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Commissioning and dosimetric verification of volumetric modulated arc therapy for multiple modalities using electronic portal imaging device-based 3D dosimetry system: a novel approach

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The purpose of this study was to validate an electronic portal imaging device (EPID) based 3-dimensional (3D) dosimetry system for the commissioning of volumetric modulated arc therapy (VMAT) delivery for flattening filter (FF) and flattening filter free (FFF) modalities based on test suites developed according to American Association of Physicists in Medicine Task Group 119 (AAPM TG 119) and pre-treatment patient specific quality assurance (PSQA).With ionisation chamber, multiple-point measurement in various planes becomes extremely difficult and time-consuming, necessitating repeated exposure of the plan. The average agreement between measured and planned doses for TG plans is recommended to be within 3%, and both the ionisation chamber and PerFRACTION™ measurement were well within this prescribed limit. Both point dose differences with the planned dose and gamma passing rates are comparable with TG reported multi-institution results. From our study, we found that no significant differences were found between FF and FFF beams for measurements using PerFRACTION™ and ion chamber. Overall, PerFRACTION™ produces acceptable results to be used for commissioning and validating VMAT and for performing PSQA. The findings support the feasibility of integrating PerFRACTION™ into routine quality assurance procedures for VMAT delivery. Further multi-institutional studies are recommended to establish global baseline values and enhance the understanding of PerFRACTION’s capabilities in diverse clinical settings.

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The data from this study are available from the corresponding author upon reasonable request.


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The authors thank medical physics team members Mr Shubham Gadge, Mr Sarthak kar, Ms Dayawoti Pegu, Mr Rajashekhar and Mr Atyantkumar Hota and radiation therapists of HBCH&RC for their assistance during the work. The authors also would like to thank Mr Ventakesh from SNC for his valuable feedback.


The authors declare that no funds, grants, or other support were received during this work.

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The authors confirm the contribution to the paper as follows:

1. Study conception and design: Raghavendra Hajare, Rituraj Kalita.

2. Data collection, analysis and interpretation of results: all authors.

3. Manuscript preparation: Raghavendra Hajare, Sreelakshmi K K.

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Correspondence to Raghavendra Hajare.

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This study was approved by institutional ethics committee.

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Hajare, R., K K, S., Kumar, A. et al. Commissioning and dosimetric verification of volumetric modulated arc therapy for multiple modalities using electronic portal imaging device-based 3D dosimetry system: a novel approach. Radiol Phys Technol 17, 412–424 (2024).

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