title: Fast, daily linac verification for segmented IMRT using electronic portal imaging.
abstract: OBJECTIVE
  Intensity modulated radiotherapy (IMRT) requires dedicated quality assurance (QA). Recently, we have published a method for fast (1-2 min) and accurate linac quality control for dynamic multileaf collimation, using a portal imaging device. This method is in routine use for daily leaf motion verification. The purpose of the present study was to develop an equivalent procedure for QA of IMRT with segmented (static) multileaf collimation (SMLC).
  
  
  METHODS
  The QA procedure is based on measurements performed during 3- to 8-month periods at Elekta, Siemens and Varian accelerators. On each measurement day, images were acquired for a field consisting of five 3 x 22 cm(2) segments. These 10 monitor unit (MU) segments were delivered in SMLC mode, moving the leaves from left to right. Deviations of realized leaf gap widths from the prescribed width were analysed to study the leaf positioning accuracy. To assess hysteresis in leaf positioning, the sequential delivery of the SMLC segments was also inverted. A static 20 x 20 cm(2) field was delivered with exposures between 1 and 50 MU to study the beam output and beam profile at low exposures. Comparisons with an ionisation chamber were made to verify the EPID dose measurements at low MU. Dedicated software was developed to improve the signal-to-noise ratio and to correct for image distortion.
  
  
  CONCLUSIONS
  The observed long-term leaf gap reproducibility (1 standard deviation) was 0.1 mm for the Varian, and 0.2 mm for the Siemens and the Elekta accelerators. In all cases the hysteresis was negligible. Down to the lowest MU, beam output measurements performed with the EPID agreed within 1+/-1% (1SD) with ionisation chamber measurements. These findings led to a fast (3-4 min) procedure for accurate, daily linac quality control for SMLC.
authors.affiliation: Department of Radiation Oncology, Erasmus MC/Daniel den Hoed Cancer Center, Rotterdam, The Netherlands. s.vieira@erasmusmc.nl
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Vieira
authors.forename: René A
authors.initials: RA
authors.lastname: Bolt
authors.forename: Maarten L P
authors.initials: ML
authors.lastname: Dirkx
authors.forename: Andries G
authors.initials: AG
authors.lastname: Visser
authors.forename: Ben J M
authors.initials: BJ
authors.lastname: Heijmen
mesh_terms: D002138:Calibration; D004583:Electrons; D004867:Equipment Design; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000532:radiotherapy*; D010315:Particle Accelerators; D019047:Phantoms, Imaging; D011786:Quality Control; D018787:Radiation Oncology / Q000295:instrumentation* / Q000379:methods; D011874:Radiometry; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000295:instrumentation* / Q000379:methods*; D015203:Reproducibility of Results