Dose verification of dynamic MLC-tracked radiotherapy using small PRESAGE® 3D dosimeters and a motion phantom

With the increasing complexity of radiotherapy treatments typical 1D and 2D quality assurance (QA) detectors may fail to detect out-of-plane dose discrepancies, in particular in the presence of motion. In this work, small samples of the PRESAGE (R) 3D radiochromic dosimeter were used in combination with a motion phantom to measure real-time multileaf collimator (MLC)-tracked radiotherapy treatments. A different sample of PRESAGE (R) was irradiated for each of three different irradiation scenarios: (1) static: static sample, without tracking (2) motion: moving sample, without tracking and (3) tracking: moving sample, with tracking. Our in-house software DynaTrack dynamically moves the linac's MLC leafs based on the target position. The doses delivered to the samples were reconstructed based on the recorded positions of the MLC and phantom during the beam delivery. PRESAGE (R) samples were imaged with an in-house optical-CT scanner. Comparison between simulated and measured 3D dose showed good agreement for all three irradiation scenarios (static: 99.2%; motion: 99.7%; tracking: 99.3% with a 3%, 2 mm and a 10% threshold local gamma criterion), failing only at the edges of the PRESAGE (R) samples (similar to 6 mm). Given that the dose distributions deposited using the DynaTrack system have been independently verified, this experiment demonstrates the ability of PRESAGE to measure 3D doses correctly in a tracking context. We conclude that this methodology could be used in the future to validate the delivery of dynamic MLC-tracked radiotherapy.