Evaluation of the conformity of intensity-modulated radiation therapy and volumetric modulated arc therapy using AAPM TG 119 protocol

The aim of this work was to evaluate the conformity of intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT), and verify the accuracy of the planning and delivery system used in this work based on the AAPM TG-119 protocol. The Eclipse 13.6 treatment planning system (TPS) was used to plan the TG-119 test suite, which included four test cases: MultiTarget, Prostate, Head/Neck, and C-Shape for IMRT and VMAT techniques with 6 MV and 10 MV acceleration voltages. The results were assessed and discussed in terms of the TG-119 protocol and the results of previous studies. In addition, point dose and planar dose measurements were done using a semiflex ion chamber and an electronic portal imaging device (EPID), respectively. The planned doses of all test cases met the criteria of the TG-119 protocol, except those for the spinal cord of the C-Shape hard case. There were no significant differences between the treatment planning doses and the doses given in the TG-119 report, with p-values ranging from 0.974 to 1 (p > 0.05). Doses to the target volumes were similar in the IMRT and VMAT plans, but the organs at risk (OARs) doses were different depending on the test case. The planning results showed that IMRT is more conformal than VMAT in certain cases. For the point dose measurements, the confidence limit (CLpoint) of 0.030 and 0.021 were better than the corresponding values of 0.045 and 0.047 given in the TG-119 report for high-dose and low-dose areas, respectively. Regarding the planar dose measurements, the CLplanar value of 0.38 obtained in this work was lower than that given in the TG-119 report (12.4). It is concluded that the dosimetry measurements performed in this study showed better confidence limits than those provided in the TG 119 report. IMRT remains more conformal in certain circumstances than the more progressive VMAT. When selecting the method of delivering a dose to the patient, several factors must be considered, including the radiotherapy technique, energy, treatment site, and tumour geometry.