EPID-based in vivo dosimetry for stereotactic body radiotherapy of non-small cell lung tumors: Initial clinical experience.

PURPOSE: EPID-based in vivo dosimetry (IVD) has been implemented for stereotactic body radiotherapy treatments of non-small cell lung cancer to check both isocenter dose and the treatment reproducibility comparing EPID portal images.

METHODS: 15 patients with lung tumors of small dimensions and treated with volumetric modulated arc therapy were enrolled for this initial experience. IVD tests supplied ratios R between in vivo reconstructed and planned isocenter doses. Moreover a γ-like analysis between daily EPID portal images and a reference one, in terms of percentage of points with γ-value smaller than 1, Pγ<1, and mean γ-values, γmean, using a local 3%-3mm criteria, was adopted to check the treatment reproducibility. Tolerance levels of 5% for R ratio, Pγ<1 higher than 90% and γmean lower than 0.67 were adopted.

RESULTS: A total of 160 EPID images, two images for each therapy session, were acquired during the treatment of the 15 patients. The overall mean of the R ratios was equal to 1.005±0.014 (1 SD), with 96.9% of tests within±5%. The 2D image γ-like analysis showed an overall γmean of 0.39±0.12 with 96.1% of tests within the tolerance level, and an average Pγ<1 value equal to 96.4±3.6% with 95.4% of tests with Pγ<1>90%. Paradigmatic discrepancies were observed in three patients: a set-up error and a patient morphological change were identified thanks to CBCT image analysis whereas the third discrepancy was not fully justified.

CONCLUSIONS: This procedure can provide improved patient safety as well as a first step to integrate IVD and CBCT dose recalculation.