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SU-G-BRB-11: On the Sensitivity of An EPID-Based 3D Dose Verification System to Detect Delivery Errors in VMAT Treatments.

PURPOSE
To investigate the sensitivity of an EPID-based 3D dose verification system to detect delivery errors in VMAT treatments.


METHODS
For this study 41 EPID-reconstructed 3D in vivo dose distributions of 15 different VMAT plans (H&N, lung, prostate and rectum) were selected. To simulate the effect of delivery errors, their TPS plans were modified by: 1) scaling of the monitor units by ±3% and ±6% and 2) systematic shifting of leaf bank positions by ±1mm, ±2mm and ±5mm. The 3D in vivo dose distributions where then compared to the unmodified and modified treatment plans. To determine the detectability of the various delivery errors, we made use of a receiver operator characteristic (ROC) methodology. True positive and false positive rates were calculated as a function of the γ-parameters γmean, γ1% (near-maximum γ) and the PTV dose parameter ΔD50 (i.e. D50 (EPID)-D50 (TPS)). The ROC curve is constructed by plotting the true positive rate vs. the false positive rate. The area under the ROC curve (AUC) then serves as a measure of the performance of the EPID dosimetry system in detecting a particular error; an ideal system has AUC=1.


RESULTS
The AUC ranges for the machine output errors and systematic leaf position errors were [0.64 - 0.93] and [0.48 - 0.92] respectively using γmean, [0.57 - 0.79] and [0.46 - 0.85] using γ1% and [0.61 - 0.77] and [0.48 - 0.62] using ΔD50 .


CONCLUSION
For the verification of VMAT deliveries, the parameter γmean is the best discriminator for the detection of systematic leaf position errors and monitor unit scaling errors. Compared to γmean and γ1%, the parameter ΔD50 performs worse as a discriminator in all cases.