Quality assurance of gating response times for surface guided motion management treatment delivery using an electronic portal imaging detector

Gating response times of monitoring system/LINAC combinations for gated radiotherapy treatments are notoriously difficult to measure. This difficulty may reflect why the incorporation of gating response times is not thoroughly considered when creating treatment margins for gated radiotherapy treatments, however ignoring the effect of gating response time could lead to significant treatment inaccuracies. This study shows a methodology which measured gating response times for AlignRT/Varian Truebeam combination which appears to be applicable to any surface guided monitoring/Linac combination as well as those combinations which incorporate extended lag times (>200 ms). Beam on lag time appears to be measurably greater than beam off lag time. Although these gating response times are slower than other gating systems on the market, the advantages surface guided radiotherapy (SGRT) could potentially provide for treatment accuracy is discussed as well as demonstrating the lack of guidance regarding SGRT with respect to gated treatments.