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. / May 2016

Two-dimensional transmission dosimetry in radiotherapy has been discussed in the literature for some time as being a potential method for in vivo dosimetry. However, it still remains to become a wide spread practice in radiotherapy clinics. This is most likely due to the variety in radiotherapy treatment sites and the challenges they would present in terms of detection and interpretation at the transmitted dose level. Thus, the full potential and limitations of applying transmission dosimetry in the presence of dosimetry errors still need to be demonstrated. This thesis is a theoretical evaluation of transmission dosimetry using the Pinnacle3 treatment planning system. The accuracy of predicting reliable and accurate absolute transmitted dose maps using the planning system dose algorithm for comparison with measured transmitted dose maps was initially investigated. The resolution in the dose calculations at the transmitted level was then evaluated for rectilinear and curved homogeneous phantoms and rectilinear inhomogeneous phantoms, followed by studies combining both surface curvature and heterogeneities using anthropomorphic phantoms. In order to perform transmitted dose calculations at clinically relevant beam focus-to-transmitted dose plane distances using clinical patient CT data it was first necessary to extend the CT volume. Finally, the thesis explored the efficacy of applying transmission dosimetry in the clinic by simulating realistic dosimetry errors in the planning system using patient treatment plans for a prostate, head and neck, and breast CRT (Conformal Radiotherapy) treatment. Any differences at the transmitted dose level were interpreted and quantified using the gamma formalism. To determine whether the transmitted dose alone was a sufficient indicator of the dosimetry errors, the magnitude in transmission dose differences were compared with those predicted at the midplane of the patient. Dose-Volume Histograms (DVHs) were also used to evaluate the clinical significance of the dose delivery errors on the target volume and surrounding healthy tissue structures. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1339807 / Thesis (Ph.D.) - University of Adelaide, School of Chemistry and Physics, 2008

<p>A commercially available amorphous silicon electronic portal imaging device (EPID) was studied with regard to its dosimetric properties and to determine its usefulness as a tool for dosimetric pre-treatment verification of radiotherapy treatment fields. The dosimetric properties that were studied include reproducibility over time, linearity with dose, dose rate dependence and ghosting effects. The pre-treatment verification is performed by acquiring dosimetric images with the EPID and comparing these images with predicted images, calculated by the treatment planning system. This method for verification was evaluated. Also, the calibration and configuration of the treatment planning system and of the EPID for dosimetric verification was performed and is presented here.</p><p>The dosimetric properties of the EPID were found to be suitable for the measurements for which it is intended. It is linear with dose and does not show significant dose rate dependence or ghosting effects. As a pre-treatment verification system it is accurate within 3% and 3mm for ~99% of a region around the irradiated area of the image.</p>

A commercially available amorphous silicon electronic portal imaging device (EPID) was studied with regard to its dosimetric properties and to determine its usefulness as a tool for dosimetric pre-treatment verification of radiotherapy treatment fields. The dosimetric properties that were studied include reproducibility over time, linearity with dose, dose rate dependence and ghosting effects. The pre-treatment verification is performed by acquiring dosimetric images with the EPID and comparing these images with predicted images, calculated by the treatment planning system. This method for verification was evaluated. Also, the calibration and configuration of the treatment planning system and of the EPID for dosimetric verification was performed and is presented here. The dosimetric properties of the EPID were found to be suitable for the measurements for which it is intended. It is linear with dose and does not show significant dose rate dependence or ghosting effects. As a pre-treatment verification system it is accurate within 3% and 3mm for ~99% of a region around the irradiated area of the image.

<p>Intensity-Modulated Radiation Treatment (IMRT) requires patient-specific quality assurance measurements, which can benefit from the convenience of using an Electronic Portal Imaging Device (EPID) for dose verification. However, EPIDs have limitations stemming from the non-uniform backscatter due to the support-arm as well as from scatter, glare, and an increased sensitivity to low-energy photons. None of these effects is typically accounted for in a treatment planning system (TPS) model, resulting in errors in calculated EPID response of up to 6%. This work addresses the non-uniform backscatter by directly incorporating a support-arm backscatter region into the TPS geometry. The shape of the backscatter region is adjusted iteratively until the TPS-calculated flood-field planar dose matches the flood-field EPID image The scatter, glare and increased low-energy response are addressed by using a radially-dependent Point-Spread Function (Kernel). The kernel is fitted using a least-squares method so that it best reproduces the EPID-acquired image for a checkerboard field. The backscatter-correction method is implemented for a Varian Clinac equipped with a 40 cm x 30 cm (512 x 384 pixel) EPID and a Pinnacle³ TPS and tested for several rectangular and IMRT fields. The scatter, glare and energy-response correction kernel is implemented and tested for a simulated checkerboard field and a simulated IMRT field. Agreement between the EPID-measured image and TPS-calculated planar dose map is seen to improve from 6% to 2% when the backscatter region is added to the Pinnacle³ model. Agreement between the simulated EPID images and simulated TPS images is improved from 14% to approx. 1% when the radially-dependent kernel is used. Simultaneous application of both the backscatter region and Point-Spread Function is a promising direction for future investigations.</p> / Master of Science (MSc)