ABSTRACT. The purpose of this work is to provide guidelines for the routine use of portal dosimetry and in vivo diode measurements to verify intensity-modulated radiotherapy (IMRT) treatments. To achieve tolerance levels that are sensitive enough to intercept problems, both the portal dosimetry and the in vivo procedure must be optimised. Portal dosimetry was improved by the introduction of an optimised twodimensional (2D) profile correction, which also accounted for the effect of backscatter from the R-arm. The scaled score, indicating the fraction of points not meeting the desired gamma evaluation criteria within the field opening, was determined as the parameter of interest. Using gamma criteria of a 3% dose difference and 3 mm distance to agreement, a ''scaled score'' threshold value of 1.5% was chosen to indicate excessive tongue and groove and other problems. The pre-treatment portal dosimetry quality assurance (QA) does not encompass verification of the patient dose calculation or position, and so it is complemented by in vivo diode measurements. Diode positioning is crucial in IMRT, and so we describe a method for diode positioning at any suitable point. We achieved 95% of IMRT field measurements within ÂĄ5% and 99% within ÂĄ8%, with improved accuracy being achieved over time owing to better positioning. Although the careful preparation and setup of the diode measurements can be time-consuming, this is compensated for by the time efficiency of the optimised procedure. Both methods are now easily absorbed into the routine work of the department. In many radiotherapy departments, routine treatment verification for conventional static treatment fields is performed during the first treatment session. This verification often consists of in vivo measurements with diodes (mostly on the beam axis) in combination with portal imaging of the treatment-field shapes superimposed on the patient's anatomy. Before the first treatment session, the treatment parameters are carefully reviewed by a qualified person and independent monitor unit (MU) calculations may be performed as an additional check.For dynamic intensity-modulated radiotherapy (IMRT) fields, a more extensive quality assurance (QA) protocol is considered to be good practice, the reasons for this being at least fourfold:(1) Both delivery and dose calculations are considerably more complex for dynamic IMRT fields than for conventional static fields.(2) Conventional portal imaging of the treatment fields provides images that are difficult to interpret because the modulated fluence is superimposed on the patient's anatomy.(3) Because of the presence of many dose gradients within the IMRT fields, conventional in vivo dosimetry on the beam axis is prone to large deviations, or can be meaningless when little dose is delivered on the beam axis.(4) Dosimetric treatment parameters, such as MU and multileaf collimator (MLC) shape (or movement pattern), depend on the individual patient plan and can vary substantially among patients as a function of the modulation. Hence,...