title: Verification of patient position and delivery of IMRT by electronic portal imaging.
abstract: OBJECTIVE
  The purpose of the work presented in this paper was to determine whether patient positioning and delivery errors could be detected using electronic portal images of intensity modulated radiotherapy (IMRT).
  
  
  METHODS
  We carried out a series of controlled experiments delivering an IMRT beam to a humanoid phantom using both the dynamic and multiple static field method of delivery. The beams were imaged, the images calibrated to remove the IMRT fluence variation and then compared with calibrated images of the reference beams without any delivery or position errors. The first set of experiments involved translating the position of the phantom both laterally and in a superior/inferior direction a distance of 1, 2, 5 and 10 mm. The phantom was also rotated 1 and 2 degrees . For the second set of measurements the phantom position was kept fixed and delivery errors were introduced to the beam. The delivery errors took the form of leaf position and segment intensity errors.
  
  
  RESULTS
  The method was able to detect shifts in the phantom position of 1 mm, leaf position errors of 2 mm, and dosimetry errors of 10% on a single segment of a 15 segment IMRT step and shoot delivery (significantly less than 1% of the total dose).
  
  
  CONCLUSIONS
  The results of this work have shown that the method of imaging the IMRT beam and calibrating the images to remove the intensity modulations could be a useful tool in verifying both the patient position and the delivery of the beam.
authors.affiliation: Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Trust, Sutton, Surrey SM2 5PT, UK.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Fielding
authors.forename: Philip M
authors.initials: PM
authors.lastname: Evans
authors.forename: Catharine H
authors.initials: CH
authors.lastname: Clark
mesh_terms: D016477:Artifacts; D002138:Calibration; D005471:Fluoroscopy; D006801:Humans; D011187:Posture; D020266:Radiotherapy, Conformal / Q000379:methods*; D015203:Reproducibility of Results; D014741:Video Recording