Comprehensive fluence model for absolute portal dose image prediction.

Amorphous silicon (a-Si) electronic portal imaging devices (EPIDs) continue to be investigated as treatment verification tools, with a particular focus on intensity modulated radiation therapy (IMRT). This verification could be accomplished through a comparison of measured portal images to predicted portal dose images. A general fluence determination tailored to portal dose image prediction would be a great asset in order to model the complex modulation of IMRT. A proposed physics-based parameter fluence model was commissioned by matching predicted EPID images to corresponding measured EPID images of multileaf collimator (MLC) defined fields. The two-source fluence model was composed of a focal Gaussian and an extrafocal Gaussian-like source. Specific aspects of the MLC and secondary collimators were also modeled (e.g., jaw and MLC transmission factors, MLC rounded leaf tips, tongue and groove effect, interleaf leakage, and leaf offsets). Several unique aspects of the model were developed based on the results of detailed Monte Carlo simulations of the linear accelerator including (1) use of a non-Gaussian extrafocal fluence source function, (2) separate energy spectra used for focal and extrafocal fluence, and (3) different off-axis energy spectra softening used for focal and extrafocal fluences. The predicted energy fluence was then convolved with Monte Carlo generated, EPID-specific dose kernels to convert incident fluence to dose delivered to the EPID. Measured EPID data were obtained with an a-Si EPID for various MLC-defined fields (from 1 x 1 to 20 x 20 cm2) over a range of source-to-detector distances. These measured profiles were used to determine the fluence model parameters in a process analogous to the commissioning of a treatment planning system. The resulting model was tested on 20 clinical IMRT plans, including ten prostate and ten oropharyngeal cases. The model predicted the open-field profiles within 2%, 2 mm, while a mean of 96.6% of pixels over all IMRT fields was in agreement with the 2%, 3 mm criteria. This model demonstrates accuracy commensurate to existing methods for IMRT pretreatment verification with portal dose image prediction of complex clinical examples (< 2%, 3 mm).