The START Trial - measurements in semi-anatomical breast and chest wall phantoms

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Abstract
This paper describes dosimetry measurements performed prior to departments entering patients into the START Trial, a breast fractionation trial. Absolute and relative doses were measured in semi-anatomical breast and chest wall phantoms, as part of a quality assurance programme visit. Doses were measured using an ionization chamber and the resulting distributions were compared with those calculated by the department. The mean ratio of measured to calculated dose at the START reference point was found to be 0.981 for the breast phantom and 0.978 for the chest wall phantom. This average measured dose was significantly less than the prescribed dose (p < 0.001). Differences were found between 2D and 3D planning systems and for departments using cobalt 60 beams. A number of departments had deviations of greater than 4%, which was the tolerance applied for this trial. It is essential for dose measurements of this type to be performed for randomized clinical trials involving radiotherapy, particularly where dose fractionation regimes are being compared.