco.iarc.who.int/today. Retrieved in May (2025).

S. Herwiningsih, F. Yuana, R. Latifah et al., Atom Indones. 50 (2024) 159.

S. Herwiningsih, A. Naba, S. Rianto et al., Indones. Phys. Rev. 6 (2023) 284.

I. Mrčela, M. Gregov, A. Matanić et al., Acta Clin. Croat. 61 (2022) 21.

H. Liu, X. Chen, Z. He et al., Comput. Med. Imaging Graphics 54 (2016) 1.

J. Calvo‐Ortega, P. B. Greer, S. Moragues-Femenía et al., Rep. Pract. Oncol. Radiother. 27 (2022) 449.

M. Huang, D. Huang, J. Zhang et al., J. Appl. Clin. Med. Phys. 18 (2017) 97.

X. Wang, L. Chen, C. Xie et al., Oncotarget 8 (2017) 109619.

H. Zhu, Q. Zhu, Z. Wang et al., Med. Phys. 50 (2023) 1205.

C. Han, J. Yi, K. Zhu et al., J. Appl. Clin. Med. Phys. 21 (2020) 98.

Y. Tanaka, M. Hashimoto, M. Ishigami et al., Radiat. Oncol. 18 (2023) 180.

S. S. Abdullah, Baghdad Sci J. 18 (2021) 1514.

A. Alexandrian, P. Mavroidis, G. Narayanasamy et al., J. Appl. Clin. Med. Phys. 21 (2020) 94.

Y. Pan, R. Yang, S. Zhang et al., Radiat. Oncol. 14 (2019) 69.

K. Iqbal, M. M. Iqbal, M. Akram et al., J. Radiother. Pract. 17 (2017) 85.

M. Miften, A. Olch, D. Mihailidis et al., Med. Phys. 45 (2018) e53.

S. Mein, L. Rankine, J. Adamovics et al., Med. Phys. 44 (2017) 6018.

S. Wang, Y. Zheng, J. Appl. Clin. Med. Phys. 24 (2023) e14106.

V. R. Gedam, A. Pradhan, Radiat. Prot. Dosim. 199 (2023) 164.

S. Herwiningsih, P. Hanlon, A. Fielding, Australas. Phys. Eng. Sci. Med. 37 (2014) 763.

C. Low, W. Toye, P. Phung et al., J. Med. Phys. 43 (2018) 112.

N. V. N. M. Sresty, Ak. Raju, B. R. Reddy et al., J. Med. Phys. 44 (2019) 222.

G. Zwierzchowski, G. Bielęda, J. Skowronek, Radiol. Oncol. 51 (2017) 469.

O. Jäkel, B. Ackermann, S. Ecker et al., Radiat. Oncol. 14 (2019) 77.

D. T. Tai, N. D. Son, T. T. H. Loan et al., A method for determination of parameters of the initial electron beam hitting the target in linac, in: J. Phys. Conf. Ser 851 (2017) 012032.

E. Chung, D. Kwon, T. Park et al., J. Appl. Clin. Med. Phys. 19 (2018) 193.

P. Yadav, A. Hallil, D. Tewatia et al., J. Appl. Clin. Med. Phys. 21 (2020) 127.

E. Pardo, J.C. Novais, M. Y. M. López et al., J. Appl. Clin. Med. Phys. 17 (2016) 132.

T. Alharthi, P. Vial, L. Holloway et al., J. Appl. Clin. Med. Phys. 22 (2021) 229.

P. Urso, R. Lorusso, L. Marzoli et al., J. Appl. Clin. Med. Phys. 19 (2018) 517.

J. D. Cho, H. Jin, S. Jung et al., Med. Phys. 50 (2023) 6624.

Y. J. M. Labagnoy, S. Oonsiri, M. Vimolnoch et al., J. Med. Phys. 48 (2023) 350.

J. Chung, S. Kang, K. Eom et al., J. Korean. Med. Sci. 31 (2016) 1742.

K. Kurosu, I. Sumida, H. Mizuno et al., J. Radiat. Res. 57 (2016) 258.

I. Sumida, H. Yamaguchi, I.J. Das et al., J. Appl. Clin. Med. Phys. 17 (2016) 259.

L. T. Oanh, D. T. Thai, T. T. H. Loan et al, Nucl. Eng. Technol. 53 (2021) 4098.

J. Qiu, S. Zhang, B. Lv et al., Technol. Cancer Res. Treat. 20 (2021) 15330338211053752.

O. Y. Mian, O. C. Thomas, J. J. Y. Lee et al., Springerplus 5 (2016) 1337.

Y. Nakaguchi, T. Ono, M. Maruyama et al., J. Appl. Clin. Med. Phys. 18 (2017) 69.




Bookmark and Share


Copyright (c) 2025 Atom Indonesia

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.