Dosimetric comparison among different head and neck radiotherapy techniques using PRESAGE® dosimeter

Purpose: The purpose of this analysis was to investigate dose distribution of Three Dimensional Conformal Radiation Therapy (3DCRT), Intensity Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) for Head and Neck cancer using 3-dimensional PRESAGE® dosimeter. Method : Computer Tomography (CT) scans of Radiological Physics Center (RPC) Head and Neck anthropomorphic phantom with both RPC standard insert and PRESAGE® insert were acquired separated with Philipp’s CT scanner and both CT scans were exported via DICOM to the pinnacle treatment planning system (TPS). Each plan was delivered twice to the RPC phantom first containing the RPC standard insert having Thermoluminescent detectors (TLD) and film dosimeters and then again containing the PRESAGE® insert having three dimensional dosimeter (PRESAGE®) by using a Varian True beam linear accelerator. After irradiation, the standard insert including point dose measurement (TLD) and planner GafChromic® EBT film measurement was read using RPC standard procedure. The 3D dose distribution from PRESAGE® was read out with the Duke Midsized optical scanner dedicated to RPC (DMOS-RPC). Dose volume histogram (DVH), mean and maximal doses for organ-at-risk (OARs) were calculated and compared among each Head and Neck technique. The prescription dose was same for all Head and Neck radiotherapy techniques which was 6.60 Gy per friction. Beam profile comparison and gamma analysis were used to quantify agreement among film measurement, PRESAGE® measurement and calculated dose distribution. Quality assurances of all plans were performed by using ArcCHECK method. Results: VMAT delivered the lowest mean and maximal doses to organ at risk (spinal cord and parotid) than IMRT and 3DCRT. Such dose distribution was verified by absolute dose distribution using TLD system. 2D gamma 5%/3 mm criteria of Pinnacle vs. EBT2 film 3DCRT (92.34%), IMRT (92.3%) and VMAT (96.63%) in axial plan respectively. It was also found that agreement between PRESAGE® and pinnacle along the axial, sagittal and coronal plans VMAT agreement was better than IMRT and 3DCRTplan excludes a 7 mm rim at the edge of the dosimeter using 2D gamma map criteria (±5%/3 mm) with 5% threshold dose. Profile showed good agreement for all plans between film, PRESAGE® and pinnacle. 3D gamma was performed for planning target volume (PTV) and organ at risks (OARs) VMAT and 3DCRT endow with better agreement than IMRT. Conclusion: VMAT delivered lowered mean and maximal doses to organ at risk and better PTV coverage. TLD, EBT film and PRESAGE® dosimeter has suggested that VMAT would be superior modality for the treatment of Head and Neck cancer than IMRT and 3DCRT.