title: An in vivo dose verification method for SBRT-VMAT delivery using the EPID.
abstract: OBJECTIVE
  Radiation treatments have become increasingly more complex with the development of volumetric modulated arc therapy (VMAT) and the use of stereotactic body radiation therapy (SBRT). SBRT involves the delivery of substantially larger doses over fewer fractions than conventional therapy. SBRT-VMAT treatments will strongly benefit from in vivo patient dose verification, as any errors in delivery can be more detrimental to the radiobiology of the patient as compared to conventional therapy. Electronic portal imaging devices (EPIDs) are available on most commercial linear accelerators (Linacs) and their documented use for dosimetry makes them valuable tools for patient dose verification. In this work, the authors customize and validate a physics-based model which utilizes on-treatment EPID images to reconstruct the 3D dose delivered to the patient during SBRT-VMAT delivery.
  
  
  METHODS
  The SBRT Linac head, including jaws, multileaf collimators, and flattening filter, were modeled using Monte Carlo methods and verified with measured data. The simulation provides energy spectrum data that are used by their "forward" model to then accurately predict fluence generated by a SBRT beam at a plane above the patient. This fluence is then transported through the patient and then the dose to the phosphor layer in the EPID is calculated. Their "inverse" model back-projects the EPID measured focal fluence to a plane upstream of the patient and recombines it with the extra-focal fluence predicted by the forward model. This estimate of total delivered fluence is then forward projected onto the patient's density matrix and a collapsed cone convolution algorithm calculates the dose delivered to the patient. The model was tested by reconstructing the dose for two prostate, three lung, and two spine SBRT-VMAT treatment fractions delivered to an anthropomorphic phantom. It was further validated against actual patient data for a lung and spine SBRT-VMAT plan. The results were verified with the treatment planning system (TPS) (ECLIPSE AAA) dose calculation.
  
  
  RESULTS
  The SBRT-VMAT reconstruction model performed very well when compared to the TPS. A stringent 2%/2 mm χ-comparison calculation gave pass rates better than 91% for the prostate plans, 88% for the lung plans, and 86% for the spine plans for voxels containing 80% or more of the prescribed dose. Patient data were 86% for the lung and 95% for the spine. A 3%/3 mm χ-comparison was also performed and gave pass rates better than 93% for all plan types.
  
  
  CONCLUSIONS
  The authors have customized and validated a robust, physics-based model that calculates the delivered dose to a patient for SBRT-VMAT delivery using on-treatment EPID images. The accuracy of the results indicates that this approach is suitable for clinical implementation. Future work will incorporate this model into both offline and real-time clinical adaptive radiotherapy.
authors.affiliation: Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada and Medical Physics Department, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R3E 0V9, Canada.
authors.forename: P M
authors.initials: PM
authors.lastname: McCowan
authors.affiliation: Medical Physics Department, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R3E 0V9, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Van Uytven
authors.affiliation: Medical Physics Department, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R3E 0V9, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Van Beek
authors.affiliation: Medical Physics Department, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R3E 0V9, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Asuni
authors.affiliation: Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada; Medical Physics Department, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R3E 0V9, Canada; and Department of Radiology, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada.
authors.forename: B M C
authors.initials: BM
authors.lastname: McCurdy
mesh_terms: D000465:Algorithms; D002574:Cervical Vertebrae / Q000528:radiation effects; D003198:Computer Simulation; D006801:Humans; D008168:Lung / Q000528:radiation effects / Q000601:surgery; D008297:Male; D008962:Models, Theoretical; D009010:Monte Carlo Method; D019047:Phantoms, Imaging; D011467:Prostate / Q000528:radiation effects; D011874:Radiometry / Q000295:instrumentation / Q000379:methods; D016634:Radiosurgery / Q000295:instrumentation / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000295:instrumentation / Q000379:methods*; D012007:Rectum / Q000528:radiation effects; D014057:Tomography, X-Ray Computed