Routine individualised patient dosimetry using electronic portal imaging devices

Abstract 

Background and purpose

To analyse the results of routine EPID measurements for individualised patient dosimetry.

Materials and methods

Calibrated camera-based EPIDs were used to measure the central field dose, which was compared with a dose prediction at the EPID level. For transit dosimetry, dose data were calculated using patient transmission and scatter, and compared with measured values. Furthermore, measured transit dose data were back-projected to an in vivo dose value at 5cm depth in water (D₅) and directly compared with D₅ from the treatment planning system. Dose differences per treatment session were calculated by weighting dose values with the number of monitor units per beam. Reported errors were categorised and analysed for approximately 37,500 images from 2511 patients during a period of 24months.

Results

Pre-treatment measurements showed a mean dose difference per treatment session of 0.0±1.7% (1SD). Transfer errors were detected and corrected prior to the first treatment session. An accelerator output variation of about 4% was found between two weekly QC measurements. Patient dosimetry showed mean transit and D₅ dose differences of −0.7±5.2% (1SD) and −0.3±5.6% (1SD) per treatment session, respectively. Dose differences could be related to set-up errors, organ motion, erroneous density corrections and changes in patient anatomy.

Conclusions

EPIDs can be used routinely to accurately verify treatment parameter transfer and machine output. By applying transit and in vivo dosimetry, more insight can be obtained with respect to the different error sources influencing dose delivery to a patient.

Keywords: Portal dosimetry, in vivo dosimetry, Video-based EPID, Verification, Clinical study