in vivo patient dose verification of volumetric modulated arc therapy including stereotactic body radiation treatment applications using portal dose images

Abstract

The complexity of radiation therapy delivery has increased over the years due to advancements in computing and technical innovation. A system of dose delivery verification has the potential to catch treatment errors and therefore improve patient safety. The goal of this thesis was to create a portal image-based in vivo dose reconstruction model for volumetric modulated arc therapy (VMAT) deliveries, specifically for stereotactic body radiation therapy (SBRT). This model-based approach should be robust and feasible within a clinical setting. VMAT involves the modulation of dose rate, gantry speed, and aperture shaping while the treatment gantry (i.e., x-ray beam) rotates about the patient. In this work, portal images were acquired using an amorphous silicon electronic portal imaging device (a-Si EPID). A geometrical characterization of the linear accelerator (linac) during VMAT delivery was performed. An angle adjustment method was determined which improves each EPID’s angular accuracy to within ±1° of the true physical angle. SBRT delivers large doses over fewer fractions than conventional radiotherapy, therefore, any error during an SBRT delivery will have a greater impact on the patient. In this work, a robust, model-based SBRT-VMAT dose reconstruction verification system using EPID images was developed. The model was determined to be clinically feasible. The accuracy of a 3D in vivo dose reconstruction, using all the EPID images acquired during treatment, is sensitive to the chosen frame averaging per EPID image: the greater the frame averaging, the larger the reconstruction error. Optimization of the EPID frame averaging number as a function of average linac gantry speed and dose per fraction were determined. The EPID-based in vivo dose reconstruction model for SBRT-VMAT developed here was determined to be robust, accurate, and clinically feasible as long as adjustments were made in order to correct for EPID image geometrical errors and frame-averaging errors.