3D EPID based dosimetry for pre-treatment verification of VMAT - methods and challenges

This article presents an overview of pre-treatment verification of volumetric modulated arc therapy (VMAT) with electronic portal imaging devices (EPIDs). Challenges to VMAT verification with EPIDs are discussed including EPID sag/flex during rotation, acquisition using cine-mode imaging, image artefacts during VMAT and determining the gantry angle for each image. The major methods that have been proposed to verify VMAT with EPIDs are introduced including those using or adapting commercial software systems and non-commercial implementations. Both two-dimensional and three-dimensional methods are reviewed.