Comparison of level-I, -II and -III dosimetry quality audits for MV-photon beams emitted from medical linear accelerators

Background: Dosimetry audits have an important role to safely deliver the prescribed radiation dose to the cancerous area. It not only maintains and improve the treatment standards but also identify issues that are potentially harmful to the patients. This article presents the results of a comparative study of beam output measurements of a high-energy photon beam emitted from a medical linear accelerator. Materials and Methods: The measurements were performed by an International Atomic Energy Commission (IAEA) Quality Assurance/Quality Control survey mission (level-I dosimetry), a national Secondary Standard Dosimetry Laboratory (SSDL) experts (level-II dosimetry) and hospital physicists (level-III dosimetry). Glass dosimeters and cylindrical ionization chambers for level I and cylindrical ionization chambers for level-II and -III dosimetry were used in water by following IAEA TRS-398 protocol. Results: The level-I dosimetry results of glass dosimeters and ionization chambers were compared and percent deviations of -0.4 % and 0.3 % were found for 6 and 15 MV-photon beams, respectively. Similarly, level-II and -III dosimetry results with respect to level-I are in good agreement and within the optimum uncertainty level of ±5%. The annual level-II dosimetry quality audits (i.e., from 2010 to 2015) showed that only one dosimetry audit is out of the optimum level set for this study. However, it is within the tolerance level set for level-II quality audit programs (i.e., < ±5%). Conclusion: In conclusion, this article has demonstrated consistent radiotherapy radiation dosimetry results for MV-photons beams. It also showed quantitative information in-line with the currently achieved accuracy and precision of external megavoltage photon beam dosimetry. Furthermore, this study also established a baseline for current routine audits of radiotherapy dosimetry. Studies of this type are essential to appropriately follow the recommendations and procedures of the pertinent dosimetry protocols.