Retrospective IMRT dose reconstruction based on cone-beam CT and MLC log-file

Purpose: Head-and-neck (HN) cone-beam computed tomography (CBCT) can be exploited to probe the IMRT dose delivered to a patient taking into account the interfraction anatomic variation and any potential inaccuracy in the IMRT delivery. The aim of this work is to reconstruct the intensity-modulated radiation therapy dose delivered to an HN patient using the CBCT and multileaf collimator (MLC) log-files. Methods and Materials: A cylindrical CT phantom was used for calibrating the electron density and validating the procedures of the dose reconstruction. Five HN patients were chosen, and for each patient, CBCTs were performed on three separate fractions spaced every 2 weeks starting from the first fraction. The respective MLC log-files were retrieved and converted into fluence maps. The dose was then reconstructed on the corresponding CBCT with the regenerated fluence maps. The reconstructed dose distribution, dosimetric endpoints, and DVHs were compared with that of the treatment plan. Results: Phantom study showed that HN CBCT can be directly used for dose reconstruction. For most treatment sessions, the CBCT-based dose reconstructions yielded DVHs of the targets close (within 3%) to that of the original treatment plans. However, dosimetric changes (within 10%) due to anatomic variations caused by setup inaccuracy, organ deformation, tumour shrinkage, or weight loss (or a combination of these) were observed for the critical organs. Conclusions: The methodology we established affords an objective dosimetric basis for the clinical decision on whether a replanning is necessary during the course of treatment and provides a valuable platform for adaptive therapy in future. (C) 2008 Elsevier Inc.