title: Using an EPID for patient-specific VMAT quality assurance.
abstract: OBJECTIVE
  A patient-specific quality assurance (QA) method was developed to verify gantry-specific individual multileaf collimator (MLC) apertures (control points) in volumetric modulated arc therapy (VMAT) plans using an electronic portal imaging device (EPID).
  
  
  METHODS
  VMAT treatment plans were generated in an Eclipse treatment planning system (TPS). DICOM images from a Varian EPID (aS1000) acquired in continuous acquisition mode were used for pretreatment QA. Each cine image file contains the grayscale image of the MLC aperture related to its specific control point and the corresponding gantry angle information. The TPS MLC file of this RapidArc plan contains the leaf positions for all 177 control points (gantry angles). In-house software was developed that interpolates the measured images based on the gantry angle and overlays them with the MLC pattern for all control points. The 38% isointensity line was used to define the edge of the MLC leaves on the portal images. The software generates graphs and tables that provide analysis for the number of mismatched leaf positions for a chosen distance to agreement at each control point and the frequency in which each particular leaf mismatches for the entire arc.
  
  
  RESULTS
  Seven patients plans were analyzed using this method. The leaves with the highest mismatched rate were found to be treatment plan dependent.
  
  
  CONCLUSIONS
  This in-house software can be used to automatically verify the MLC leaf positions for all control points of VMAT plans using cine images acquired by an EPID.
authors.affiliation: Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA. mohammad.bakhtiari@roswellpark.org
authors.forename: M
authors.initials: M
authors.lastname: Bakhtiari
authors.forename: L
authors.initials: L
authors.lastname: Kumaraswamy
authors.forename: D W
authors.initials: DW
authors.lastname: Bailey
authors.forename: S
authors.initials: S
authors.lastname: de Boer
authors.forename: H K
authors.initials: HK
authors.lastname: Malhotra
authors.forename: M B
authors.initials: MB
authors.lastname: Podgorsak
mesh_terms: D055615:Electrical Equipment and Supplies; D004566:Electrodes; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000532:radiotherapy; D057285:Precision Medicine / Q000295:instrumentation / Q000379:methods*; D011786:Quality Control; D020266:Radiotherapy, Conformal / Q000295:instrumentation* / Q000592:standards*; D012984:Software