3D dose delivery verification using repeated cone-beam imaging and EPID dosimetry for stereotactic body radiotherapy of non-small cell lung cancer

Purpose: To implement a 3D dose verification procedure, based on in-room cone-beam CT imaging and portal dosimetry, for lung cancer patients treated with stereotactic body radiotherapy (SBRT). Materials and methods: MV cone-beam CT scans were made for patient positioning and calibrated for dose calculation purposes. Prior to treatment, the treatment fields were captured using a calibrated electronic portal imaging device (EPID). A Monte Carlo dose reconstruction model was used to estimate the 3D dose delivered to the patient inside the cone-beam CT images. The planned and delivered dose distributions were compared for 4 patients and 10 treatment fractions using dose-volume histograms and gamma analysis. Results: The gamma analysis showed a good agreement between the planned and delivered dose distributions for patients without changes in anatomy. The delivered mean dose per fraction inside the target volume deviated on average 1.1 +/- 1.4% from the planned dose. For the critical organs, only minor differences were observed between the reconstructed and planned dose. Conclusions: A method was presented that allows verification of the dose delivered in 3D for lung cancer patients treated with SBRT. The procedure is independent of the treatment planning system and uses in-room MV cone-beam CT imaging and portal dosimetry. (C) 2009 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 94 (2010) 188-194