Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department


Major Professor

Vladimir Feygelman, Ph.D.

Co-Major Professor

Ghanim Ullah, Ph.D.

Committee Member

Kujtim Latifi, Ph.D.

Committee Member

Timothy Ritter, Ph.D.


Diode arrays, IMRT QA, PSQA, VMAT QA


The aim of this work is primarily to validate the advanced techniques for treatment planning and dosimetric verification for modern megavoltage x-ray radiotherapy. With the advent of modern radiotherapy techniques, there is a great need for assuring quality of the radiation dose distributions generated by the advanced intensity modulated treatments (IMRT/VMAT). This is typically accomplished by the assessment of the treatment plan quality at the planning stage and then verification of the dose distributions through measurements on the phantoms or independent dose calculations prior to the actual delivery of these plans to patients. The major focus of this work is to clinically evaluate the modern 2D and 3D dose verification techniques.

The measurement-based dosimetry systems investigated were ArcCHECK/3DVH and SRS MapCHECK. AcrCHECK/3DVH system uses the measurement-guided dose reconstruction algorithm to correct the predicted dose in the patient dataset. The system was intended for VMAT/IMRT QA. SRS MapCHECK was investigated for SRS treatments. The independent dose calculation system was DoseCHECK which employed a GPU-accelerated convolution-superposition of algorithm for 3D dose reconstruction on the patient dataset. Next, a hybrid dose verification system (PerFRACTION) was evaluated, which takes input from both the treatment planning system and the linac EPID and produces a measurement-guided 3D dose distribution for comparison with the plan. This system was investigated for potential QA applications to a modern, efficient SRS technique, involving simultaneously treating multiple targets with a single isocenter. The performance of all dosimetry systems was validated against well-characterized independent dosimeters, such as ion chamber, film and scintillator detectors, or 3D arrays (Delta4), using stringent dose comparison criteria to test their limits for the intended clinical applications.

For the initial plan quality evaluation of a novel tool (Feasibility DVH) was investigated. This tool a priori estimates best achievable dose volume histograms for a specific patient, based on the basic physics properties of the megavoltage x-rays, thus helping the planners to guide their efforts.

All studied dosimetry systems showed an excellent agreement of the average gamma (a mathematical combination of DD and DTA) passing rates >98% for most of the plans. The 3% DD/2mm DTA criteria were used for extracranial plans and 3%/1mm for intracranial SRS plans. As dictated by the logic of the application, the comparisons were made against TPS calculations, a bi-planar array, or film measurements. Similarly the average percent point dose errors <2% were observed against the ion chambers or film. In the rare instances when the deviations were larger, intuitive explanations were provided, based on either the physics of the plans or inhomogeneous patient anatomy and resulting algorithm limitations.

Feasibility DVH was shown to reliably predict the best possible organ sparing for clinical head-and-neck VMAT plans.

Overall the investigated dosimetry systems were found reliable and feasible for their intended clinical use.