Dosimetric Comparison of IMRT with 3D-CRT Regarding Their Contribution to the Treatment Plan Optimization Using Rando Phantom with a Realistic Lung Cancer Radiotherapy Treatment Planning

Document Type : Original Paper


1 1. Department of Physics, Ferhat Abbas-Setif1University, Campus El-Bèz, Setif, Algeria 2. Laboratory of Dosing, Analysis and Characterization in high resolution, Campus El-Bèz, Setif, Algeria 3. Department of Radiotherapy, Fighting against Cancer Medical Centre, Sétif, Algeria

2 1. Department of Physics, Ferhat Abbas-Setif1University, Campus El-Bèz, Setif, Algeria 2. Laboratory of Dosing, Analysis and Characterization in high resolution, Campus El-Bèz, Setif, Algeria

3 Department of Radiotherapy, Fighting against Cancer Medical Centre, Sétif, Algeria


Introduction: This study compared a three-dimensional conformal radiation therapy (3D-CRT) with a recently implemented intensity modulation radiation therapy (IMRT) technique performed in the irradiation of lung cancer. The objective of this study is to demonstrate the dosimetric advantages of IMRT in target coverage, dose homogeneity, and reducing toxicity.
Material and Methods: Depth point doses were compared as calculated by the Varian Eclipse treatment planning system (TPS) on virtual created patient and experimentally measured by thermoluminescence (TL) dosimetry. For treatment planning the same lesion of the real case with different volumes and structures contouring details were created on Rando anthropomorphic phantom computed tomography (CT) data. Dose measurement was performed by calibrated thermoluminescent detectors.
Results: The difference between experimental TL measured doses and calculated doses in both techniques show mean values of ~3% (IMRT) and ~1% (3D-CRT) for high dose (>0.55Gy) and ~7% IMRT and 6.5% (3D-CRT) for low dose (<0.55Gy). All IMRT optimized plans improved the heart (-28.3%), the spinal cord (-25.3%), and the left lung (-41.55%) sparing significantly, compared to the 3D-CRT plans. The optimized dose-volume histograms, the dose covering indices, and the dose profile across heterogeneity interfaces showed a significant improvement in dose conformity by IMRT.
Conclusion: These findings demonstrate well that TL dosimetry when combined with suitable point dose measurement procedures can efficiently be used as an external and independent dose audit for the comparison between 3D-CRT and IMRT. IMRT with its dose-volume optimization algorithm can achieve a treatment plan quality in lung cancer radiotherapy unachievable by 3D-CRT.   


Main Subjects

  1. Bouacid SS, Kharfi F, Boulakhssaim F. Comparison of measured and calculated doses in a Rando phantom with a realistic lung radiotherapy treatment plan including heterogeneities. Radiat Environ Biophys. 2018 Sep 11; 57:365–73.
  2. Landberg T, Chavaudra J, Dobbs J, Gerard JP, Hanks G, Horiot JG, et al. Report 62: Prescribing, Recording and Reporting Photon Beam Therapy (Supplement to ICRU report 50). Journal of the ICRU. 1999 Nov 1; 32 (1).  
  3. Landberg T, Chavaudra J, Dobbs J, Hanks G, Johansson KA. Report 50: Prescribing, Recording and Reporting Photon Beam Therapy. Journal of the ICRU. 1993 Sept 1; 26 (1).
  4. Varian medical system: Eclipse Algorithms Reference Guide. P/N B502612R03A, Palto Alto. 2009.
  5. Kharfi F, Ketfi R. Irradiated black pepper identification based on thermoluminescence of silicate minerals. J Radioanal Nucl Chem. 2018 Jan 11; 315:503–7.
  6. DTU Nutech. Denmark. Guide to the Risø TL/OSL Reader. 2015. Available from:
  7. Vol I. Prescribing, Recording, and Reporting Photon-Beam Intensity-Modulated Radiation Therapy (IMRT): Contents. Journal of the ICRU. 2010 Apr;  10(1).
  8. Feuvret L, Noel G, Mazeron JJ, Bey P. Conformity index: a review. Int J Radiat Oncol Biol Phys. 2006 Feb 1; 64(2):333-42.
  9. Sheng K, Molloy JA, Larner JM, Read PW. A dosimetric comparison of non-coplanar IMRT versus Helical Tomotherapy for nasal cavity and paranasal sinus cancer. Radiother Oncol. 2007 Feb; 82(2):174-8.
  10. Oelfke U, Nill S, Wilkens JJ. Physical optimization. InImage-guided IMRT. 2006.
  11. Lu R, Radke RJ, Yang J, Happersett L, Yorke E, Jackson A. Reduced-order constrained optimization in IMRT planning. Physics in Medicine & Biology. 2008 Nov 7;53(23):6749.
  12. Xing L, Li J, Donaldson S, Le Q, Boyer A. Optimization of importance factors in inverse planning. Phys Med Biol. 1999 Oct; 44(10):2525-36.
  13. Lu R, Radke R, Happersett L, Yang J, Chui C, Yorke E, et al. Reduced-order parameter optimization for simplifying prostate IMRT planning. Phys. Med. Biol. 2007 Jan 17; 52:849–70.
  14. Webb S. Optimisation of conformal radiotherapy dose distributions by simulated annealing. Phys Med Biol. 1989 Oct; 34(10):1349-70.
  15. Morrill S. M., Lane R. G., Jacobson G, Rosen II. Treatment planning optimization using constrained simulated annealing. Phys Med Biol. 1991 Oct; 36(10):1341-61.
  16. Webb S. Optimization by simulated annealing ofthree-dimensional, conformai treatment planning for radiation fields defined by a multileaf collimator: II. Inclusion of two-dimensional modulation of the x-ray intensity. Phys Med Biol. 1992 Sep; 37 (8):1689-704.
  17. Bortfeld T. Optimized planning using physical objectives and constraints. Semin Radiat Oncol. 1999 Jan; 9(1):20-34.
  18. IMRTCWG. Intensity-modulated radiotherapy: current status and issues of interest. Int J Radiat Oncol Biol Phys. 2001 Nov 15; 51(4):880-914.
  19. Vanetti E, Nicolini G, Nord J. On the role of the optimization algorithm of Rapid Arc volumetric modulated arc therapy on plan quality and efficiency. Med Phys. 2011 Nov; 38(11):5844-56.
  20. Zacarias AS, Mills MD. Algorithm for correcting optimization convergence errors in Eclipse. J Appl Clin Med Phys. 2009 Oct 14; 10(4):3061.
  21. Holmes T. and Mackie TR. A comparison of three inverse treatment planning algorithms. Phys Med Biol. 1994 Jan; 39(1):91-106.
  22. Jeraj R, Keall PJ, Sieber JV. The effect of dose calculation accuracy on inverse treatment planning. Phys Med Biol. 2002 Feb 7;47(3):391-407.
  23. Jeraj R, Wu C, Mackie TR. Optimizer convergence and local minima errors and their clinical importance, Phys Med Biol. 2003 Aug 12; 48(17):2809–27.
  24. Dogan N, Siebers JV, Keall PJ, Lerma F, Wu Y, Fatyga M, et al. Improving IMRT dose accuracy via deliverable Monte Carlo optimization for the treatment of head and neck cancer patients. Med Phys. 2006 Nov; 33(11):4033-43
  25. Mihaylov IB, Siebers JV. Evaluation of dose prediction errors and optimization convergence errors of deliverable-based head-and-neck IMRT plans computed with a superposition/convolution dose algorithm. Med Phys. 2008 Aug; 35(8): 3722-7.
  26. Tol JP, Dahele M, Doornaert P, Slotman BJ, Verbakel WF. Different treatment planning protocols can lead to large differences in organ at risk sparing. Radiother Oncol. 2014 Nov; 113(2):267-71.
  27. Chen MJ, Novaes PE, Gadia R, Motta R. Guidelines for the treatment of lung cancer using radiotherapy. Rev Assoc Med Bras. 2017 Sep; 63(9):729-32.
  28. Chan C, Lang S, Rowbottom C, Guckenberger, M, Faivre-Finn C. Intensity-modulated radiotherapy for lung cancer: current status and future developments. J Thorac Oncol. 2014 Nov; 9(11):1598-608.
  29. Murshed H, Liu HH, Liao Z, Barker JL, Wang X, Tucker SL, et al. Dose and volume reduction for normal lung using intensity-modulated radiotherapy for advanced-stage nonsmall-cell lung cancer. Int J Radiat Oncol Biol Phys. 2004 Mar 15;58(4):1258-67.
  30. Zhang GG, Ku L, Dilling TJ, Stevens CW, Zhang RR, Li W, et al. Volumetric modulated arc planning for lung stereotactic body radiotherapy using conventional and unflattened photon beams: a dosimetric comparison with 3D technique. Radiat Oncol. 2011 Nov 9 ;6:152.
  31. Cattaneo GM, Dell'oca I, Broggi S, Fiorino C, Perna L, Pasetti M, et al. Treatment planning comparison between conformal radiotherapy and helical tomotherapy in the case of locally advanced-stage NSCLC. Radiother Oncol. 2008 Sep; 88(3):310-8. 
  32. Chan OS, Lee MC, Hung AW, Chang AT, Yeung RM, Lee AW. The superiority of hybrid-volumetric arc therapy (VMAT) technique over double arcs VMAT and 3D-conformal technique in the treatment of locally advanced non-small cell lung cancer–a planning study. Radiother Oncol. 2011 Nov;101(2):298-302.
  33. Liu HH, Wang X, Dong L, Wu Q, Liao Z, Stevens CW, et al. Feasibility of sparing lung and other thoracic structures with intensity-modulated radiotherapy for non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2004 Mar 15; 58(4):1268-79.
  34. McGrath SD, Matuszak MM, Yan D, Kestin LL, Martinez AA, Grills IS. Volumetric modulated arc therapy for delivery of hypofractionated stereotactic lung radiotherapy: A dosimetric and treatment efficiency analysis. Radiother Oncol. 2010 May; 95(2):153-7.
  35. Christian JA, Bedford JL, Webb S, Brada M. Comparison of inverse planned three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2007 Mar 1;67(3):735-41.
  36. Bree Id, van Hinsberg MG, van Veelen LR. High-dose radiotherapy in inoperable nonsmall cell lung cancer: comparison of volumetric modulated arc therapy, dynamic IMRT and 3D conformal radiotherapy, Med Dosim. 2012 Mar 28; 37(4):353–7.
  37. Ong CL, Verbakel WF, Cuijpers JP, Slotman BJ, Lagerwaard FJ, Senan S. Stereotactic radiotherapy for peripheral lung tumors: a comparison of volumetric modulated arc therapy with 3 other delivery techniques. Radiother Oncol. 2010 Dec; 97(3):437-42.
  38. Simeonova A, Abo-Madyan Y, El-Haddad M, Welzel G, Polednik M, Boggula R, et al. Comparison of anisotropic aperture based intensity modulated radiotherapy with 3D-conformal radiotherapy for the treatment of large lung tumors. Radiother Oncol. 2012 Feb; 102(2):268-73.
  39. Boyle J, Ackerson B, Gu L, Chris R, Kelsey R. Dosimetric advantages of intensity modulated radiation therapy in locally advanced lung cancer. Adv Radiat Oncol. 2017 Jan-Mar; 2(1): 6–11.
  40. Moon SH, Cho KH, Lee CG, Keum KC, Kim YS, Wu HG, et al. IMRT vs. 2D-radiotherapy or 3D-conformal radiotherapy of nasopharyngeal carcinoma. Strahlenther Onkol. 2016 Jun; 192(6):377-85.
  41. Fiandra C, Filippi AR, Catuzzo P, Botticella A, Ciammella P, Franco P, et al. Different IMRT solutions vs. 3D-Conformal Radiotherapy in early stage Hodgkin’s lymphoma: dosimetric comparison and clinical considerations. Radiat Oncol. 2012 Nov 2; 7:186-95.