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Improving dose delivery accuracy with EPID in vivo dosimetry: results from a multicenter study

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Abstract

Purpose

To investigate critical aspects and effectiveness of in vivo dosimetry (IVD) tests obtained by an electronic portal imaging device (EPID) in a multicenter and multisystem context.

Materials and methods

Eight centers with three commercial systems—SoftDiso (SD, Best Medical Italy, Chianciano, Italy), Dosimetry Check (DC, Math Resolution, LCC), and PerFRACTION (PF, Sun Nuclear Corporation, SNC, Melbourne, FL)—collected IVD results for a total of 2002 patients and 32,276 tests. Data are summarized for IVD software, radiotherapy technique, and anatomical site. Every center reported the number of patients and tests analyzed, and the percentage of tests outside of the tolerance level (OTL%). OTL% was categorized as being due to incorrect patient setup, incorrect use of immobilization devices, incorrect dose computation, anatomical variations, and unknown causes.

Results

The three systems use different approaches and customized alert indices, based on local protocols. For Volumetric Modulated Arc Therapy (VMAT) treatments OTL% mean values were up to 8.9% for SD, 18.0% for DC, and 16.0% for PF. Errors due to “anatomical variations” for head and neck were up to 9.0% for SD and DC and 8.0% for PF systems, while for abdomen and pelvis/prostate treatments were up to 9%, 17.0%, and 9.0% for SD, DC, and PF, respectively. The comparison among techniques gave 3% for Stereotactic Body Radiation Therapy, 7.0% (range 4.7–8.9%) for VMAT, 10.4% (range 7.0–12.2%) for Intensity Modulated Radiation Therapy, and 13.2% (range 8.8–21.0%) for 3D Conformal Radiation Therapy.

Conclusion

The results obtained with different IVD software and among centers were consistent and showed an acceptable homogeneity. EPID IVD was effective in intercepting important errors.

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Authors and Affiliations

  1. S. C. Fisica Sanitaria Firenze-Empoli, Medical Physics Unit of Radiation Oncology Dept., Azienda Sanitaria USL Toscana Centro Florence, Via dell’Antella 58, 50012, Bagno a Ripoli, Firenze, Italy

    M. Esposito Ph. D.

  2. UOC di Fisica Sanitaria, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy

    A. Piermattei M. Sc., A. Fidanzio M. Sc. & F. Greco M. Sc.

  3. Medical Physics, Candiolo Cancer Institute—FPO IRCCS, Turin, Italy

    S. Bresciani M. Sc. & L. Botez M. Sc.

  4. Department of Radiation Oncology, Sichuan Cancer Hospital, Chengdu, China

    L. C. Orlandini M. Sc.

  5. Dipartimento di Radioterapia, Università di Chieti, Chieti, Italy

    M. D. Falco M. Sc. & S. Giancaterino M. Sc.

  6. Medical Physics Unit, Fondazione di ricerca e cura “Giovanni Paolo II”, Campobasso, Italy

    S. Cilla Ph. D. & A. Ianiro M. Sc.

  7. OGP S. Camillo de Lellis, Rieti, Italy

    R. Nigro M. Sc. & S. Riccardi M. Sc.

  8. AUSL Piacenza, Piacenza, Italy

    E. Villaggi M. Sc.

  9. S. C. Fisica Sanitaria Firenze-Empoli, Azienda Sanitaria USL Toscana Centro Florence, Florence, Italy

    S. Russo M. Sc.

  10. S.C. Fisica Sanitaria, A.O. Ordine Mauriziano di Torino, Torino, Italy

    M. Stasi M. Sc.

Authors
  1. M. Esposito Ph. D.
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  2. A. Piermattei M. Sc.
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  3. S. Bresciani M. Sc.
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  4. L. C. Orlandini M. Sc.
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  5. M. D. Falco M. Sc.
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  6. S. Giancaterino M. Sc.
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  7. S. Cilla Ph. D.
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  8. A. Ianiro M. Sc.
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  9. R. Nigro M. Sc.
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  10. L. Botez M. Sc.
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  11. S. Riccardi M. Sc.
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  12. A. Fidanzio M. Sc.
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  13. F. Greco M. Sc.
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  14. E. Villaggi M. Sc.
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  15. S. Russo M. Sc.
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  16. M. Stasi M. Sc.
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Consortia

Working Group EPID In Vivo Dosimetry of the Italian Association of Medical Physics AIFM

Corresponding author

Correspondence to M. Esposito Ph. D..

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Conflict of interest

M. Esposito, A. Piermattei, S. Bresciani, L.C. Orlandini, M.D. Falco, S. Giancaterino, S. Cilla, A. Ianiro, R. Nigro, L. Botez, S. Riccardi, A. Fidanzio, F. Greco, E. Villaggi, S. Russo, and M. Stasi declare that they have no competing interests. The authors received no financial support for the research, authorship, and publication of this article.

Ethical standards

This study was performed according to the national legislations and the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Esposito, M., Piermattei, A., Bresciani, S. et al. Improving dose delivery accuracy with EPID in vivo dosimetry: results from a multicenter study. Strahlenther Onkol 197, 633–643 (2021). https://doi.org/10.1007/s00066-021-01749-6

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  • DOI: https://doi.org/10.1007/s00066-021-01749-6

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