Enhanced resistance to radiation could be caused by both chronic hypoxia and acute hypoxic which has been reported in prostate cancer in various studies. Therefore currently used dose prescriptions (70Gy in 35 fractions) for external beam radiation therapy (EBRT) of prostate cancer has been suggested insufficient to provide optimum clinical outcome. In this study, we propose a Biologically Guided Radiation Therapy approach to boost dose in hypoxic prostate tumor regions while sparing the urethra. A previously proposed hypoxia model was modified for prostate cancer and incorporated into treatment plan optimization. The concept of equivalent uniform dose (EUD) was used in the optimization and evaluation of results. CT data from 25 prostate cancer patients who recently received EBRT at the British Columbia Cancer Agency (BCCA) and hypothetical hypoxic regions manually drawn on these CT scans were selected for this study. The results show that our methods could boost dose in target volume to substantially higher levels. EUD of planning target volume increased to more than 80Gy, despite accounting for effects of hypoxia. This increase was achieved with only minor changes in dose in normal tissues, typically less than 5Gy. Notably, urethra sparing was excellent with a EUD around 64Gy. Robustness of the proposed approach is verified against various hypoxic settings. EUD comparison between RT plans in biological guided and conventional approaches using the same RT technique (Volumetric Modulated Arc Therapy) also suggests that biologically guided radiation therapy (BGRT) approach is more suitable for dose painting purposes with the advantage of delivering sufficient dose to hypoxia region in different scenarios and sparing normal tissue better. Furthermore, we also investigated the impact of inter-fraction patient set-up error and intra-fraction organ motion on the high dose gradients achieved with this proposed dose painting method and explored the feasibility of adapting geometrical uncertainties (represented as systematic error and random error) into treatment planning. Image error obtained from EPID images are used to derive systematic uncertainty and random uncertainty. During the geometrical uncertainty adapted optimization, dose matrix in PTV is shifted based on systematic error and convolved with a Gaussian kernel which is pre-calculated using random error. CT sets and organ contours from five patients who enrolled in the previous dose painting i study are selected. For each of them, seven plans are generated using cumulated uncertainty data which was collected after every five fractions. We also present the outcome in terms of equivalent uniform dose (EUD). For four of the patients, EUD history of all seven plans suggests using the proposed optimization method with uncertainty data from the first five fractions, it is possible to achieve the same target coverage of static treatment plans (difference in EUD less than 1Gy). Meanwhile, the elimination of PTV margin also leads to a significant dose reduction (more than 15Gy) in rectum. / Science, Faculty of / Physics and Astronomy, Department of / Graduate

Purpose/Objectives: Intensity Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) provide advantages in delivery of radiation allowing conformality of delivered dose to the planning target and reducing dose to organs at risk (OAR), however, at the potential cost of low dose spread. Due to the central location of the esophagus and GE junction, dose to lungs, heart, spinal cord, liver, and kidneys must be considered. Low dose spread is of particular concern with respect to healthy lung tissue. This study comprehensively compares volumetric dose statistics of the standard three-dimensional conformal radiation therapy (3D-CRT) compared with VMAT and IMRT for distal esophageal cancer treatment. Materials/Methods: Forty patients who underwent pre-operative radiation therapy for esophageal cancer between 2012-2014 were retrieved from our database. Pinnacle planning software was used to create 3D-CRT, VMAT and IMRT radiation plans for all patients. Forty-five (45) Gy was prescribed for each patient with D95% > 42.75Gy for the planning target volume (PTV). All plans were optimized to maintain PTV coverage while reducing dose to OAR with specific emphasis on lung and heart dose. Volumetric dose statistics were obtained, and Wilcoxon signed rank test was used to compare 3D-CRT vs IMRT and VMAT for Conformity Index, Integral Dose, Monitor Units, lung (V5Gy, V20Gy, mean, max), heart (V30Gy, mean, max), spinal cord max, bilateral kidneys (V20Gy, mean) and liver mean dose. Comparison was also made for IMRT vs VMAT. Results: For both IMRT and VMAT compared with 3D-CRT, statistically significant pairwise differences were noted for Conformity Index (-28.51%, -30.70%, P<.001), Integral Dose (-14.0%, -14.8%, P<.001), Monitor Units (107.2%, 80.4%, P<.001), lung (V20Gy: -49.7%,-57.4%, mean: -20.3%,-24.9%, P <.001), heart (V30Gy : -10.1%,-14.3%, mean -10.4%,-13.4%, P <.001), spinal cord (max 13.3%,9.5%, P <.001) and liver (mean -29.9%,-24.3%, P <.001). No significant differences were noted for VMAT and IMRT compared with 3D-CRT for lung (V5Gy, max dose), heart (max dose) and bilateral kidneys (mean). VMAT did offer statistically significant improvement in Conformity Index, Monitor Units, lung V20Gy and mean dose as well as heart V30Gy and mean dose compared to IMRT. Conclusion: VMAT and IMRT offer excellent sparing of key organs (lung, heart) with respect to volumetric constraints. Max point doses as well as lung V5Gy, which can be an indication of low dose spread for esophageal treatment, were not conclusively different. While 3D-CRT offers acceptable treatment, VMAT should be the standard modality of radiation treatment where facilities exist. / Thesis / Master of Science (MSc)

No description available.

For more than 50 years attening filters have been inserted into the beam path oflinacs to produce a uniform energy fluence distribution of the photon beam and make it suitable for clinical use. Recently, linacs without flattening fifilter (Flattening FilterFree - FFF) are increasingly used in radiotherapy because of its benefifits, e.g. high dose rate (2000 MU/min), reduced scattered and leakage radiation. Hypofractionated radiotherapy is interested in the high dose rate of FFF beams to shorten the treatment delivery time (TDT) especially the FFF beams have acceptable flatness at small fifieldsizes. Radiotherapy techniques that deliver intensity-modulated beams (IMBs), e.g.Tomotherapy, intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT), deal with the non-uniformity of the FFF beam profifile and produce homogeneous dose to the target as FF beams do. Siemens modified the Artiste linac in order to enable photon beam delivery with and without a flattening fifilter. The VMAT version developed by Siemens for Artiste linacs as a novel radiation technique is a modulated arc therapy (mARC). mARC technique is available with single, double and multiple complete or partial arcs. The aims of the current study were the determination of the main characteristics of 7 MV and 11 MV FFF photon beams in comparison with their corresponding 6 MV and 10 MV FF photon beams from Artiste digital linacs. Furthermore, IMRT planning comparisons using FF and FFF photon beams were performed using an Oncentra planning system. The performance of various mARC techniques were estimated and compared with Step and Shoot (S&S) IMRT by using a RayStation planning system. The mARC plans created by FF and FFF beams were evaluated to know which technique is the best. All the treatment plans were created for simple and complex shaped target volumes. The treatment plans are compared using two parameters - plan quality and treatment effi ciency. In addition to the planning study, the plan quality assurance of IMRT and mARC plans were performed using two difffferent volumetric quality assurance devices, Delta4 and Octavius 4D. Removal of the flattening fifilter causes changes in the dosimetric features of photon beams. IMRT plans with and without flattening fifilter were clinically acceptable where both plans have similar quality. In comparison with IMRT-FF, IMRT-FFF plansrequire more MUs and for some clinical cases require longer TDT. mARC technique can deliver dose distributions that are comparable to S&S-IMRT and could be an alternative with a potential to improve the effi ciency of the IMRT treatment delivery.

As técnicas radioterápicas evoluíram muito nas últimas décadas, destacando-se a utilização de feixes segmentados por colimadores de multifolhas, os quais permitem entregar maior quantidade de dose com maior precisão espacial. Os sistemas de planejamento em radioterapia (TPS), entretanto, são em grande parte fechados, com acesso restrito aos parâmetros de cálculo de dose. Desta forma, o presente trabalho teve como principal objetivo comparar valores de dose envolvidas em tratamentos radioterápicos, medidos com a técnica de dosimetria termoluminescente (TL), usando um objeto simulador antropomórfico (Alderson Rando Phantom - ARP) como paciente, com valores de referência extraídos dos TPS em simulações realistas de tratamento. O objeto simulador continha dosímetros TL de LiF (TLD100) posicionados na pelve, no tórax, na cabeça e no pescoço, a fim de que fossem monitoradas regiões com dose homogênea (como no volume alvo planejado - PTV), regiões com gradiente de dose e regiões afastadas do PTV. As irradiações foram feitas usando técnicas de radioterapia conformacional 3D e radioterapia por modulação da intensidade do feixe (IMRT). Quatro TPS foram utilizados: CadPlan, ECLIPSE, Helax-TMS e KonRad. Em algumas situações utilizaram-se algoritmos de cálculo implementados pelos fabricantes nos TPS; dois deles baseados em correção de heterogeneidades (Batho e pencil beam) e um deles baseado em convolução e superposição de feixes simulados (collapsed cone). Nos casos de irradiações com IMRT os algoritmos foram sempre usados. Paralelamente ao uso do ARP, utilizou-se um objeto simulador com água com objetivo de verificar o comportamento dos dosímetros TL expostos a feixes de fótons de alta energia, em comparação com câmaras de ionização cilíndricas do tipo Farmer (volume interno de 0,6 cm3). Além disso, esse objeto simulador possibilitou garantir a qualidade de suportes desenvolvidos para a câmara e para os dosímetros, nos casos de medidas em água. A irradiação da pelve do objeto simulador ARP, região com poucas heterogeneidades, revelou que o comportamento do material que o constitui é equivalente ao da água e, por isso, pode ser usado na simulação de tecido humano em feixes de radioterapia. Simulações de tratamentos revelaram compatibilidade entre valores medidos e planejados no interior do PTV, com discrepâncias menores que 2%; valores que estão dentro dos limites estabelecidos pelo ICRU62 (+7%/-5%, 2?). Nas regiões afastadas do PTV, todos os códigos de planejamento apresentaram discrepâncias relativamente grandes, evidenciando limitações no cálculo de componentes secondárias. Apesar dos algoritmos de cálculo aumentarem a concordância entre doses medidas e planejadas, não foi possível identificar diferenças entre os algoritmos pencil beam e collapsed cone. Em regiões onde havia alto gradiente de dose, as discrepâncias se tornam maiores devido à dificuldade em posicionar os dosímetros no mesmo ponto em que o cálculo é feito. Sistematicamente, observou-se que a técnica para radioterapia 3D apresenta valores de dose dentro dos limites preestabelecidos, enquanto IMRT mostra valores com maior exatidão. / The last decades noticed a massive improvement in radiotherapy techniques and the use of segmented beams produced by multileaf collimators. However, the dose radiation therapy planning systems (TPS) in use are characterized by the restriction of access to the calculation algorithms. The aim of this work was to compare dose values measured in an anthropomorphic phantom (Alderson Rando Phantom - ARP) to the reference dose values obtained from the TPS in real case simulations of radiotherapy treatments. Thermoluminescent dosimetry (TLD) technique was used to evaluate the doses. LiF dosimeters (TLD100) were positioned on the phantom pelvis, thorax, head and neck at homogeneous dose regions, as the Planned Target Volume (PTV), gradient dose regions, and areas far from PTV. The doses were delivered using two techniques, 3D conformal radiotherapy and Intensity Modulated Radiation Therapy (IMRT). Four TPS were used: CadPlan, ECLIPSE, Helax-TMS and KonRad. In several situations, calculation algorithms implemented in these planning systems were employed to take heterogeneities into account: two of them were correction-based algorithms (Batho and Pencil Beam) and one of them based in beam convolution-superposition (Collapsed Cone). Furthermore, a liquid water phantom was used to compare the TLD behavior to the Farmer thimble chamber (0,6 cc internal volume) results when exposed to high-energy photon beams. It was also possible to verify the quality of the PMMA supports that wer used in the calibration of the dosimeters on clinical beam, obtaining reliable results. Both the ARP pelvis and a water phantom showed similar behavior under irradiation, indicating that, in highly homogenous regions, the ARP material can be used to simulate human soft tissues under radiotherapy treatment. Inside the PTV, the dosimetry performed in the ARP, showed compatibility between measured and planned dose values, with discrepancies smaller than 2%, which are within the ICRU62 fixed limits (+7%/-5%, 2?). When the algorithms were used, a better agreement between the experimental and planned doses was achieved, but it was not possible to discriminate the Pencil Beam and Collapsed Cone algorithms. In regions with large dose gradients, the discrepancies between experimental and planned dose values are higher as the difficulties the position of the dosimeters are more critical. The measured doses, when the 3D radiotherapy technique was used, were within the ICRU62 pre-established limits whereas the IMRT technique provider more accurate values.

Die fraktionierte stereotaktisch geführte Radiotherapie stellt eine Möglichkeit der Behandlung intrakranieller Tumoren dar, bei denen eine chirurgische Resektion nicht oder nicht vollständig möglich ist. Ziel dieser Arbeit war der Vergleich der Dosisverteilung von Bestrahlungsplänen, die mittels fluenzmodulierter (IMRT) und 3D konformaler stereotaktisch geführter Bestrahlungstechnik (conformal beam) für Hypophysenadenome und petroclivale Meningeome erstellt wurden. Auf Basis des CT-Datensatzes eines Alderson-Phantoms erfolgten zunächst die systematische Untersuchung der IMRT Eingabeparameter und die Definition von Dosis-Volumen-Constraints für beide Tumorentitäten. Im Anschluss wurden die gewonnenen Erkenntnisse bei der fluenzmodulierten Bestrahlungsplanung von 10 realen Patienten, 5 je Tumorentität, angewendet. Zusätzlich wurde für jeden dieser Patienten ein 3D konformaler Bestrahlungsplan erstellt. Die Evaluation der Bestrahlungspläne erfolgte durch verschiedene quantitativer Parameter unter Einbeziehung der subjektiven Beurteilung der Dosisverteilung. Bei beiden Tumorentitäten lieferte in je 4 von 5 Fällen die IMRT einen Vorteil gegenüber der conformal beam Bestrahlung, der vor allem auf der besseren Erfassung, Dosishomogenität und höheren Median-Dosis im bestrahlten Zielvolumen (PTV) beruhte. Komplex geformte Zielvolumina profitierten dabei besonders von der Fluenzmodulation. Dem stand jedoch in einigen Fälle eine stärke Belastung der Risikoorgane (OAR) mit einer höheren Dosis und die generell höhere Anzahl notwendiger Monitoreinheiten gegenüber. Zuletzt wurde auf Basis von MatLAB eine Software entwickelt, welche die Verifikation von stereotaktisch geführten IMRT-Bestrahlungen und die Analyse von Winston-Lutz-Tests ermöglicht.

As técnicas radioterápicas evoluíram muito nas últimas décadas, destacando-se a utilização de feixes segmentados por colimadores de multifolhas, os quais permitem entregar maior quantidade de dose com maior precisão espacial. Os sistemas de planejamento em radioterapia (TPS), entretanto, são em grande parte fechados, com acesso restrito aos parâmetros de cálculo de dose. Desta forma, o presente trabalho teve como principal objetivo comparar valores de dose envolvidas em tratamentos radioterápicos, medidos com a técnica de dosimetria termoluminescente (TL), usando um objeto simulador antropomórfico (Alderson Rando Phantom - ARP) como paciente, com valores de referência extraídos dos TPS em simulações realistas de tratamento. O objeto simulador continha dosímetros TL de LiF (TLD100) posicionados na pelve, no tórax, na cabeça e no pescoço, a fim de que fossem monitoradas regiões com dose homogênea (como no volume alvo planejado - PTV), regiões com gradiente de dose e regiões afastadas do PTV. As irradiações foram feitas usando técnicas de radioterapia conformacional 3D e radioterapia por modulação da intensidade do feixe (IMRT). Quatro TPS foram utilizados: CadPlan, ECLIPSE, Helax-TMS e KonRad. Em algumas situações utilizaram-se algoritmos de cálculo implementados pelos fabricantes nos TPS; dois deles baseados em correção de heterogeneidades (Batho e pencil beam) e um deles baseado em convolução e superposição de feixes simulados (collapsed cone). Nos casos de irradiações com IMRT os algoritmos foram sempre usados. Paralelamente ao uso do ARP, utilizou-se um objeto simulador com água com objetivo de verificar o comportamento dos dosímetros TL expostos a feixes de fótons de alta energia, em comparação com câmaras de ionização cilíndricas do tipo Farmer (volume interno de 0,6 cm3). Além disso, esse objeto simulador possibilitou garantir a qualidade de suportes desenvolvidos para a câmara e para os dosímetros, nos casos de medidas em água. A irradiação da pelve do objeto simulador ARP, região com poucas heterogeneidades, revelou que o comportamento do material que o constitui é equivalente ao da água e, por isso, pode ser usado na simulação de tecido humano em feixes de radioterapia. Simulações de tratamentos revelaram compatibilidade entre valores medidos e planejados no interior do PTV, com discrepâncias menores que 2%; valores que estão dentro dos limites estabelecidos pelo ICRU62 (+7%/-5%, 2?). Nas regiões afastadas do PTV, todos os códigos de planejamento apresentaram discrepâncias relativamente grandes, evidenciando limitações no cálculo de componentes secondárias. Apesar dos algoritmos de cálculo aumentarem a concordância entre doses medidas e planejadas, não foi possível identificar diferenças entre os algoritmos pencil beam e collapsed cone. Em regiões onde havia alto gradiente de dose, as discrepâncias se tornam maiores devido à dificuldade em posicionar os dosímetros no mesmo ponto em que o cálculo é feito. Sistematicamente, observou-se que a técnica para radioterapia 3D apresenta valores de dose dentro dos limites preestabelecidos, enquanto IMRT mostra valores com maior exatidão. / The last decades noticed a massive improvement in radiotherapy techniques and the use of segmented beams produced by multileaf collimators. However, the dose radiation therapy planning systems (TPS) in use are characterized by the restriction of access to the calculation algorithms. The aim of this work was to compare dose values measured in an anthropomorphic phantom (Alderson Rando Phantom - ARP) to the reference dose values obtained from the TPS in real case simulations of radiotherapy treatments. Thermoluminescent dosimetry (TLD) technique was used to evaluate the doses. LiF dosimeters (TLD100) were positioned on the phantom pelvis, thorax, head and neck at homogeneous dose regions, as the Planned Target Volume (PTV), gradient dose regions, and areas far from PTV. The doses were delivered using two techniques, 3D conformal radiotherapy and Intensity Modulated Radiation Therapy (IMRT). Four TPS were used: CadPlan, ECLIPSE, Helax-TMS and KonRad. In several situations, calculation algorithms implemented in these planning systems were employed to take heterogeneities into account: two of them were correction-based algorithms (Batho and Pencil Beam) and one of them based in beam convolution-superposition (Collapsed Cone). Furthermore, a liquid water phantom was used to compare the TLD behavior to the Farmer thimble chamber (0,6 cc internal volume) results when exposed to high-energy photon beams. It was also possible to verify the quality of the PMMA supports that wer used in the calibration of the dosimeters on clinical beam, obtaining reliable results. Both the ARP pelvis and a water phantom showed similar behavior under irradiation, indicating that, in highly homogenous regions, the ARP material can be used to simulate human soft tissues under radiotherapy treatment. Inside the PTV, the dosimetry performed in the ARP, showed compatibility between measured and planned dose values, with discrepancies smaller than 2%, which are within the ICRU62 fixed limits (+7%/-5%, 2?). When the algorithms were used, a better agreement between the experimental and planned doses was achieved, but it was not possible to discriminate the Pencil Beam and Collapsed Cone algorithms. In regions with large dose gradients, the discrepancies between experimental and planned dose values are higher as the difficulties the position of the dosimeters are more critical. The measured doses, when the 3D radiotherapy technique was used, were within the ICRU62 pre-established limits whereas the IMRT technique provider more accurate values.

Die fraktionierte stereotaktisch geführte Radiotherapie stellt eine Möglichkeit der Behandlung intrakranieller Tumoren dar, bei denen eine chirurgische Resektion nicht oder nicht vollständig möglich ist. Ziel dieser Arbeit war der Vergleich der Dosisverteilung von Bestrahlungsplänen, die mittels fluenzmodulierter (IMRT) und 3D konformaler stereotaktisch geführter Bestrahlungstechnik (conformal beam) für Hypophysenadenome und petroclivale Meningeome erstellt wurden. Auf Basis des CT-Datensatzes eines Alderson-Phantoms erfolgten zunächst die systematische Untersuchung der IMRT Eingabeparameter und die Definition von Dosis-Volumen-Constraints für beide Tumorentitäten. Im Anschluss wurden die gewonnenen Erkenntnisse bei der fluenzmodulierten Bestrahlungsplanung von 10 realen Patienten, 5 je Tumorentität, angewendet. Zusätzlich wurde für jeden dieser Patienten ein 3D konformaler Bestrahlungsplan erstellt. Die Evaluation der Bestrahlungspläne erfolgte durch verschiedene quantitativer Parameter unter Einbeziehung der subjektiven Beurteilung der Dosisverteilung. Bei beiden Tumorentitäten lieferte in je 4 von 5 Fällen die IMRT einen Vorteil gegenüber der conformal beam Bestrahlung, der vor allem auf der besseren Erfassung, Dosishomogenität und höheren Median-Dosis im bestrahlten Zielvolumen (PTV) beruhte. Komplex geformte Zielvolumina profitierten dabei besonders von der Fluenzmodulation. Dem stand jedoch in einigen Fälle eine stärke Belastung der Risikoorgane (OAR) mit einer höheren Dosis und die generell höhere Anzahl notwendiger Monitoreinheiten gegenüber. Zuletzt wurde auf Basis von MatLAB eine Software entwickelt, welche die Verifikation von stereotaktisch geführten IMRT-Bestrahlungen und die Analyse von Winston-Lutz-Tests ermöglicht.

BACKGROUND:The aim of the study is to assess the effectiveness of intensity-modulated radiotherapy (IMRT) or image-guided radiotherapy (IGRT) for the prevention of retropharyngeal nodal recurrences in locally advanced head and neck cancer.METHODS:A retrospective review of 76 patients with head and neck cancer undergoing concurrent chemoradiation or postoperative radiotherapy with IMRT or IGRT who were at risk for retropharyngeal nodal recurrences because of anatomic site (hypopharynx, nasopharynx, oropharynx) and/or the presence of nodal metastases was undertaken.The prevalence of retropharyngeal nodal recurrences was assessed on follow-up positron emission tomography (PET)-CT scans.RESULTS:At a median follow-up of 22months (4-53months), no patient developed retropharyngeal nodal recurrences.CONCLUSION:Prophylactic irradiation of retropharyngeal lymph nodes with IMRT or IGRT provides effective regional control for individuals at risk for recurrence in these nodes.

Atualmente a radioterapia de intensidade modulada (IMRT) está sendo implementada em um número crescente de centros no Brasil. Como conseqüência disto, muitas instituições estão enfrentando o problema de executar um programa de controle de qualidade antes e durante a execução do IMRT na prática da rotina clínica. O objetivo deste trabalho é avaliar e propor uma metodologia para o controle de qualidade de tratamentos com IMRT. Uma câmara de ionização e um detector bidimensional foram utilizados para avaliar a dose absoluta total de todos os campos em um determinado ponto. A distribuição de dose relativa total de todos os campos foi medida com filmes radiocrômicos e um detector bidimensional em uma profundidade no objeto simulador. Uma comparação entre as distribuições de dose medidas e calculadas foi realizada usando o método do índice gama, avaliando o percentual de pontos que satisfazem os critérios de diferença dose de ±3% e distância de concordância de ±3 mm. Como resultado da dosimetria absoluta de 113 feixes de IMRT medidos com uma câmara de ionização e 81 feixes usando o detector bidimensional, foi proposto um nível de ação de cerca de ± 5% em relação ao sistema de planejamento e de tratamento para a verificação da dose em um único ponto na região de baixo gradiente de dose. A análise das medições com o detector bidimensional mostrou que o valor da função gama foi <1 para 97,7% dos dados e, para o filme, o valor da função gama foi <1 para 96,6% dos dados. Neste trabalho pode-se concluir que para uma entrega exata de dose em IMRT sliding-window com um colimador micro multilâminas, os parâmetros de dose total absoluta e distribuição de dose total relativa devem ser verificados por dosimetria absoluta e relativa respectivamente. / Intensity modulated radiation therapy (IMRT) is currently been implemented in a rapidly growing number of centers in Brazil. As consequence many institutions are now facing the problem of performing a comprehensive quality control program before and during the implementation of IMRT in the clinical routine practice. The aim of this work is to evaluate and propose a methodology for quality assurance in IMRT treatments. An ionization chamber and a two-dimensional array detector were performed to assess the absolute value of the total dose of all fields in one specific point. The relative total dose distribution of all fields was measured with a radiochromic film and a two-dimensional array at one depth in a phantom. A comparison between measured and calculated dose distributions was performed using the gamma-index method, assessing the percentage of points that meet the criteria of ±3% dose difference and ±3 mm distance to agreement. As a result of 113 tested IMRT beams using ionization chamber and 81 using two-dimensional array, the proposal was to take an action level of about ± 5% compared to the treatment planning systems and measurements, for the verification of the dose in a single point at the low gradient dose region. Analysis of the two-dimensional array measurements showed that the gamma value was <1 for 97.7% of the data and for the film the gamma value was <1 for 96.6% of the data. This can be concluded that for an accurate delivery of dose in sliding-window IMRT with micro multileaf collimator, the absolute value of the total dose and the relative total dose distribution should be checked by absolute and relative dosimetry respectively.