title: Development of an accurate EPID-based output measurement and dosimetric verification tool for electron beam therapy.
abstract: OBJECTIVE
  To develop an efficient and robust tool for output measurement and absolute dose verification of electron beam therapy by using a high spatial-resolution and high frame-rate amorphous silicon flat panel electronic portal imaging device (EPID).
  
  
  METHODS
  The dosimetric characteristics of the EPID, including saturation, linearity, and ghosting effect, were first investigated on a Varian Clinac 21EX accelerator. The response kernels of the individual pixels of the EPID to all available electron energies (6, 9, 12, 16, and 20 MeV) were calculated by using Monte Carlo (MC) simulations, which formed the basis to deconvolve an EPID raw images to the incident electron fluence map. The two-dimensional (2D) dose distribution at reference depths in water was obtained by using the constructed fluence map with a MC simulated pencil beam kernel with consideration of the geometric and structural information of the EPID. Output factor measurements were carried out with the EPID at a nominal source-surface distance of 100 cm for 2 × 2, 3 × 3, 6 × 6, 10 × 10, and 15 × 15 cm(2) fields for all available electron energies, and the results were compared with that measured in a solid water phantom using film and a Farmer-type ion chamber. The dose distributions at a reference depth specific to each energy and the flatness and symmetry of the 10 × 10 cm(2) electron beam were also measured using EPID, and the results were compared with ion chamber array and water scan measurements. Finally, three patient cases with various field sizes and irregular cutout shapes were also investigated.
  
  
  RESULTS
  EPID-measured dose changed linearly with the monitor units and showed little ghosting effect for dose rate up to 600 MU/min. The flatness and symmetry measured with the EPID were found to be consistent with ion chamber array and water scan measurements. The EPID-measured output factors for standard square fields of 2 × 2, 3 × 3, 6 × 6, 10 × 10, 15 × 15 cm(2) agreed with film and ion chamber measurements. The average discrepancy between EPID and ion chamber/film measurements was 0.81% ± 0.60% (SD) and 1.34% ± 0.75%, respectively. For the three clinical cases, the difference in output between the EPID- and ion chamber array measured values was found to be 1.13% ± 0.11%, 0.54% ± 0.10%, and 0.74% ± 0.11%, respectively. Furthermore, the γ-index analysis showed an excellent agreement between the EPID- and ion chamber array measured dose distributions: 100% of the pixels passed the criteria of 3%/3 mm. When the γ-index was set to be 2%/2 mm, the pass rate was found to be 99.0% ± 0.07%, 98.2% ± 0.14%, and 100% for the three cases.
  
  
  CONCLUSIONS
  The EPID dosimetry system developed in this work provides an accurate and reliable tool for routine output measurement and dosimetric verification of electron beam therapy. Coupled with its portability and ease of use, the proposed system promises to replace the current film-based approach for fast and reliable assessment of small and irregular electron field dosimetry.
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, Calilfornia 94305.
authors.forename: Aiping
authors.initials: A
authors.lastname: Ding
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, Calilfornia 94305.
authors.forename: Lei
authors.initials: L
authors.lastname: Xing
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, Calilfornia 94305.
authors.forename: Bin
authors.initials: B
authors.lastname: Han
mesh_terms: D004583:Electrons / Q000627:therapeutic use; D004867:Equipment Design; D011785:Quality Assurance, Health Care / Q000379:methods; D011874:Radiometry / Q000295:instrumentation* / Q000379:methods*; D011879:Radiotherapy Dosage; D061089:Radiotherapy, Image-Guided / Q000295:instrumentation* / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000295:instrumentation* / Q000379:methods*