Clinical Experience of Intensity Modulated Radiotherapy Pre-Treatment Quality Assurance for Carcinoma Head and Neck Patients with EPID and IMatriXX in Rural Center

Background: Radiation therapy techniques as Intensity Modulated Radiotherapy (IMRT), rapid arc have been used for treatment of cancer with high accuracy. Objective: Verification of planned and delivered dose distribution is important, therefore current study aims to analyse quality assurance (QA) results of IMRT by Electronic Portal Imaging Device (EPID) and IMatriXX in head and neck Carcinoma (Ca H&N) patients.Material and Methods: In this experimental study, performance of an EPID and IMatriXX was assessed with dose measurements using ionization chamber. Calibrated IMatriXX and EPID are used for pre-treatment patient specific quality assurance (PSQA), for ۱۲۲ patients’ plans of Ca H&N with IMRT treatment technique on linear accelerator. Dose images were acquired and compared with gamma evaluation (۳% / ۳ mm) and three scalar parameters, named average γ (γavg), maximum γ (γmax) and area gamma <۱, were analyzed in the region of interest. Results: The γ correlation comparisons yielded average correlation of ۰.۹۹۰ and ۰.۹۸۲ for IMatriXX and EPID respectively. Maximum value of gamma is ۰.۹۹۸, while minimum gamma is ۰.۸۷۲ for IMatriXX and ۰.۹۵۳ for EPID. For students, unpaired ‘t’ test analysis is applied for comparison to two data sets. P-value was set at ۰.۰۰۵ which, for this study, was computed ۰.۰۰۱, showing good correlation between measured data with IMatriXX and EPID. Conclusion: The EPID and IMatriXX have significantly improved dosimetric properties, resulting in more sensitive, accurate measurements before actual treatment. The result shows EPID can be replaced with other dosimetry method and ionization chamber measurements. Portal imager is an efficient, accurate and sensitive dosimetry tool and is also the basis of pre-treatment quality assurance protocol.