Characterization of cylindrical ionization chambers for patient specific IMRT QA

Proven conventional dosimetry techniques do not provide accuracy and precision in the measurement of inverse planned intensity-modulated radiation therapy (IMRT) fields. Dynamic and step-and-shoot multileaf collimation (DMLC/SMLC) challenge current ionization chamber dosimetry practices. Ionization chamber performance in these fields is evaluated for three cylindrical chambers of varying volumes (PinPoint (PP): 0.015 cm(3), IC10: 0.13 cm(3), Farmer type NE2571 (FT): 0.69 cm(3)) in terms of measurement reproducibility, dose measurement linearity, and IMRT dose measurements. Fifty IMRT patient specific quality assurance dose measurements were performed with each chamber. DMLC measurements are compared between chambers, and to dose calculations from a commercial treatment planning system (TPS) that used a finite size pencil-beam model (FSPB). Ten SMLC measurements are compared to Monte Carlo simulations available in the TPS. The three chambers demonstrated adequate measurement reproducibility characteristics for both open and DMLC fields, with each chamber able to perform within 2% (2SD) for DMLC fields. Both smaller volume chambers over responded (> 5%) when irradiated with a small number of monitor units in open fields. FT and IC10 chambers demonstrated dose linearity in DMLC fields down to 10 monitor units, while dose linearity for the PP chamber broke down at 100 monitor units. The evaluation of 50 DMLC treatment plan quality assurance procedures revealed that the FT chamber measurements were closest to the FSPB calculated values (FSPB: 1.0, FT: 0.973 +/- 0.044, IC10: 0.963 +/- 0.048, PP: 0.944 +/- 0.071). Quality assurance plans calculated independently with Monte Carlo more closely matched chamber measurements (FSPB: 1.0, MC: 0.97, FT: 0.95). Measurements of absorbed dose to water in IMRT fields are highly chamber and IMRT plan dependent.