title: Daily QA of linear accelerators using only EPID and OBI.
abstract: OBJECTIVE
  As treatment delivery becomes more complex, there is a pressing need for robust quality assurance (QA) tools to improve efficiency and comprehensiveness while simultaneously maintaining high accuracy and sensitivity. This work aims to present the hardware and software tools developed for comprehensive QA of linear accelerator (LINAC) using only electronic portal imaging devices (EPIDs) and kV flat panel detectors.
  
  
  METHODS
  A daily QA phantom, which includes two orthogonally positioned phantoms for QA of MV-beams and kV onboard imaging (OBI) is suspended from the gantry accessory holder to test both geometric and dosimetric components of a LINAC and an OBI. The MV component consists of a 0.5 cm water-equivalent plastic sheet incorporating 11 circular steel plugs for transmission measurements through multiple thicknesses and one resolution plug for MV-image quality testing. The kV-phantom consists of a Leeds phantom (TOR-18 FG phantom supplied by Varian) for testing low and high contrast resolutions. In the developed process, the existing LINAC tools were used to automate daily acquisition of MV and kV images and software tools were developed for simultaneous analysis of these images. A method was developed to derive and evaluate traditional QA parameters from these images [output, flatness, symmetry, uniformity, TPR20/10, and positional accuracy of the jaws and multileaf collimators (MLCs)]. The EPID-based daily QA tools were validated by performing measurements on a detuned 6 MV beam to test its effectiveness in detecting errors in output, symmetry, energy, and MLC positions. The developed QA process was clinically commissioned, implemented, and evaluated on a Varian TrueBeam LINAC (Varian Medical System, Palo Alto, CA) over a period of three months.
  
  
  RESULTS
  Machine output constancy measured with an EPID (as compared against a calibrated ion-chamber) is shown to be within ±0.5%. Beam symmetry and flatness deviations measured using an EPID and a 2D ion-chamber array agree within ±0.5% and ±1.2% for crossline and inline profiles, respectively. MLC position errors of 0.5 mm can be detected using a picket fence test. The field size and phantom positioning accuracy can be determined within 0.5 mm. The entire daily QA process takes ∼15 min to perform tests for 5 photon beams, MLC tests, and imaging checks.
  
  
  CONCLUSIONS
  The exclusive use of EPID-based QA tools, including a QA phantom and simultaneous analysis software tools, has been demonstrated as a viable, efficient, and comprehensive process for daily evaluation of LINAC performance.
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, Missouri 63110.
authors.forename: Baozhou
authors.initials: B
authors.lastname: Sun
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, Missouri 63110.
authors.forename: S Murty
authors.initials: SM
authors.lastname: Goddu
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, Missouri 63110.
authors.forename: Sridhar
authors.initials: S
authors.lastname: Yaddanapudi
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, Missouri 63110.
authors.forename: Camille
authors.initials: C
authors.lastname: Noel
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, Missouri 63110.
authors.forename: Hua
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, Missouri 63110.
authors.forename: Bin
authors.initials: B
authors.lastname: Cai
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, Missouri 63110.
authors.forename: James
authors.initials: J
authors.lastname: Kavanaugh
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, Missouri 63110.
authors.forename: Sasa
authors.initials: S
authors.lastname: Mutic
mesh_terms: D055615:Electrical Equipment and Supplies; D007091:Image Processing, Computer-Assisted; D010315:Particle Accelerators / Q000592:standards*; D019047:Phantoms, Imaging; D011786:Quality Control; D050397:Radiotherapy, Intensity-Modulated; D013997:Time Factors