title: Overview of 3-year experience with large-scale electronic portal imaging device-based 3-dimensional transit dosimetry.
abstract: OBJECTIVE
  To assess the usefulness of electronic portal imaging device (EPID)-based 3-dimensional (3D) transit dosimetry in a radiation therapy department by analyzing a large set of dose verification results.
  
  
  METHODS
  In our institution, routine in vivo dose verification of all treatments is performed by means of 3D transit dosimetry using amorphous silicon EPIDs. The total 3D dose distribution is reconstructed using a back-projection algorithm and compared with the planned dose distribution using 3D gamma evaluation. Dose reconstruction and gamma evaluation software runs automatically in our clinic, and analysis results are (almost) immediately available. If a deviation exceeds our alert criteria, manual inspection is required. If necessary, additional phantom measurements are performed to separate patient-related errors from planning or delivery errors. Three-dimensional transit dosimetry results were analyzed per treatment site between 2012 and 2014 and the origin of the deviations was assessed.
  
  
  RESULTS
  In total, 4689 of 15,076 plans (31%) exceeded the alert criteria between 2012 and 2014. These alerts were patient-related and attributable to limitations of our back-projection and dose calculation algorithm or to external sources. Clinically relevant deviations were detected for approximately 1 of 430 patient treatments. Most of these errors were because of anatomical changes or deviations from the routine clinical procedure and would not have been detected by pretreatment verification. Although cone beam computed tomography scans yielded information about anatomical changes, their effect on the dose delivery was assessed quantitatively by means of 3D in vivo dosimetry.
  
  
  CONCLUSIONS
  EPID-based transit dosimetry is a fast and efficient dose verification technique. It provides more useful information and is less time-consuming than pretreatment verification measurements of intensity modulated radiation therapy and volumetric modulated arc therapy. Large-scale implementation of 3D transit dosimetry is therefore a powerful method to guarantee safe dose delivery during radiation therapy.
authors.affiliation: Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. Electronic address: b.mijnheer@nki.nl.
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Mijnheer
authors.affiliation: Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Patrick
authors.initials: P
authors.lastname: González
authors.affiliation: Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Igor
authors.initials: I
authors.lastname: Olaciregui-Ruiz
authors.affiliation: Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Roel A
authors.initials: RA
authors.lastname: Rozendaal
authors.affiliation: Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Marcel
authors.initials: M
authors.lastname: van Herk
authors.affiliation: Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Anton
authors.initials: A
authors.lastname: Mans
mesh_terms: D003198:Computer Simulation; D004867:Equipment Design; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008175:Lung Neoplasms / Q000532:radiotherapy*; D011874:Radiometry / Q000295:instrumentation* / Q000379:methods; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000295:instrumentation* / Q000379:methods; D013997:Time Factors