Dosimetric impact of placement errors in optically stimulated luminescent in vivo dosimetry in radiotherapy

Introduction Studies have suggested that optically stimulated luminescent dosimeters (OSLDs) can be used for in vivo dosimetry of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT). Clinical uncertainties such as placement error have not been thoroughly investigated. The purpose of this work was to measure OSLD placement error in a clinical sample and analyze its dosimetric impact. Methods and materials The analysis consisted of three parts: first, quantification of placement error in a clinical sample of 128 patients yielding 293 cone-beam CT (CBCT) with visible OSLDs registered to the treatment plan; Second, correlation of placement error and clinical OSLD measurements; third, simulation of dosimeter placement in the treatment plan and correlation of recalculated dose with placement error. Results In the first analysis, average placement error was 9.7 ± 9.5 mm. In the second analysis, placement error and measured-to-planned dose agreement yielded no correlation (R2 = 0.02) for a subsample of 77 CBCTs of 55 head-and-neck patients. Average placement error was 7.0 ± 6.0 mm. Several factors, including image-guided shifts, introduced uncharacterized uncertainty to the measured-to-planned dose agreement. The third analysis isolated placement error from these other effects. Average dosimetric error was −2.4 ± 19.3%. Simulated dosimetric impact was weakly correlated with placement error (R2 = 0.39). Removing outliers reduced the average dosimetric error to −2.1 ± 10.9%, marginally improving the correlation (R2 = 0.44). Conclusion Placement error can substantially impact measured-to-planned dose agreement of OSLDs in high gradient regions, demonstrating the criticality of accurate dosimeter placement for IMRT and VMAT treatments.