Delivery verification in sequential and helical tomotherapy

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Abstract
Conformal and conformal avoidance radiation therapy are new therapeutic techniques that are generally characterized by high dose gradients. The success of this kind of treatment relies on quality assurance procedures in order to verify the delivery of the treatment. A delivery verification technique should consider quality assurance procedures for patient positioning and radiation delivery verification. A methodology for radiation delivery verification was developed and tested with our tomotherapy workbench. The procedure was investigated for two cases. The first treatment using a torus-shaped target was optimized for 72 beam directions and sequentially delivered as a single slice to a 33 cm diameter cylinder of homogeneous solid water. For the second treatment, a random pattern of energy fluence was helically delivered for two slices to a 9.0 cm diameter phantom containing inhomogeneities. The presented process provides the energy fluence (or a related quantity) delivered through the multileaf collimator (MLC) using the signal measured at the exit detector during the treatment delivery. As this information is created for every pulse of the accelerator, the energy fluence and state for each MLC leaf were verified on a pulse-by-pulse basis. The pulse-by-pulse results were averaged to obtain projection-by-projection information to allow for a comparison with the planned delivery. The errors between the planned and delivered energy fluences were concentrated between +/-2.0%, with none beyond +/-3.5%. In addition to accurately achieving radiation delivery verification, the process is fast, which could translate to radiation delivery verification in real time. This technique can also be extended to reconstruct the dose actually deposited in the patient or phantom (dose reconstruction).