6X FFF Research Articles

Fixed-Field IMRT for Cervix Carcinoma Patients on an MR-LINAC Platform: Dosimetric Feasibility and Challenges

To investigate the impact of MR-LINAC performance characteristics and inverse planning implementation on the feasibility of fixed-field IMRT for cervix carcinoma patients by benchmarking MR-LINAC plans against clinically used VMAT plans in a single institution study and multi-institutional treatment planning challenge. For 10 cervix cancer patients who had previously received Linac-based VMAT, new treatment plans were optimized for MR-LINAC IMRT using 6X FFF fixed fields with maximum available field size of 27.4 x 24.1 cm2. Dose optimization was performed on the clinically used planning CT and structure set. Prescribed dose was 48.6 Gy in 27 fractions for all patients with 6 patients receiving an additional integrated boost for a total of 58.05 Gy to involved nodes. Constraints were based on our institutional protocol as per Table 1. IMRT delivery time was limited to 20 min. Original clinically used VMAT plans were generated on Eclipse (Varian Medical System) using 3 to 4 arcs. For the multi-institutional planning challenge, the data set from a single patient was anonymized and shared to participants. Participants used a single MR-based Linac planning platform to generate a plan based on our institutional constraints, with maximum treatment time limited to 20 min. For all analyses, a paired samples t-test was used to compare the significance defined at p < 0.05. For MR-LINAC plans, the mean number of fields used was 23, mean number of segments 229, and the average estimated treatment delivery time was 17.3 minutes. MR-LINAC plans showed a significantly higher heterogeneity and dose to organs at risk compared to VMAT plans (Table 1). For the planning challenge, a total of 30 participants registered interest. Of this, seven plans were submitted to the challenge. On average, participants generated a plan that would be acceptable based on our institutional constraints (Table 1). However, the volumetric dose to bowel and pelvic bones were higher on MR-LINAC plans compared to the reference VMAT plan. MR-LINAC fixed-field IMRT for cervix cancer patients is feasible but system constraints and optimization implementation result in greater dose heterogeneity and worse organ-at-risk sparing compared to Linac based VMAT. Further research is needed to determine if potential reduction of treatment margins, allowed by better MRI soft-tissue visualization, will result in MR-LINAC IMRT superior to Linac VMAT.

Optimized Volumetric Modulated Arc Technique for Noninvasive Cardiac Ablation to Treat Ventricular Tachycardia

Recent publications (Cuculich et al., NEJM-2017, Robinson et al., Circulation-2019) have shown promising outcomes of radioablation using a single-fraction SBRT to treat patients with refractory, life-threatening, VT. This prompted growing interest across the world to use SBRT to treat VT. The primary goal of this study is to explore an alternative VMAT planning technique to achieve greater Non-Target Heart-Tissue (NTHT) sparing while simultaneously allowing for breath hold (BH) treatments. 13 patients were selected who previously received a single fraction dose of 35 Gy to ITV and 25 Gy to PTV utilizing 3 non-coplanar VMAT arcs of 6 MV photon beams using HD-MLC on a radiosurgery-optimized linac. To further improve NTHT sparing we retrospectively re-planned each patient using 10 ipsi-lateral arcs with optimal gantry, couch and collimator angles. Two plans were generated using 6X FFF and 10X FFF beams with dynamic jaw-tracking. Gantry arc lengths were limited to 90° (< 15s/arc) for feasibility of a potential BH treatments. Couch angles were limited to ± 15° to avoid collisions. Plans were optimized to maximize the NTHT sparing while meeting the protocol constraints for the stomach, esophagus and colon (OAR). Plan quality metrics for both clinical and reoptimized plans are summarized in Table 1. Revised plans showed adequate target coverage (V95%Rx=>95%), better dose conformity and gradient, while meeting the dose constraints of the OARs. Excellent NTHT sparing is achieved by reducing the volumes of V20Gy by 43 cc and V5Gy by 250 cc. Average mean dose reduction of 2.5 (range: 0.6 – 6.0) Gy and 2.2 (0.7 – 5.7 Gy) was observed in 6X FFF and 10X FFF plans, respectively. Revised plans showed the possibility of treating each arc in a single BH. The standardized technique used in this study showed improved NTHT sparing and better dose conformity. This result may be important for the group of patients where cardiac toxicity may play a vital role in long-term survival. BH treatments may reduce the required PTV margins resulting in further NTHT sparing.Abstract 3778; Table 1Vol. (cc)Plan TypeTarget CoverageConformityMean D (Gy)%VRx%V95%RxConformity IndexGradient MeasureITV48.1 ± 29Clinical38.4 ± 1.197.6 ± 2.499.7 ± 0.66X FFF36.9 ± 0.494.2 ± 3.199.3 ± 0.810X FFF36.8 ± 0.890.5 ± 11.698.7 ± 2.0PTV138.9 ± 67.8Clinical33.6 ± 1.199.0 ± 0.899.7 ± 0.41.14 ± 0.122.01 ± 0.476X FFF32.3 ± 0.493.8 ± 2.596.8 ± 2.21.02 ± 0.041.76 ± 0.4710X FFF32.3 ± 0.494.2 ± 2.397.1 ± 1.81.03 ± 0.031.55 ± 0.26Non-Target Heart TissueMean D (Gy)%V25%V20%V15%V10%V5%V2Clinical6.2 ± 2.10.9 ± 0.84.9 ± 2.511.2 ± 5.421.4 ± 9.140.5 ± 13.966.7 ± 17.86X FFF3.7 ± 1.10.3 ± 0.31.9 ± 2.74.9 ± 1.610.1 ± 3.622.5 ± 8.945.9 ± 15.7Vol. spared (cc)9 ± 1143.± 3590 ± 76160 ± 113250 ± 146284 ± 20910X FFF4.0 ± 1.10.4 ± 0.32.2 ± 0.75.5 ± 1.711.4 ± 3.825.5 ± 9.649.6 ± 16.5Vol. spared (cc)8 ± 1039 ± 3381 ± 75142 ± 108208 ± 111233 ± 150 Open table in a new tab

Increase in Superficial Dose in Whole-Breast Irradiation with O-Ring Straight-through 6X FFF Linac Compared to Traditional C-arm Linac with Flattening Filter: In-vivo Dosimetry and Planning Study

Increase in Superficial Dose in Whole-Breast Irradiation with O-Ring Straight-through 6X FFF Linac Compared to Traditional C-arm Linac with Flattening Filter: In-vivo Dosimetry and Planning Study

SU‐F‐T‐555: Accurate Stereotactic Cone TMRs Converted from PDDs Scanned with Ray Trace

Purpose:To investigate whether the accuracy of TMRs for stereotactic cones converted from PDDs scanned with Ray Trace can be improved, when compared against the TMRs converted from the traditional PDDs.Methods:Ray Trace measurement in Sun Nuclear 3D Scanner is for accurate scan of small field PDDs. The system detects the center of field at two depths, for example, at 3 and 20 cm in our study, and then performs scan along the line passing the two centers. With both Ray Trace and the traditional method, PDDs for conical cones of 4, 5, 7.5, 10, 12.5, 15, and 17.5 mm diameter (jaws set to 5×5 cm) were obtained for 6X FFF and 10X FFF energies on a Varian Edge linac, using Edge detectors. The formalism of converting PDD to TMR given in Khan's book (4th Edition, p.161) was applied. Sp values at dmax were obtained by measuring cone Scp and Sc. Continuous direct measurement of TMR by filling/draining water to/from the tank and spot measurement by moving the tank and detector were also performed with the same equipment, using 100 cm SDD.Results:For 6XFFF energy and all the cones, TMRs converted from Ray Trace were very close to the continuous and spot measurement, while TMRs converted from traditional PDDs had larger deviation. Along the central axis beyond dmax, 1.7% of TMR data points calculated from Ray Trace had more 3% deviation from measurement, with maximal deviation of 5.2%. Whereas, 34% of TMR points calculated from traditional PDDs had more than 3% deviation, with maximum of 5.7%. In this initial study, Ray Trace scans for 10XFFF beam were noisy, further measurement is warranted.Conclusion:The Ray Trace could improve the accuracy of PDDs measurement and the calculated TMRs for stereotactic cones, which was within 3% of the measured TMRs.

SU‐E‐T‐733: The Effects of Duty Cycle On Gated VMAT Delivery

Purpose:When delivering gated VMAT treatments, the gantry moves back and forth after each beam interruption. There are more beam interruptions with smaller duty cycles. This is a study of the effects of gating and duty cycle on the dose output from the treatment machine.Methods:5 previously‐treated SBRT lung patients with 6X FFF RapidArc plans and 4 previously‐treated lung patients with 6X RapidArc plans are used for this study. The treatment machine is a TrueBeam STx with HD‐MLC. A sinusoidal motion generator is used to gate the beam. A MapCheck, and a 0.6 cc ion chamber sandwiched in solid water phantom are used for dose measurements. The MapCheck is used to measure non‐gated, gated with 50% and 30% duty cycles. The ion chamber is used to measure non‐gated and gated with 30% duty cycles.Results:For the 5 SBRT lung plans with 6X FFF, the average percentage of diodes with dose difference less than 0.1% is 99.5% between non‐gated and 50% duty cycle, and 99.7% between non‐gated and 30% duty cycle. For the 4 lung plans with 6X, the average percentage of diodes with dose difference less than 0.1% is 99.5% between non‐gated and 50% duty cycle, and 98.9% between non‐gated and 30% duty cycle. Using the ion chamber, the measured dose difference between non‐gated and 30% duty cycle is within 0.1% for all 10 SBRT arcs and within 0.2% for all 10 non‐SBRT arcs.Conclusion:On a TrueBeam machine, the VMAT dose delivery difference is within 0.2% between non‐gated and gated treatments. This difference decreases with the increase of duty cycle, also decreases with the decrease of target volume.

TH-CD-304-01: Evaluating the Accuracy of Absolute Portal Dosimetry On the EDGE Linear Accelerator

Purpose: To validate the accuracy of the Varian (Palo Alto, CA) absolute portal dosimetry (APD) platform for the EDGE linear accelerator and evaluate the performance of an improved, non-transit EPID dosimetry system which is optimized to mitigate the known limitations of the current, clinically available solution. Methods: Measurements were performed using the Varian EDGE in 6X FFF mode and aS1200 MV detector—a new, high energy, backscatter-shielded, amorphous silicon EPID (43×43 cm 2 ). Integrated images were acquired for 124 clinical, IMRT/VMAT fields. The raw images were corrected for pixel sensitivity variation and off-axis differential energy response and converted to dose in water at 5cm depth using an empirical dose model. Delivered doses were compared to reference doses calculated in a water phantom using the TPS dose calculation algorithm. Per-beam analysis was performed using gamma evaluation with 3%/1mm dose difference/distance-to-agreement specifications. Additionally, composite EPID doses were calculated for 16 IMRT/VMAT treatment plans and benchmarked against gafchromic EBT3 film measurements, with agreement being analyzed using 3%/3mm, 2%/2mm and 3%/1mm gamma criteria. Results: The converted EPID doses showed good agreement with calculated doses to water. An average of 98.1% (± 4.4%) of pixels passed per-beam gamma analysis with a stringent 3%/1mm criteria. The comparison of EPID measurements with film also yielded high pass rates for varying plan complexities and over a wide range of doses (maximum planar dose: 2.6–36.4 Gy) for each level of gamma criteria. Average gamma indices were 99.7%, 96.1% and 90.3% for 3%/3mm, 2%/2mm and 3%/1mm parameters, respectively. Conclusion: The APD platform on the EDGE includes hardware upgrades, advanced detector calibration techniques and more sophisticated calculation capabilities which allow for accurate, high-resolution absolute dose verification for conventional as well as SRS and SBRT IMRT/VMAT cases. Further investigation is needed to evaluate the error detectability of this QA method. This work was supported in part by Varian Medical Systems (Palo Alto, CA)

SU‐E‐T‐757: TMRs Calculated From PDDs Versus the Direct Measurements for Small Field SRS Cones

Purpose:To investigate the variation of TMR for SRS cones obtained by TMR scanning, calculation from PDDs, and point measurements. The obtained TMRs were also compared to the representative data from the vendor.Methods:TMRs for conical cones of 4, 5, 7.5, 10, 12.5, 15, and 17.5 mm diameter (jaws set to 5×5 cm) were obtained for 6X FFF and 10X FFF energies on a Varian Edge linac. TMR scanning was performed with a Sun Nuclear 3D scanner and Edge detector at 100 cm SDD. TMR point measurements were measured with a Wellhofer tank and Edge detector, at multiple depths from 0.5 to 20 cm and 100 cm SDD. PDDs for converting to TMR were scanned with a Wellhofer system and SFD detector. The formalism of converting PDD to TMR, given in Khan's book (4th Edition, p.161) was applied. Sp values at dmax were obtained by measuring Scp and Sc of the cones (jaws set to 5×5 cm) using the Edge detector, and normalized to the 10×10 cm field.Results:Along the central axis beyond dmax, the RMS and maximum percent difference of TMRs obtained with different methods were as follows: (a) 1.3% (max=3.5%) for the calculated TMRs from PDDs versus direct scanning; (b) 1.2% (max=3.3%) for direct scanning versus point measurement; (c) 1.8% (max=5.1%) for the calculated versus point measurements; (d) 1.0% (max=3.6%) for direct scanning versus vendor data; (e) 1.6% (max=7.2%) for the calculated versus vendor data.Conclusion:The overall accuracy of TMRs calculated from PDDs was comparable with that of direct scanning. However, the uncertainty at depths greater than 20 cm, increased up to 5% when compared to point measurements. This issue must be considered when developing a beam model for small field SRS planning using cones.

Sci-Sat AM: Stereo - 04: Evaluation of VMAT interplay effect for lung SABR using TrueBeam 10XFFF beam

During a VMAT treatment delivery, the interplay effect between the moving target and varying machine parameters result in dose distributions that are different from those initially planned. In this work, we investigate this effect for lung SABR by using 4D dose calculation derived from the Varian TrueBeam trajectory log file. The impact of treatment start phase is also evaluated. A QUASAR™ respiratory motion phantom was scanned with motion amplitudes of 0.4, 1, 2 and 3 cm with a 4 second period. MIP and the average dataset were generated from the 4DCT. A static CT was also acquired with the tumor in its centre position. Plans were optimized with 10X FFF beam until PTV and fictitious critical structures met the dose constraints. Ten temporally interleaved plans were constructed with the temporal machine parameter information from the trajectory log file. Ten plans were calculated with isocentre shifts to simulate respiratory motion and then summed. For each motion amplitude, three separate sum plans were created with various phase shifts (no phase shift, maximum inhalation and maximum exhalation) to assess the impact of treatment start phase. For all the phase shifts investigated, the DVH for PTV demonstrated good dose coverage. However, a careful review of slice by slice plan comparison indicates dose “holes” are observed within PTV. The PTV dose difference between various treatment start phases can be as high as 19%. This assumes all treatment fractions have identical treatment start phase. Our future work includes evaluation of interplay effect for various breathing periods.

SU‐F‐BRE‐10: Methods to Simulate and Measure the Attenuation for Modeling a Couch Top with Rails for FFF Treatment Delivery On the Varian Edge Linac

Purpose:To measure attenuation for modelling of the KVue Couchtop for 6X and 10X FFF SRS/SBRT treatmentMethods:Treatment planning simulation studies were done using 6X FFF beams to estimate the dosimetric impact of KVue couchtops (including the Q‐Fix IGRT [carbon fiber] and Calypso [nonconductive Kevlar material]) with a structure model obtained from a research workstation (Eclipse, advanced planning interface (API) v13). Prior to installation on the Varian Edge linac, the couchtop along with (Kevlar) rails were CT scanned with the rails at various positions. An additional scan with the couchtop 15cm above the CT table top was obtained with 20cm solid water to facilitate precised/indexed data acquisition. Measurements for attenuation were obtained for field sizes of 2, 4 and 10 cm2 at 42 gantry angles including 6 pairs of opposing fields and other angles for oblique delivery where the beams traversed the couchtop and or rails. The delivery was fully automated with xml scripts running in developer mode. The results were then used to determine an accurate structure model for AAA (Eclipse v11) planning of IMRT and RapidArc delivery.Results:The planning simulation relative dose attenuation for oblique entry was not significantly different than the Exact IGRT or BrainLab iBeam couch except that the rails added 6% additional attenuation. The relative attenuation measurements for PA, PA (rails: inner position), oblique, oblique (rails: outer position), oblique (rails: inner position) were: −2.0%, −2.5%, −15.6%, −2.5%, −5.0% for 6X FFF and −1.4%, −1.5%, −12.2%, − 2.5%, −5.0% for 10X FFF with slight decrease in attenuation versus field size. A Couch structure model (with HU values) was developed. Calculation compared to measurement showed good agreement except for oblique (rails: outer position) where differences approached a magnitude of 6%.Conclusion:A model of the couch structures has been developed accounting for attenuation for FFF beams.

SU-E-T-364: 6X FFF and 10X FFF Portal Dosimetry Output Factor Verification: Application for SRS/SBRT

Purpose: To enhance portal dosimetry of high dose rate SRS/SBRT plan verifications with extensive imager measurement of output factors (OF). Methods: Electronic portal image dosimetry (EPID), implemented on the Varian Edge allows for acquisition of its two energies: 6X FFF and 10 FFF (1400 and 2400 MU/min, respectively) at source to imager distance (SID) =100cm without imager saturation. Square and rectangular aSi OF following EPID calibration were obtained. Data taken was similar to that obtained during beam commissioning (of almost all field sizes from 1×1 to 15×15 and 20×20 cm{sup 2}, [Trilogy] and [Edge], respectively) to construct a table using the OF tool for use in the Portal Dosimetry Prediction Algorithm (PDIP v11). The Trilogy 6x SRS 1000 MU/min EPID data were taken at 140 SID. The large number of OF were obtained for comparison to that obtained with diode detectors and ion chambers (cc13 for >3×3 field size). As Edge PDIP verification is currently ongoing, EPID measurements of three SRS/SBRT plans for the Trilogy were taken and compared to results obtained prior to these measurements. Results: The relative difference output factors of field sizes 2×2 and higher compared to commissioning data were (mean+/-SD, [range]): Edge 6X (−1.9+/−2.9%, [−5.9%,3.1%]), Edgemore » 10X (−0.7+/−1.2%, [− 3.3%,0.8%] and Trilogy (0.03+/−0.5%, [−1.4%,1.1%]) with EPID over predicting. The results for the 140 SID showed excellent agreement throughout except at the 1×1 to 1×15 and 15×1 field sizes where differences were: −10.6%, −6.0% and −5.8%. The differences were also most pronounced for the 1×1 at 100 SID. They were −7.4% and −11.5% for 6X and 10X, respectively. The Gamma (3%, 1mm) for three clinical plans improved by 8.7+/−1.8%. Conclusion: Results indicate that imager output factor measurements at any SID of high dose rate SRS/SBRT are quite reliable for portal dosimetry plan verification except for the smallest fields. This work was not funded by Varian Oncology Systems. Some authors have other work partly funded by Varian Oncology Systems.« less

TH‐E‐BRE‐09: TrueBeam Monte Carlo Absolute Dose Calculations Using Monitor Chamber Backscatter Simulations and Linac‐Logged Target Current

Purpose:To simulate and measure radiation backscattered into the monitor chamber of a TrueBeam linac; establish a rigorous framework for absolute dose calculations for TrueBeam Monte Carlo (MC) simulations through a novel approach, taking into account the backscattered radiation and the actual machine output during beam delivery; improve agreement between measured and simulated relative output factors.Methods:The ‘monitor backscatter factor’ is an essential ingredient of a well‐established MC absolute dose formalism (the MC equivalent of the TG‐51 protocol). This quantity was determined for the 6 MV, 6X FFF, and 10X FFF beams by two independent Methods: (1) MC simulations in the monitor chamber of the TrueBeam linac; (2) linac‐generated beam record data for target current, logged for each beam delivery. Upper head MC simulations used a freelyavailable manufacturer‐provided interface to a cloud‐based platform, allowing use of the same head model as that used to generate the publicly‐available TrueBeam phase spaces, without revealing the upper head design. The MC absolute dose formalism was expanded to allow direct use of target current data.Results:The relation between backscatter, number of electrons incident on the target for one monitor unit, and MC absolute dose was analyzed for open fields, as well as a jaw‐tracking VMAT plan. The agreement between the two methods was better than 0.15%. It was demonstrated that the agreement between measured and simulated relative output factors improves across all field sizes when backscatter is taken into account.Conclusion:For the first time, simulated monitor chamber dose and measured target current for an actual TrueBeam linac were incorporated in the MC absolute dose formalism. In conjunction with the use of MC inputs generated from post‐delivery trajectory‐log files, the present method allows accurate MC dose calculations, without resorting to any of the simplifying assumptions previously made in the TrueBeam MC literature. This work has been partially funded by Varian Medical Systems.

SU-E-T-614: Derivation of Equations to Define Inflection Points and Its Analysis in Flattening Filter Free Photon Beams Based On the Principle of Polynomial function

Purpose: The objective of this work is to present a mechanism for calculating inflection points on profiles at various depths and field sizes and also a significant study on the percentage of doses at the inflection points for various field sizes and depths for 6XFFF and 10XFFF energy profiles. Methods: Graphical representation was done on Percentage of dose versus Inflection points. Also using the polynomial function, the authors formulated equations for calculating spot-on inflection point on the profiles for 6X FFF and 10X FFF energies for all field sizes and at various depths. Results: In a flattening filter free radiation beam which is not like in Flattened beams, the dose at inflection point of the profile decreases as field size increases for 10XFFF. Whereas in 6XFFF, the dose at the inflection point initially increases up to 10x10cm2 and then decreases. The polynomial function was fitted for both FFF beams for all field sizes and depths. For small fields less than 5x5 cm2 the inflection point and FWHM are almost same and hence analysis can be done just like in FF beams. A change in 10% of dose can change the field width by 1mm. Conclusion: The present study, Derivative of equations based on the polynomial equation to define inflection point concept is precise and accurate way to derive the inflection point dose on any FFF beam profile at any depth with less than 1% accuracy. Corrections can be done in future studies based on the multiple number of machine data. Also a brief study was done to evaluate the inflection point positions with respect to dose in FFF energies for various field sizes and depths for 6XFFF and 10XFFF energy profiles.

SU-E-T-370: Measurement of Conical Cone Output Factors for the Varian Edge Linear Accelerator

Purpose: To quantify the impact of detector type, SSD/depth, and intermediate reference on conical cone output factor (OF) measurements for the Varian Edge linac. Methods: OF's for 4, 5, 7.5, 10, 12.5, 15, and 17.5 mm diameter cones relative to 10cmx10cm field were measured for the 6X FFF and 10X FFF energies, with jaws set to 5cmx5cm. Measurements were performed with an Edge diode (0.8mmx0.8mmx0.03mm WxLxT), stereotatic diode SFD, photon diode, CC01 and pinpoint chambers (2mm diameter for both). 95cm SSD/5cm depth were used in a water tank. For the measurement with diodes, OF's were cross-referred to CC13 ion chamber measurements with 3cmx3cm field, as recommended, to help mitigate the energy variation in diode response with field size. Results were compared to the representative data from Varian measured with Edge detector. With SFD, OF's at 98.5cm SSD/1.5cm depth and 90cm SSD/10cm depth were also measured. Results: OF's measured with the Edge detector matched within 1.3% (max diff) with the representative data from Varian. For the SFD, OF's matched within 1.3% for the 4, 5 and 17.5 mm cones and within 3.7% for the other cones. OF's with photon diode were within 1.3% except for the 4 and 5 mm conesmore » where they were 8.1% and 3.7%, respectively. OF's for the CC01 and pinpoint chamber deviated up to 36% and 44%, respectively for the 4 mm cone. OF's after intermediate reference with 3cmx3cm field changed by 3.7% for SFD, 0.8% for photon diode, and 0.6% for Edge detector. OF's at 98.5cm SSD/1.5cm depth were 10.8% higher than that at 95cm SSD/5cm depth, and OF's at 90cm SSD/1.5cm depth were 7.5% lower. Conclusion: OF's measured with the Edge detector appear to be reliable. CC01 and pinpoint chambers do not appear suitable for measuring the small cone OF's. SSD/depth affects OF measurements significantly.« less

Monte Carlo modeling of HD120 multileaf collimator on Varian TrueBeam linear accelerator for verification of 6X and 6X FFF VMAT SABR treatment plans.

A Monte Carlo (MC) validation of the vendor‐supplied Varian TrueBeam 6 MV flattened (6X) phase‐space file and the first implementation of the Siebers‐Keall MC MLC model as applied to the HD120 MLC (for 6X flat and 6X flattening filterfree (6X FFF) beams) are described. The MC model is validated in the context of VMAT patient‐specific quality assurance. The Monte Carlo commissioning process involves: 1) validating the calculated open‐field percentage depth doses (PDDs), profiles, and output factors (OF), 2) adapting the Siebers‐Keall MLC model to match the new HD120‐MLC geometry and material composition, 3) determining the absolute dose conversion factor for the MC calculation, and 4) validating this entire linac/MLC in the context of dose calculation verification for clinical VMAT plans. MC PDDs for the 6X beams agree with the measured data to within 2.0% for field sizes ranging from 2 × 2 to 40 × 40 cm2. Measured and MC profiles show agreement in the 50% field width and the 80%‐20% penumbra region to within 1.3 mm for all square field sizes. MC OFs for the 2 to 40 cm2 square fields agree with measurement to within 1.6%. Verification of VMAT SABR lung, liver, and vertebra plans demonstrate that measured and MC ion chamber doses agree within 0.6% for the 6X beam and within 2.0% for the 6X FFF beam. A 3D gamma factor analysis demonstrates that for the 6X beam, > 99% of voxels meet the pass criteria (3%/3 mm). For the 6X FFF beam, > 94% of voxels meet this criteria. The TrueBeam accelerator delivering 6X and 6X FFF beams with the HD120 MLC can be modeled in Monte Carlo to provide an independent 3D dose calculation for clinical VMAT plans. This quality assurance tool has been used clinically to verify over 140 6X and 16 6X FFF TrueBeam treatment plans.PACS number: 87.55.K‐

WE‐E‐141‐01: Accurate Calibration and Measurement of Unflattened Photon Beams

Purpose: To accurately quantify and account for systematic errors in the measurement of dose for unflattened photon beams due to characteristics specific to these beams. Methods: Dose measurements were taken on five photon beams (6X, 6X FFF, 10X, 10X FFF, and 15X) on a Varian TrueBeam STx using one diode and five ion chambers (PTW Farmer, CC13, CC04, and PTW 3D Pinpoint) which were selected to span a range of dimensions. Errors in the percent depth dose (PDD) due to depth dependent P_ion effects were measured. High‐resolution diode scans for profiles at 6X FFF and 10X FFF were used to create an analytical fit model. This model was used to calculate the reduction in dose (caused by volume averaging) in unflattened beams due to chamber size. Each chamber was cross‐calibrated (using the flattened beams) against the farmer chamber to determine N_D,w(Co‐60). These N_D,w(Co‐60) values were then used to determine the absolute dose in the FFF beams. Results: Changes in P_ion were most pronounced in the 10X FFF beam. This effect resulted in a 1% and 1.5% increase in the measured PDD at depths of 10cm and 20cm, respectively, for 10X FFF with the CC13 chamber. The farmer chamber had the most significant volume averaging effect with a calculated (and measured) dose reduction of 0.35% and 0.72% for 6X FFF and 10X FFF, respectively. An analytical correction factor, P_Flat, was developed to account for this effect. Conclusion: Corrections are necessary to reduce the errors produced when measuring dose in unflattened beams. Two types of errors were quantified that will each lower the measured dose to dmax. When following a TG‐51 calibration, uncorrected absolute dose measurements may Result in a worst‐case error on the order of 2%. We developed an analytical correction factor that substantially reduces this error for common farmer chambers.