A national dosimetric audit of IMRT

Background and purpose: A dosimetric audit of IMRT has been carried out within the UK between June 2009 and March 2010 in order to provide an independent check of safe implementation and to identify problems in the modelling and delivery of IMRT. Methods and materials: A mail based audit involving film and alanine dosimeters was utilized. Measurements were made for each individual field in an IMRT plan isocentrically in a flat water-equivalent phantom at a depth of 5 cm. The films and alanine dosimeters were processed and analysed centrally; additional ion chamber measurements were made by each participating centre. Results: 57 of 62 centres participated, with a total of 78 plans submitted. For the film measurements, all 176 fields from the less complex IMRT plans (including prostate and breast plans) achieved over 95% pixels passing a gamma criterion of 3%/3 mm within the 20% isodose. For the more complex IMRT plans (mainly head and neck) 8/245 fields (3.3%) achieved less than 95% pixels passing a 4%/4 mm gamma criterion. Of the alanine measurements, 4/78 (5.1%) of the measurements differed by >5% from the dose predicted by the treatment planning system. Three of these were large deviations of -77.1%, -29.1% and 14.1% respectively. Excluding the three measurements outside 10%, the mean difference was 0.05% with a standard deviation of 1.5%. The out of tolerance results have been subjected to further investigations. Conclusions: A dosimetric audit has been successfully carried out of IMRT implementation by over 90% of UK radiotherapy departments. The audit shows that modelling and delivery of IMRT is accurate, suggesting that the implementation of IMRT has been carried out safely. (C) 2011 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 99 (2011) 246-252