title: Initial clinical experience performing patient treatment verification with an electronic portal imaging device transit dosimeter.
abstract: OBJECTIVE
  To prospectively evaluate a 2-dimensional transit dosimetry algorithm's performance on a patient population and to analyze the issues that would arise in a widespread clinical adoption of transit electronic portal imaging device (EPID) dosimetry.
  
  
  METHODS
  Eleven patients were enrolled on the protocol; 9 completed and were analyzed. Pretreatment intensity modulated radiation therapy (IMRT) patient-specific quality assurance was performed using a stringent local 3%, 3-mm γ criterion to verify that the planned fluence had been appropriately transferred to and delivered by the linear accelerator. Transit dosimetric EPID images were then acquired during treatment and compared offline with predicted transit images using a global 5%, 3-mm γ criterion.
  
  
  RESULTS
  There were 288 transit images analyzed. The overall γ pass rate was 89.1%±9.8% (average±1 SD). For the subset of images for which the linear accelerator couch did not interfere with the measurement, the γ pass rate was 95.7%±2.4%. A case study is presented in which the transit dosimetry algorithm was able to identify that a lung patient's bilateral pleural effusion had resolved in the time between the planning CT scan and the treatment.
  
  
  CONCLUSIONS
  The EPID transit dosimetry algorithm under consideration, previously described and verified in a phantom study, is feasible for use in treatment delivery verification for real patients. Two-dimensional EPID transit dosimetry can play an important role in indicating when a treatment delivery is inconsistent with the original plan.
authors.affiliation: Department of Applied Physics and Applied Mathematics, Columbia University, New York, New York; Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York. Electronic address: BerryS@MSKCC.org.
authors.forename: Sean L
authors.initials: SL
authors.lastname: Berry
authors.affiliation: Department of Radiation Oncology, Columbia University, New York, New York.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Polvorosa
authors.affiliation: Department of Radiation Oncology, Columbia University, New York, New York.
authors.forename: Simon
authors.initials: S
authors.lastname: Cheng
authors.affiliation: Department of Radiation Oncology, Columbia University, New York, New York.
authors.forename: Israel
authors.initials: I
authors.lastname: Deutsch
authors.affiliation: Department of Radiation Oncology, Columbia University, New York, New York.
authors.forename: K S Clifford
authors.initials: KS
authors.lastname: Chao
authors.affiliation: Department of Radiation Oncology, Columbia University, New York, New York.
authors.forename: Cheng-Shie
authors.initials: CS
authors.lastname: Wuu
mesh_terms: D000465:Algorithms; D001932:Brain Neoplasms / Q000532:radiotherapy; D005240:Feasibility Studies; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D009369:Neoplasms / Q000532:radiotherapy*; D010315:Particle Accelerators / Q000295:instrumentation*; D010996:Pleural Effusion / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000592:standards; D011859:Radiography; D011874:Radiometry / Q000295:instrumentation*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000592:standards*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods / Q000592:standards*