EPID sensitivity to delivery errors for pre-treatment verification of lung SBRT VMAT plans

Purpose: To study the sensitivity of an Electronic Portal Imaging Device (EPID) in detecting delivery errors for VMAT lung stereotactic body radiotherapy (SBRT) using the Collapsed Arc method. Methods: Baseline VMAT plans and plans with errors intentionally introduced were generated for 15 lung SBRT patients. Three types of errors were introduced by modifying collimator angles and multi-leaf collimator (MLC) field sizes (MLCFS) and MLC shifts by +/- 5, +/- 2, and +/- 1 degrees or millimeters. A total of 103 plans were measured with EPID on an Elekta Synergy Linear Accelerator (Agility MLC) and compared to both the original treatment planning system (TPS) Collapsed Arc dose matrix and the no-error plan baseline EPID measurements. Gamma analysis was performed using the OmniPro-I'mRT (IBA Dosimetry) software and gamma criteria of 1%/1 mm, 2%/1 mm, 2%/2 mm, and 3%/3. Results: When the error-introduced EPID measured dose matrices were compared to the TPS matrices, the majority of simulated errors were detected with gamma tolerance of 2%/1 mm and 1%/1 mm. When the error-introduced EPID measured dose matrices were compared to the baseline EPID measurements, all the MLCFS and MLC shift errors, and +/- 5 degrees collimator errors were detected using 2%/1 mm and 1%/1 mm gamma criteria. Conclusion: This work demonstrates the feasibility and effectiveness of the collapsed arc technique and EPID for pre-treatment verification of lung SBRT VMAT plans. The EPID was able to detect the majority of MLC and the larger collimator errors with sensitivity to errors depending on the gamma tolerances.