Two Years of Clinical Experience with DAVID

A Translucent Multi-Wire Detector for On-Line Verification of

Patient Treatments
B. Poppe1+2, H.K. Looe1+2, A. Rhmann1+2, Y. Upphoff2, K. Willborn2
and D. Harder3
1WG Medical Radiation Physics, Carl von Ossietzky University,Oldenburg Germany
2Pius-Hospital, Oldenburg, Germany
3Prof. emer., University of Gttingen, Germany

INTRODUCTION
A complete IMRT QA program based on a combination of the 2DARRAY (Type 10024, PTW-Freiburg, Germany) and the DAVID
system (PTW-Freiburg) has been developed and implemented in
our clinic by Poppe et al [1, 2, 3]. During the daily fraction, the
DAVID system is used for in-vivo verification of the delivery. In this
work, we are going to present this IMRT QA program and our latest
clinical experiences with the DAVID system.
MATERIALS AND METHODS
The DAVID system is a device for the permanent in-vivo verification
of IMRT photon beam profiles by a radiation detector positioned at
the radiation entrance side of the patient [1]. The system consists
of a flat, multi-wire transmission-type ionization chamber, placed in
the accessory holder of the linac. Each of detection wires of the
chamber is positioned exactly in the projection line of a MLC leaf
pair, the signal of each wire is proportional to the line integral of the
ionization density along this wire and thereby to the opening width
of this leaf pair.

Fig. 1. (a) The DAVID transmission detector array, serving for permanent
supervision of the MLC, at its operation position in the accessory holder of
the Siemens PRIMUS accelerator. (b) The 2D-ARRAY, serving for daily
accelerator checks and dosimetric plan verification, at its operation position in
the gantry mount of the Siemens PRIMUS accelerator.

RESULTS
The reference measurement for each IMRT plan is acquired with
the DAVID system in parallel to the dosimetric plan verification (Fig.
1). During daily treatment the corresponding signals in all channels
are re-measured with the system and compared to the reference
values. A warning is set if there is a deviation beyond a user
defined threshold.
The DAVID system has been used in the last 24 months in our
clinic to verify all IMRT deliveries. Overall more the 50.000
segments have been verified with the system.
During this time some minor deviations such as MLC decalibrations
and monitor chamber drifts have been detected.
Lost MLC Segments
For one patient an initial IMRT plan had been calculated with
Oncentra Master Plan (OMP), verified by the methods described
above and prepared for the first irradiation of the patient.
Meanwhile it appeared that a small correction to some of the subfields would improve the dose distribution. These minor
modifications were performed on a separate treatment planning
system (Helax) in which the manual correction of single leaves
within an IMRT plan sequence is possible. Both planning systems
are compatible to each other and use the same calculation
algorithms, therefore a DICOM export from OMP to Helax was
performed and the plan correction was made manually. The
modified plan was re-imported into the R&V system after the
modification. However, the MLC information of a few segments was
lost during this process, resulting in rectangular fields. In a
subsequent visual inspection this error was not detected by the
staff. As a second security step and to document the intended
changes in the dose distribution no new DAVID reference values
were collected before the initial irradiation of the modified plan.
Accordingly, during the first irradiation of the modified plan, the
DAVID system was able to detect the erroneous segments.

Fig. 2 Examples of the measured DAVID channel signals at gantry angle 0 for
some selected fractions. Artificial errors, introduced in the 15th, 19th, 23rd and
25th fraction, were detected as deviations from the reference signals. Figure
taken from (3).

DISCUSSION AND CONCLUSIONS

The DAVID system closes a gap by securing the daily monitoring of
the IMRT plan delivery for each segment. The results collected during
the day can be analyzed at regular intervals and errors can be
identified and corrected before the next fraction if necessary. With the
combination of the 2D-ARRAY and the DAVID system it is possible to
identify deviations in the machine parameters and their impacts on
the quality of the patient treatment.

REFERENCES
1. Poppe B, Thieke C, Beyer D, Kollhoff R, Djouguela A, Rhmann A, Willborn KC and Harder D (2006)
DAVID-a translucent multi-wire transmission ionisation chamber for in vivo verification of IMRT and
conformal irradiation techniques. Phys Med Biol 51:1237-48
2. Poppe B, Blechschmidt A, Djouguela A, Kollhoff R, Rubach A and Harder D (2006) Two-dimensional
ionisation-chamber arrays for IMRT plan verification. Med Phys 33:1005-15
3. Poppe B, Looe HK, Chofor N, Rhmann A., Harder D, Willborn K (2010) Clinical performance of a
transmission detector array for the permanent supervision of IMRT deliveries. Radiother Oncol 95, 158165