The error observed in a measured portal dose image depends on how much its FS differs from the 30 x 40 cm2 calibration conditions. The proposed methods for correcting for FS specific backscatter effectively improved the ability of the EPID to perform dosimetric measurements. Correcting for FS specific backscatter is important for accurate EPID dosimetry and can be carried out using the methods presented within this investigation.

A prediction of the transit PDI behind a phantom or patient can be created for the purposes of treatment verification via an extension of the Van Esch through-air PDI algorithm. The results of the verification measurements through phantoms indicate that further investigation through patients during their treatments is warranted.

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Portal dose images acquired with an amorphous silicon electronic portal imaging device (EPID) suffer from artifacts related to backscattered radiation. The backscatter signal varies as a function of field size (FS) and location on the EPID. Most current portal dosimetry algorithms fail to account for the FS dependence. The ramifications of this omission are investigated and solutions for correcting the measured dose images for FS specific backscatter are proposed. Method and Materials: A series of open field dose images were obtained for field sizes ranging from 2x2 to 30x40 cm 2 and analyzed to determine the amount of backscatter present. Two methods to account for the relationship between FS and backscatter are offered: discrete FS specific correction matrices and a single generalized equation. Each approach was tested on the clinical dosimetric images for 10 patients, 49 treatment fields to see whether there was an improvement in the dosimetric result over the vendor's algorithm. Results: Backscatter manifests itself as an asymmetry in the measured signal primarily in the inplane direction. The maximum error is 3.6% for 10x10 and 12.5x12.5 cm 2 field sizes. The asymmetry decreased with increasing FS to 0.6% for fields larger than 30x30 cm 2. The dosimetric comparison between the measured and predicted dose images was significantly improved (p << .001) with the FS specific backscatter correction. The average percentage of points passing a 2%, 2mm gamma criteria increased from 90.6% to between 96.7% and 97.2%. Conclusion: The error observed in a measured portal dose image depends on how much its FS differs from the 30x40 cm 2 calibration conditions. The proposed methods for correcting for FS specific backscatter effectively improved the ability of the EPID to perform dosimetric measurements. Correcting for FS specific backscatter is important for accurate EPID dosimetry and can be carried out using the described methods.

Plan checks are important components of a robust quality assurance (QA) program. Recently, the American Association of Physicists in Medicine (AAPM) published two reports concerning plan and chart checking, Task Group (TG) 275 and Medical Physics Practice Guideline (MPPG) 11.A. The purpose of the current study was to crosswalk initial plan check failure modes revealed in TG 275 against our institutional QA program and local incident reporting data. Ten physicists reviewed 46 high-risk failure modes reported in Table S1.A.i of the TG 275 report. The committee identified steps in our planning process which sufficiently checked each failure mode. Failure modes that were not covered were noted for follow-up. A multidisciplinary committee reviewed the narratives of 1599 locally-reported incidents in our Radiation Oncology Incident Learning System (ROILS) database and categorized each into the high-risk TG 275 failure modes. We found that over half of the 46 high-risk failure modes, six of which were top-ten failure modes, were covered in part by daily contouring peer-review rounds, upstream of the traditional initial plan check. Five failure modes were not adequately covered, three of which concerned pregnancy, pacemakers, and prior dose. Of the 1599 incidents analyzed, 710 were germane to the initial plan check, 23.4% of which concerned missing pregnancy attestations. Most, however, were caught prior to CT simulation (98.8%). Physics review and initial plan check were the least efficacious checks, with error detection rates of 31.8% and 31.3%, respectively, for some failure modes. Our QA process that includes daily contouring rounds resulted in increased upstream error detection. This work has led to several initiatives in the department, including increased automation and enhancement of several policies and procedures. With TG 275 and MPPG 11.A as a guide, we strongly recommend that departments consider an internal chart checking policy and procedure review.