Clinical practice and evaluation of electronic portal imaging device for VMAT quality assurance

Volumetric-modulated arc therapy (VMAT) is a novel extension of the intensity-modulated radiation therapy (IMRT) technique, which has brought challenges to dose verification. To perform VMAT pretreatment quality assurance, an electronic portal imaging device (EPID) can be applied. This study's aim was to evaluate EPID performance for VMAT dose verification. First, dosimetric characteristics of EPID were investigated. Then 10 selected VMAT dose plans were measured by EPID with the rotational method. The overall variation of EPID dosimetric characteristics was within 1.4% for VMAT. The film system serving as a conventional tool for verification showed good agreement both with EPID measurements ([94.1 ± 1.5]% with 3 mm/3% criteria) and treatment planning system (TPS) calculations ([97.4 ± 2.8]% with 3 mm/3% criteria). In addition, EPID measurements for VMAT presented good agreement with TPS calculations ([99.1 ± 0.6]% with 3 mm/3% criteria). The EPID system performed the robustness of potential error findings in TPS calculations and the delivery system. This study demonstrated that an EPID system can be used as a reliable and efficient quality assurance tool for VMAT dose verification.