title: Evaluation of an aSi-EPID with flattening filter free beams: applicability to the GLAaS algorithm for portal dosimetry and first experience for pretreatment QA of RapidArc.
abstract: OBJECTIVE
  To demonstrate the feasibility of portal dosimetry with an amorphous silicon mega voltage imager for flattening filter free (FFF) photon beams by means of the GLAaS methodology and to validate it for pretreatment quality assurance of volumetric modulated arc therapy (RapidArc).
  
  
  METHODS
  The GLAaS algorithm, developed for flattened beams, was applied to FFF beams of nominal energy of 6 and 10 MV generated by a Varian TrueBeam (TB). The amorphous silicon electronic portal imager [named mega voltage imager (MVI) on TB] was used to generate integrated images that were converted into matrices of absorbed dose to water. To enable GLAaS use under the increased dose-per-pulse and dose-rate conditions of the FFF beams, new operational source-detector-distance (SDD) was identified to solve detector saturation issues. Empirical corrections were defined to account for the shape of the profiles of the FFF beams to expand the original methodology of beam profile and arm backscattering correction. GLAaS for FFF beams was validated on pretreatment verification of RapidArc plans for three different TB linacs. In addition, the first pretreatment results from clinical experience on 74 arcs were reported in terms of γ analysis.
  
  
  RESULTS
  MVI saturates at 100 cm SDD for FFF beams but this can be avoided if images are acquired at 150 cm for all nominal dose rates of FFF beams. Rotational stability of the gantry-imager system was tested and resulted in a minimal apparent imager displacement during rotation of 0.2 ± 0.2 mm at SDD = 150 cm. The accuracy of this approach was tested with three different Varian TrueBeam linacs from different institutes. Data were stratified per energy and machine and showed no dependence with beam quality and MLC model. The results from clinical pretreatment quality assurance, provided a gamma agreement index (GAI) in the field area for six and ten FFF beams of (99.8 ± 0.3)% and (99.5 ± 0.6)% with distance to agreement and dose difference criteria set to 3 mm/3% with 2 mm/2% thresholds, GAI resulted (95.7.0 ± 2.3)% and (97.2 ± 2.1)%.
  
  
  CONCLUSIONS
  The GLAaS methodology, introduced in clinical practice for conventional flattened photon beams for machine, IMRT, and RapidArc quality assurance, was successfully adapted for FFF beams of Varian TrueBeam Linac. The detector saturation effects could be eliminated if the portal images acquired at 150 cm for all nominal dose rates of FFF beams.
authors: IOSI, Oncology Institute of Southern Switzerland, Radiation Oncology Department, Medical Physics Unit, Bellinzona CH-6500, Switzerland.
authors: G
authors: G
authors: Nicolini
authors: A
authors: A
authors: Clivio
authors: E
authors: E
authors: Vanetti
authors: H
authors: H
authors: Krauss
authors: P
authors: P
authors: Fenoglietto
authors: L
authors: L
authors: Cozzi
authors: A
authors: A
authors: Fogliata
mesh_terms: D000465:Algorithms; D002138:Calibration; D004867:Equipment Design; D006801:Humans; D010315:Particle Accelerators; D017785:Photons; D011786:Quality Control; D011874:Radiometry / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D015203:Reproducibility of Results; D012542:Scattering, Radiation; D012825:Silicon / Q000737:chemistry*
chemical_list: D012825:Silicon