Performance of a Full-Scale Upstream MAPS-Based Verification Device for Radiotherapy.

Intensity-modulated radiotherapy is a widely used technique for accurately targeting cancerous tumours in difficult locations using dynamically shaped beams. This is ideally accompanied by real-time independent verification. Monolithic active pixel sensors are a viable candidate for providing upstream beam monitoring during treatment. We have already demonstrated that a Monolithic Active Pixel Sensor (MAPS)-based system can fulfill all clinical requirements except for the minimum required size. Here, we report the performance of a large-scale demonstrator system consisting of a matrix of 2 × 2 sensors, which is large enough to cover almost all radiotherapy treatment fields when affixed to the shadow tray of the LINAC head. When building a matrix structure, a small dead area is inevitable. Here, we report that with a newly developed position algorithm, leaf positions can be reconstructed over the entire range with a position resolution of below ∼200 μm in the centre of the sensor, which worsens to just below 300 μm in the middle of the gap between two sensors. A leaf position resolution below 300 μm results in a dose error below 2%, which is good enough for clinical deployment.