Current Practices and Clinical Implementation of Electronic Portal Imaging Device-based Dosimetry in Indian Radiotherapy Centres: A National Survey

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Purpose: This study aims to assess the current prevalence, utilization patterns, and operational challenges of electronic portal imaging device (EPID)-based dosimetry systems in Indian radiotherapy centres. Materials and Methods: A multiple-choice survey was distributed through Google Forms to medical physicists in India. The four-section survey covered treatment techniques, EPID availability and dosimetry, alternative detectors, and future challenges. Responses were limited to one per institution, with follow-up reminders. Results: A total of 237 responses were received with a response rate of 62.2%. Among these, 73% of institutions currently use EPID-based dosimetry systems. Of these users, 42.2% rely on EPID for daily quality assurance (QA), and 62.4% of institutions use EPID for more than 50% of their total QA workflow. The primary tasks performed using EPID systems include patient-specific QA (PSQA) for intensity modulated radiation therapy (100%), periodic machine QA (58.4%), PSQA for stereotactic radiation therapy/stereotactic body radiation therapy (48.6%), machine commissioning (18.5%), and in vivo dosimetry (10.4%). Among institutions not currently using EPID due to nonavailability, 89.1% expressed willingness to adopt it for PSQA in the future. Major challenges in implementing EPID dosimetry were software limitations (34.2%) and maintenance and calibration issues (35.0%). After adopting EPID dosimetry, 79.8% of institutions observed improvements compared to conventional detectors. In addition, 93.7% of institutions believed that EPID dosimetry implementation would reduce physicist workload through automated software and resource optimization. Conclusion: This study reveals the widespread use of EPID systems and highlights that implementation offers certain advantages. However, issues such as software limitations, high initial cost, and the need for affordable or free resources remain barriers to wider adoption.

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