EPID-based 3D dosimetry for pre-treatment FFF VMAT stereotactic body radiotherapy plan verification using dosimetry Check™

Purpose: The software Dosimetry Check (DC) reconstructs the 3D dose distribution on CT images data set by using EPID measured signal. This study aimed to evaluate DC for stereotactic body radiotherapy (SBRT) with unflattened photon beams (FFF) for dosimetric independent plan verification in pre-treatment modality. Methods: DC v.4.1 was configured for Varian TrueBeam STx FFF beams equipped with EPID aS-1200. The DC FFF models were tested using arc open fields (from 1 x 1 cm(2) to 15 x 15 cm(2)) and VMAT (Volumetric Modulated Arc Therapy) SBRT plans on phantom and patient CTs. DC dose distributions (D-DC) were compared with that calculated by Eclipse with Acums XB algorithm (D-AXB) and one measured by Octavius 1000 SRS detector (D-OCT). All differences were quantified in terms of the local 3D gamma passing rate (%GP), DVH and point dose differences. Results: DC was configured for FFF VMAT using an appropriate correction procedure. %GP(2%2mm) (mean+standard deviation) of D-OCT-D-DC was 96.3 +/- 2.7% for open fields whereas it was 90.1 +/- 5.9% for plans on homogeneous phantom CT. However, average %GP(3%3mm) of D-AXB-D-DC was 95.0 +/- 4.1 for treatments on patient CT. The fraction of plans passing the %GP(3%3mm) DQA tolerance level [10% (50%) of maximum dose threshold] were 20/20 (14/20) and 18/20 (16/20) for OCT on phantom CT and DC on patient CT, respectively. Conclusions: DC characterization for FFF beams was performed. For stereotactic VMAT plan verifications DC showed good agreement with TPS whereas underlined discrepancies with Octavius in the high dose regions. A customized tolerance level is required for EPID-based VMAT FFF pre-treatment verification when DC system is applied.