Dosimetric performance of continuous EPID imaging in stereotactic treatment conditions

PurposeThis study aims at investigating the dosimetric characteristics of a Varian aS1000 EPID, focusing on its continuous acquisition mode under the challenging conditions that can be met in stereotactic radiotherapy verification.MethodsAn aS1000 EPID installed on a Varian TrueBeamSTx was irradiated with 6 and 10 MV unflattened and flattened photon beams. In order to avoid detector saturation, the source-to-detector distance (SDD) was set to 150 or 180 cm depending on the dose rate. EPID image sets were acquired in continuous mode (CM) and also in the commonly used integrated mode (IM) for comparison, to evaluate dose linearity (including dose rate dependence), repeatability, reproducibility, stability, ghosting effect and field size dependence.ResultsCM response linearity was found to be within 0.8% of IM and independent of dose rate. Response repeatability was slightly better for IM and FF beams, being in all cases within 0.9%. Reproducibility was within 0.6% for both modes and all beam qualities. Response stability between continuous frames varied within 1% for dynamic and static irradiations and for all the beam qualities, showing its independence from these parameters. Ghosting effect was not significant, being comparable to signal variations between continuous frames (±1%). Field size dependence in both modes agreed within 1%.ConclusionsThe dosimetric response of the aS1000 EPID in CM with FFF beams and high dose rates is comparable to that in IM and for flattened beams provided that the appropriate SDD is used. aS1000 EPID in continuous acquisition mode is therefore suitable for stereotactic applications.     

EPID in vivo dosimetry in RapidArc technique

Aim

The aim of the study was to estimate the dose at the reference point applying an aSi-EPID device in the course of patient treatment.

Materials and methods

The method assumes direct proportionality between EPID signal and dose delivered to the patient reference point during the treatment session. The procedure consists of treatment plan calculation for the actual patient in the arc technique. The plan was realized with an elliptic water-equivalent phantom. An ionization chamber inside the phantom measured the dose delivered to the reference point. Simultaneously, the EPID matrix measured the CU distribution. EPID signal was also registered during patient irradiation with the same treatment plan. The formula for in vivo dose calculation was based on the CU(g) function, EPID signal registered during therapy and the relation between the dose and EPID signal level measured for the phantom. In vivo dose was compared with dose planned with the treatment planning system.Irradiation was performed with a Clinac accelerator by Varian Medical Systems in the RapidArc technique. The Clinac was equipped with an EPID matrix (electronic portal image device) of aSi-1000. Treatment plans were calculated with the Eclipse/Helios system. The phantom was a Scanditronix/Wellhöfer Slab phantom, and the ionization chamber was a 0.6 ccm PTW chamber.

Results

In vivo dose calculations were performed for five patients. Planned dose at the reference point was 2 Gy for each treatment plan. Mean in vivo dose was in the range of 1.96–2.09.

Conclusions

Our method was shown to be appropriate for in vivo dose evaluation in the RapidArc technique.     

Quantifying the performance of two different types of commercial software programs for 3D patient dose reconstruction for prostate cancer patients: Machine log files vs. machine log files with EPID images

We clarified the reconstructed 3D dose difference between two different commercial software programs (Mobius3D v2.0 and PerFRACTION v1.6.4).Five prostate cancer patients treated with IMRT (74 Gy/37 Fr) were studied. Log files and cine EPID images were acquired for each fraction. 3D patient dose was reconstructed using log files (Mobius3D) or log files with EPID imaging (PerFRACTION). The treatment planning dose was re-calculated on homogeneous and heterogeneous phantoms, and log files and cine EPID images were acquired. Measured doses were compared with the reconstructed point doses in the phantom. Next, we compared dosimetric metrics (mean dose for PTV, rectum, and bladder) calculated by Mobius3D and PerFRACTION for all fractions from five patients.Dose difference at isocenter between measurement and reconstructed dose for two software programs was within 3.0% in both homogeneous and heterogeneous phantoms. Moreover, the dose difference was larger using skip arc plan than that using full arc plan, especially for PerFRACTION (e.g., dose difference at isocenter for PerFRACTION: 0.34% for full arc plan vs. −4.50% for skip arc plan in patient 1).For patients, differences in dosimetric parameters were within 1% for almost all fractions. PerFRACTION had wider range of dose difference between first fraction and the other fractions than Mobius3D (e.g., maximum difference: 0.50% for Mobius3D vs. 1.85% for PerFRACTION), possibly because EPID may detect some types of MLC positioning errors such as miscalibration errors or mechanical backlash which cannot be detected by log files, or that EPID data might include image acquisition failure and image noise.     

Role of “the frame cycle time” in portal dose imaging using an aS500-II EPID

IntroductionThis paper evaluates the role of an acquisition parameter, the frame cycle time “FCT”, in the performance of an aS500-II EPID.Materials and methodsThe work presented rests on the study of the Varian EPID aS500-II and the image acquisition system 3 (IAS3). We are interested in integrated acquisition using asynchronous mode. For better understanding the image acquisition operation, we investigated the influence of the “frame cycle time” on the speed of acquisition, the pixel value of the averaged gray-scale frame and the noise, using 6 and 15 MV X-ray beams and dose rates of 1–6 Gy/min on 2100 C/D Linacs.ResultsIn the integrated mode not synchronized to beam pulses, only one parameter the frame cycle time “FCT” influences the pixel value. The pixel value of the averaged gray-scale frame is proportional to this parameter. When the FCT <55 ms (speed of acquisition V_f/s > 18 frames/s), the speed of acquisition becomes unstable and leads to a fluctuation of the portal dose response. A timing instability and saturation are detected when the dose per frame exceeds 1.53 MU/frame. Rules were deduced to avoid saturation and to optimize this dosimetric mode.ConclusionThe choice of the acquisition parameter is essential for the accurate portal dose imaging.     

A comparison of electronic portal dosimetry verification methods for use in stereotactic radiotherapy

Three methods of transit dosimetry using Electronic Portal Imaging Devices (EPIDs) were investigated for use in routine in-vivo dosimetry for cranial stereotactic radiosurgery and radiotherapy. The approaches examined were (a) A full Monte Carlo (MC) simulation of radiation transport through the linear accelerator and patient; (b) Calculation of the expected fluence by a treatment planning system (TPS); (c) Point doses calculated along the central axis compared to doses calculated using parameters acquired using the EPID. A dosimetric comparison of each of the three methods predicted doses at the imager plane to within ±5% and a gamma comparison for the MC and TPS based approaches showed good agreement for a range of dose and distance to agreement criteria. The MC technique was most time consuming, followed by the TPS calculation with the point dose calculation significantly quicker than the other methods.     

An assessment of a 3D EPID-based dosimetry system using conventional two- and three-dimensional detectors for VMAT

PurposeTo provide a 3D dosimetric evaluation of a commercial portal dosimetry system using 2D/3D detectors under ideal conditions using VMAT.MethodsA 2D ion chamber array, radiochromic film and gel dosimeter were utilised to provide a dosimetric evaluation of transit phantom and pre-treatment ‘fluence’ EPID back-projected dose distributions for a standard VMAT plan. In-house 2D and 3D gamma methods compared pass statistics relative to each dosimeter and TPS dose distributions.ResultsFluence mode and transit EPID dose distributions back-projected onto phantom geometry produced 2D gamma pass rates in excess of 97% relative to other tested detectors and exported TPS dose planes when a 3%, 3 mm global gamma criterion was applied. Use of a gel dosimeter within a glass vial allowed comparison of measured 3D dose distributions versus EPID 3D dose and TPS calculated distributions. 3D gamma comparisons between modalities at 3%, 3 mm gave pass rates in excess of 92%. Use of fluence mode was indicative of transit results under ideal conditions with slightly reduced dose definition.Conclusions3D EPID back projected dose distributions were validated against detectors in both 2D and 3D. Cross validation of transit dose delivered to a patient is limited due to reasons of practicality and the tests presented are recommended as a guideline for 3D EPID dosimetry commissioning; allowing direct comparison between detector, TPS, fluence and transit modes. The results indicate achievable gamma scores for a complex VMAT plan in a homogenous phantom geometry and contributes to growing experience of 3D EPID dosimetry.     

QA of dynamic MLC based on EPID portal dosimetry

PurposeDynamic delivery of intensity modulated beams (dIMRT) requires not only accurate verification of leaf positioning but also a control on the speed of motion. The latter is a parameter that has a major impact on the dose delivered to the patient. Time consumed in quality assurance (QA) procedures is an issue of relevance in any radiotherapy department. Electronic portal imaging dosimetry (EPID) can be very efficient for routine tests. The purpose of this work is to investigate the ability of our EPID for detecting small errors in leaf positioning, and to present our daily QA procedures for dIMRT based on EPID.Methods and materialsA Varian 2100 CD Clinac equipped with an 80 leaf Millennium MLC and with amorphous silicon based EPID (aS500, Varian) is used. The daily QA program consists in performing: Stability check of the EPID signal, Garden fence test, Sweeping slit test, and Leaf speed test.Results and discussionThe EPID system exhibits good long term reproducibility. The mean portal dose at the centre of a 10 × 10 cm² static field was 1.002 ± 0.004 (range 1.013–0.995) for the period evaluated of 47 weeks. Garden fence test shows that leaf position errors of up to 0.2 mm can be detected. With the Sweeping slit test we are able to detect small deviations on the gap width and errors of individual leaves of 0.5 and 0.2 mm. With the Leaf speed test problems due to motor fatigue or friction between leaves can be detected.ConclusionsThis set of tests takes no longer than 5 min in the linac treatment room. With EPID dosimetry, a consistent daily QA program can be applied, giving complete information about positioning/speed MLC.     

In-vivo EPID dosimetry for IMRT and VMAT based on through-air predicted portal dose algorithm

We have adapted the methodology of Berry et al. (2012) for Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) treatments at a fixed source to imager distance (SID) based on the manufacturer’s through-air portal dose image prediction algorithm. In order to fix the SID a correction factor was introduced to account for the change in air gap between patient and imager. Commissioning data, collected with multiple field sizes, solid water thicknesses and air gaps, were acquired at 150 cm SID on the Varian aS1200 EPID. The method was verified using six IMRT and seven VMAT plans on up to three different phantoms. The method’s sensitivity and accuracy were investigated by introducing errors. A global 3%/3 mm gamma was used to assess the differences between the predicted and measured portal dose images. The effect of a varying air gap on EPID signal was found to be significant – varying by up to 30% with field size, phantom thickness, and air gap. All IMRT plans passed the 3%/3 mm gamma criteria by more than 95% on the three phantoms. 23 of 24 arcs from the VMAT plans passed the 3%/3 mm gamma criteria by more than 95%. This method was found to be sensitive to a range of potential errors. The presented approach provides fast and accurate in-vivo EPID dosimetry for IMRT and VMAT treatments and can potentially replace many pre-treatment verifications.     

A study on dosimetric properties of electronic portal imaging device and its use as a quality assurance tool in Volumetric Modulated Arc Therapy

Aim

In this study, the dosimetric properties of the electronic portal imaging device were examined and the quality assurance testing of Volumetric Modulated Arc Therapy was performed.

Background

RapidArc involves the variable dose rate, leaf speed and the gantry rotation. The imager was studied for the effects like dose, dose rate, field size, leaf speed and sag during gantry rotation.

Materials and methods

A Varian RapidArc machine equipped with 120 multileaf collimator and amorphous silicon detector was used for the study. The characteristics that are variable in RapidArc treatment were studied for the portal imager. The accuracy of a dynamic multileaf collimator position at different gantry angles and during gantry rotation was examined using the picket fence test. The control of the dose rate and gantry speed was verified using a test field irradiating seven strips of the same dose with different dose rate and gantry speeds. The control over leaf speed during arc was verified by irradiating four strips of different leaf speeds with the same dose in each strip. To verify the results, the RapidArc test procedure was compared with the X-Omat film and verified for a period of 6 weeks using EPID.

Results

The effect of gantry rotation on leaf accuracy was minimal. The dose in segments showed good agreement with mean deviation of 0.8% for dose rate control and 1.09% for leaf speed control over different gantry speeds.

Conclusion

The results provided a precise control of gantry speed, dose rate and leaf speeds during RapidArc delivery and were consistent over 6 weeks.     

In silico investigation of factors affecting the MV imaging performance of a novel water-equivalent EPID

PurposeA Geant4 model of a novel, water-equivalent electronic portal imaging device (EPID) prototype for radiotherapy imaging and dosimetry utilising an array of plastic scintillating fibres (PSFs) has been developed. Monte Carlo (MC) simulations were performed to quantify the PSF-EPID imaging performance and to investigate design aspects affecting performance for optimisation.MethodsUsing the Geant4 model, the PSF-EPID’s imaging performance for 6 MV photon beams was quantified in terms of its modulation transfer function (MTF), noise power spectrum (NPS) and detective quantum efficiency (DQE). Model parameters, including fibre dimensions, optical cladding reflectivity and scintillation yield, were varied to investigate impact on imaging performance.ResultsThe MC-calculated DQE(0) for the reference PSF-EPID geometry employing 30 mm fibres was approximately nine times greater than values reported for commercial EPIDs. When using 10 mm long fibres, the PSF-EPID DQE(0) was still approximately three times greater than that of a commercial EPID. Increased fibre length, cladding reflectivity and scintillation yield produced the greatest decreases in NPS and increases in DQE.ConclusionsThe potential to develop an optimised next-generation water-equivalent EPID with MV imaging performance at least comparable to commercial EPIDs has been demonstrated. Factors most important for optimising prototype design include fibre length, cladding reflectivity and scintillation yield.     

In-vivo dose measurements with MOSFET dosimeters during MV portal imaging

BackgroundThe purpose of this study was to investigate the feasibility of MOSFET dosimeter in measuring eye dose during 2D MV portal imaging for setup verification in radiotherapy.Materials and methodsThe in-vivo dose measurements were performed by placing the dosimeters over the eyes of 30 brain patients during the acquisition of portal images in linear accelerator by delivering 1 MU with the field sizes of 10 × 10 cm² and 15 × 15 cm².ResultsThe mean doses received by the left and right eyes of 10 out of 30 patients when both eyes were completely inside the anterior portal field were found to be 2.56 ± 0.2 cGy and 2.75 ± 0.2, respectively. Similarly, for next 10 patients out of the same 30 patients the mean doses to left and right eyes when both eyes were completely out of the anterior portal fields were found to be 0.13 ± 0.02 cGy and 0.17 ± 0.02 cGy, respectively. The mean doses to ipsilateral and contralateral eye for the last 10 patients when one eye was inside the anterior portal field were found to be 3.28 ± 0.2 cGy and 0.36 ± 0.1 cGy, respectively.ConclusionThe promising results obtained during 2D MV portal imaging using MOSFET have shown that this dosimeter is well suitable for assessing low doses during imaging thereby enabling to optimize the imaging procedure using the dosimetric data obtained. In addition, the documentation of the dose received by the patient during imaging procedure is possible with the help of an in-built software in conjunction with the MOSFET reader module.     

A Deep Learning-based correction to EPID dosimetry for attenuation and scatter in the Unity MR-Linac system

PurposeEPID dosimetry in the Unity MR-Linac system allows for reconstruction of absolute dose distributions within the patient geometry. Dose reconstruction is accurate for the parts of the beam arriving at the EPID through the MRI central unattenuated region, free of gradient coils, resulting in a maximum field size of ~10 × 22 cm² at isocentre. The purpose of this study is to develop a Deep Learning-based method to improve the accuracy of 2D EPID reconstructed dose distributions outside this central region, accounting for the effects of the extra attenuation and scatter.MethodsA U-Net was trained to correct EPID dose images calculated at the isocenter inside a cylindrical phantom using the corresponding TPS dose images as ground truth for training. The model was evaluated using a 5-fold cross validation procedure. The clinical validity of the U-Net corrected dose images (the so-called DEEPID dose images) was assessed with in vivo verification data of 45 large rectum IMRT fields. The sensitivity of DEEPID to leaf bank position errors (±1.5 mm) and ±5% MU delivery errors was also tested.ResultsCompared to the TPS, in vivo 2D DEEPID dose images showed an average γ-pass rate of 90.2% (72.6%–99.4%) outside the central unattenuated region. Without DEEPID correction, this number was 44.5% (4.0%–78.4%). DEEPID correctly detected the introduced delivery errors.ConclusionsDEEPID allows for accurate dose reconstruction using the entire EPID image, thus enabling dosimetric verification for field sizes up to ~19 × 22 cm² at isocentre. The method can be used to detect clinically relevant errors.     

Electronic portal imaging (EPI) on linear accelerator

The EPI has become available recently in the Oncoradiological Centre of Budapest. The purpose of this paper is to review the construction and operation of the electronic portal imaging devices (EPIDs). The different EPID systems as well the EPID technique vs. portal films are compared. The advantages in patient set-up and the detection of the set-up errors are discussed. The use of the EPID technique in the clinical everyday practice is detailed. Recommendations of the set-up error correction for the most often occurring failures is given.     

Evaluation of two-dimensional electronic portal imaging device using integrated images during volumetric modulated arc therapy for prostate cancer

BackgroundThe aim of the study was to evaluate analysis criteria for the identification of the presence of rectal gas during volumetric modulated arc therapy (VMAT) for prostate cancer patients by using electronic portal imaging device (EPID)-based in vivo dosimetry (IVD).Materials and methodsAll measurements were performed by determining the cumulative EPID images in an integrated acquisition mode and analyzed using PerFRACTION commercial software. Systematic setup errors were simulated by moving the anthropomorphic phantom in each translational and rotational direction. The inhomogeneity regions were also simulated by the I’mRT phantom attached to the Quasar phantom. The presence of small and large air cavities (12 and 48 cm³) was controlled by moving the Quasar phantom in several timings during VMAT. Sixteen prostate cancer patients received EPID-based IVD during VMAT.ResultsIn the phantom study, no systematic setup error was detected in the range that can happen in clinical (< 5-mm and < 3 degree). The pass rate of 2% dose difference (DD2%) in small and large air cavities was 98.74% and 79.05%, respectively, in the appearance of the air cavity after irradiation three quarter times. In the clinical study, some fractions caused a sharp decline in the DD2% pass rate. The proportion for DD2% < 90% was 13.4% of all fractions. Rectal gas was confirmed in 11.0% of fractions by acquiring kilo-voltage X-ray images after the treatment.ConclusionsOur results suggest that analysis criteria of 2% dose difference in EPID-based IVD was a suitable method for identification of rectal gas during VMAT for prostate cancer patients.     

Evaluation of application of EPID for rapid QC testing of linear accelerator

Aim

Evaluation of application of EPID for rapid QC testing of linear accelerator.

Incorrect dosimetric leaf separation in IMRT and VMAT treatment planning: Clinical impact and correlation with pretreatment quality assurance

PurposeDynamic treatment planning algorithms use a dosimetric leaf separation (DLS) parameter to model the multi-leaf collimator (MLC) characteristics. Here, we quantify the dosimetric impact of an incorrect DLS parameter and investigate whether common pretreatment quality assurance (QA) methods can detect this effect.Methods16 treatment plans with intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) technique for multiple treatment sites were calculated with a correct and incorrect setting of the DLS, corresponding to a MLC gap difference of 0.5 mm. Pretreatment verification QA was performed with a bi-planar diode array phantom and the electronic portal imaging device (EPID). Measurements were compared to the correct and incorrect planned doses using gamma evaluation with both global (G) and local (L) normalization. Correlation, specificity and sensitivity between the dose volume histogram (DVH) points for the planning target volume (PTV) and the gamma passing rates were calculated.ResultsThe change in PTV and organs at risk DVH parameters were 0.4–4.1%. Good correlation (>0.83) between the PTV_mean dose deviation and measured gamma passing rates was observed. Optimal gamma settings with 3%L/3 mm (per beam and composite plan) and 3%G/2 mm (composite plan) for the diode array phantom and 2%G/2 mm (composite plan) for the EPID system were found. Global normalization and per beam ROC analysis of the diode array phantom showed an area under the curve <0.6.ConclusionsA DLS error can worsen pretreatment QA using gamma analysis with reasonable credibility for the composite plan. A low detectability was demonstrated for a 3%G/3 mm per beam gamma setting.     

Radiomics analysis of EPID measurements for patient positioning error detection in thyroid associated ophthalmopathy radiotherapy

PurposeElectronic portal imaging detector (EPID)-based patient positioning verification is an important component of safe radiotherapy treatment delivery. In computer simulation studies, learning-based approaches have proven to be superior to conventional gamma analysis in the detection of positioning errors. To approximate a clinical scenario, the detectability of positioning errors via EPID measurements was assessed using radiomics analysis for patients with thyroid-associated ophthalmopathy.MethodsTreatment plans of 40 patients with thyroid-associated ophthalmopathy were delivered to a solid anthropomorphic head phantom. To simulate positioning errors, combinations of 0-, 2-, and 4-mm translation errors in the left–right (LR), superior-inferior (SI), and anterior-posterior (AP) directions were introduced to the phantom. The positioning errors-induced dose differences between measured portal dose images were used to predict the magnitude and direction of positioning errors. The detectability of positioning errors was assessed via radiomics analysis of the dose differences. Three classification models—support vector machine (SVM), k-nearest neighbors (KNN), and XGBoost—were used for the detection of positioning errors (positioning errors larger or smaller than 3 mm in an arbitrary direction) and direction classification (positioning errors larger or smaller than 3 mm in a specific direction). The receiver operating characteristic curve and the area under the ROC curve (AUC) were used to evaluate the performance of classification models.ResultsFor the detection of positioning errors, the AUC values of SVM, KNN, and XGBoost models were all above 0.90. For LR, SI, and AP direction classification, the highest AUC values were 0.76, 0.91, and 0.80, respectively.ConclusionsCombined radiomics and machine learning approaches are capable of detecting the magnitude and direction of positioning errors from EPID measurements. This study is a further step toward machine learning-based positioning error detection during treatment delivery with EPID measurements.     

Exploration of temporal stability and prognostic power of radiomic features based on electronic portal imaging device images

PurposeWe aimed to explore the temporal stability of radiomic features in the presence of tumor motion and the prognostic powers of temporally stable features.MethodsWe selected single fraction dynamic electronic portal imaging device (EPID) (n = 275 frames) and static digitally reconstructed radiographs (DRRs) of 11 lung cancer patients, who received stereotactic body radiation therapy (SBRT) under free breathing. Forty-seven statistical radiomic features, which consisted of 14 histogram-based features and 33 texture features derived from the graylevel co-occurrence and graylevel run-length matrices, were computed. The temporal stability was assessed by using a multiplication of the intra-class correlation coefficients (ICCs) between features derived from the EPID and DRR images at three quantization levels. The prognostic powers of the features were investigated using a different database of lung cancer patients (n = 221) based on a Kaplan-Meier survival analysis.ResultsFifteen radiomic features were found to be temporally stable for various quantization levels. Among these features, seven features have shown potentials for prognostic prediction in lung cancer patients.ConclusionsThis study suggests a novel approach to select temporally stable radiomic features, which could hold prognostic powers in lung cancer patients.     

A strategy to determine off-axis dosimetric leaf gap using OSLD and EPID

BackgroundThe aim of the study was to investigate the dosimetric feasibility of using optically stimulated luminescence dosimeters (OSLD) and an electronic portal imaging device (EPID) for central axis (CA X) and off-axis (OAX) dosimetric leaf gap (DLG) measurement.Materials and methodsThe Clinac 2100C/D linear accelerator equipped with Millennium-120 multileaf collimator (MLC) and EPID was utilized for this study. The DLG values at CA X and ± 1 cm OAX (1 cm superior and inferior to the CA X position, respectively along the plane perpendicular to MLC motion) were measured using OSLD (DLG_OSLD) and validated using ionization chamber dosimetry (DLG_ICD). The two-dimensional DLG map (2D DLG_EPID) was derived from the portal images of the DLG plan using a custom-developed software application that incorporated sliding aperture-specific correction factors.ResultsDLG_OSLD and DLG_ICD, though measured with diverse setup in different media, showed similar variation both at CA X and ± 1 cm OAX positions. The corresponding DLG_EPID values derived using aperture specific corrections were found to be in agreement with DLG_OSLD and DLG_ICD. The 2D DLG_EPID map provides insight into the varying patterns of the DLG with respect to each leaf pair at any position across the exposed field.ConclusionsCommensurate results of DLG_OSLD with DLG_ICD values have proven the efficacy of OSLD as an appropriate dosimeter for DLG measurement. The 2D DLG_{EP ID} map opens a potential pathway to accurately model the rounded-leaf end transmission with discrete leaf-specific DLG values for commissioning of a modern treatment planning system.