Leaf sequencing and dosimetric verification in intensity-modulated radiotherapy

Although sophisticated means to calculate and deliver intensity modulated radiotherapy (IMRT) have been developed by many groups, methods to verify the delivery, as well as definitions of acceptability of a treatment in terms of these measurements are the most problematic at this stage of advancement of IMRT. Present intensity modulated radiotherapy systems fail to account for many dosimetric characteristics of the delivery system. In this dissertation, a dosimetrically based leaf sequencing algorithm is developed and implemented for multileaf collimated intensity modulated radiotherapy. The dosimetric considerations are investigated and are shown to significantly improve the outcome in terms of an agreement between desired and delivered radiation dose distributions. Subsequently, a system for determining the desirability of a produced intensity modulated radiotherapy plan in terms of deliverability of calculated profiles with the use of a multileaf collimator is developed. Three deliverability scoring indices are defined to evaluate the deliverability of the profiles. Gradient Index (GI) is a measure of the complexity of the profile in terms of gradients. Baseline Index (BI) is the fraction of the profile that is planned to get lower than the minimum level of transmission radiation. Cumulative Monitor Unit Index (CMUI) is the ratio of the cumulative monitor units (CMU) required for obtaining the desired profile to an average dose level in the profile. The dosimetric investigations of the deliverability scoring indices are presented, showing a clear correlation between scoring indices and dosimetric accuracy. Finally, materials and methods are developed for verification of intensity modulated radiotherapy. Dosimetric verification starts from investigations of the developed leaf sequencing algorithm, then extends to dosimetric verification in terms of deliverability, and lastly, dosimetric verification of complete clinical IMRT plans is performed.