Comparison between Electronic Portal Imaging Devices and ion chamber matrix for intensity-modulated radiotherapy quality assurance

The treatment with intensity-modulated radiotherapy (IMRT) demands an individual and specific quality assurance procedure. The use of ion chamber matrix is a well establish method to dose distribution verifications, despite the lower spatial resolution. An alternative method arising is the use of the Electronic Portal Imaging Devices (EPIDs). The aim of this paper is to validate the EPID use for quality assurance of IMRT comparing it to the previous method employing an ion chamber matrix. We analyzed 10 treatment planning for different tumor sites and photons energies of the linac Trilogy (Varian Medical Systems). We used Sliding-window IMRT and the measurements were acquired in EPID and in Physikalisch-Technische Werkstätten (PTW) 2D Array seven29. Two different software were used to analyze the data: Verisoft version 4.0, for Array data; and Eclipse 8.6 with Portal Dosimetry for EPID data. The evaluation of concordance levels between measured and predicted images used the Gamma Index tool with 3% of dose difference and 3 mm of distance to agreement. The EPID showed worse results for approval percentiles, in average 2.17%, and bigger values of average gamma index, although its analysis confirmed the approvals of all planning. This happens because of the better sensitivity generated by the higher spatial resolution of the EPID, 0,784 mm against 1,0 cm of the Array, so it has bigger capacity to identify small dose variations. The EPID, jointly with the Portal Dosimetry, proved to be excellent tools to perform pre-treatment IMRT verifications, providing significant gain in dose distribution analysis. Also, the EPID is easier for positioning, for images manipulation, for data acquisition and analysis and has detection area 60% bigger. (author)