Abstract
Purpose: Medical linacs with dose rates as high as 2400 cGy/min at 10MV and 1400 cGy/min at 6MV have been clinically installed in many institutions. In reality, little is known about the accuracy of delivery at these high dose rates, particularly for complex treatment plans with simultaneous motion of gantry and multileaf‐collimator (MLC) aperture. We present measurements that examine the dosimetric accuracy of dynamically‐shaped RapidArc™ and IMRT beams at the highest available dose rates. Methods: An Eclipse™ ver. 8.9 planning system commissioned with the analytic anisotropy algorithm (AAA™) for the flattening‐filter‐free X‐ray beams of the Varian TrueBeam™ linear accelerator with a high‐definition 120‐leaf MLC (HDMLC) accessory was used to create RapidArc™ and IMRT lung‐ and abdominal‐target patient treatment plans deliverable in the FFF mode of TrueBeam™. Verification plans applied to a 22‐cm diameter cylindrical polymethylmethacrylate phantom configured as water‐ equivalent material with an electron density of 1.147 were delivered at the highest available dose rates. Dose was measured with TG‐51 cross‐ calibrated ScandiDos® Delta4™dual orthogonal‐plane 1069‐diode system for conventional 2 Gy fractions and for 15Gy–16.5 Gy fractions characteristic of stereotactic body radiotherapy(SBRT). Delivery was repeated with conventional dose rate (400 cGy/min). Measured results for the two dose rates were compared with each other, and with Eclipse treatment plans. Results: Excellent agreement was found between 2400 and 400 MU/min delivery. A sample 2‐arc RapidArc™ plan gave absolute relative dose difference ratio of 0.42%±0.21% for the 439 points measuring above 10% of prescription dose, with maximum dose difference over all 1069 measurement points being 0.76% of prescription. For a small‐field 1‐ arc plan, quantities were 0.96%±0.14% for 103 points, and maximum difference over all 1069 points was 1.61%. Gated versus ungated delivery for 200 cGy/fx showed negligible differences at both 400 and 2400 dose rates. Eclipse calculations demonstrated reasonable agreement with absolute dose measurement.
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