SU-F-T-384: Step and Shoot IMRT, VMAT and Autoplan VMAT Nasopharnyx Plan Robustness to Linear Accelerator Delivery Errors

Abstract

Purpose: To identify the robustness of different treatment techniques in respect to simulated linac errors on the dose distribution to the target volume and organs at risk for step and shoot IMRT (ssIMRT), VMAT and Autoplan generated VMAT nasopharynx plans. Methods: A nasopharynx patient dataset was retrospectively replanned with three different techniques: 7 beam ssIMRT, one arc manual generated VMAT and one arc automatically generated VMAT. Treatment simulated uncertainties: gantry, collimator, MLC field size and MLC shifts, were introduced into these plans at increments of 5,2,1,−1,−2 and −5 (degrees or mm) and recalculated in Pinnacle. The mean and maximum doses were calculated for the high dose PTV, parotids, brainstem, and spinal cord and then compared to the original baseline plan. Results: Simulated gantry angle errors have <1% effect on the PTV, ssIMRT is most sensitive. The small collimator errors (±1 and ±2 degrees) impacted the mean PTV dose by <2% for all techniques, however for the ±5 degree errors mean target varied by up to 7% for the Autoplan VMAT and 10% for the max dose to the spinal cord and brain stem, seen in all techniques. The simulated MLC shifts introduced the largest errors for the Autoplan VMAT, with the larger MLC modulation presumably being the cause. The most critical error observed, was the MLC field size error, where even small errors of 1 mm, caused significant changes to both the PTV and the OAR. The ssIMRT is the least sensitive and the Autoplan the most sensitive, with target errors of up to 20% over and under dosages observed. Conclusion: For a nasopharynx patient the plan robustness observed is highest for the ssIMRT plan and lowest for the Autoplan generated VMAT plan. This could be caused by the more complex MLC modulation seen for the VMAT plans. This project is supported by a grant from NSW Cancer Council.