Dosimetric properties of an amorphous-silicon EPID used in continuous acquisition mode for application to dynamic and arc IMRT.

Dosimetric properties of an amorphous-silicon electronic portal imaging device (EPID) operated in a real-time acquisition mode were investigated. This mode will be essential for time-resolved dose verification of dynamic (sliding window) intensity modulated radiation therapy (IMRT) and intensity modulated arc radiation therapy (arc-IMRT). The EPID was used in continuous acquisition mode (i.e., "cine" mode) where individual sequential image frames are acquired in real time. The properties studied include dose linearity, reproducibility of response, and image stability. Results of using the continuous acquisition mode with several example treatments including dynamic IMRT, arc treatment, and single-arc-IMRT are compared to results using the well-studied integrated acquisition mode (i.e., "frame averaging" or "IMRT" mode). Real-time EPID response was also compared to real-time ion-chamber data for selected points in the deliveries. The example treatment deliveries in both continuous and integrated acquisition modes were converted to arbitrary EPID dose units via a calibration field. The summation of all acquired continuous mode images was compared using percentage dose difference to the single image acquired in the integrated mode using in-field pixels only (defined as those pixels > 10% of maximum, in-field signal). Using the continuous acquisition mode, the EPID response was not linear with dose. It was found that the continuous mode dose response corresponded approximately to dropping one image per acquisition session. Reproducibility of EPID response to low monitor units (MUs) was found to be poor but greatly improved with increasing MU. Open field profiles were found to be stable in the cross-plane direction but required several frames to become stable in the in-plane direction. However, both of these issues are clinically insignificant due to arc-IMRT deliveries requiring relatively large monitor units (> 100 MU). Analysis of the five IMRT, arc, and arc-IMRT tests revealed that all examples compared to within 2% of maximum dose for more than 95% of in-field pixels. The continuous acquisition mode is suited to time-resolved dosimetry applications including arc-IMRT and dynamic IMRT, giving comparable dose results to the well-studied integrated acquisition mode, although caution should be used in low MU applications. Time-resolved EPID dose information also compared well to time-resolved ion-chamber measurements.