Leaf Gap Research Articles

Direct Measurement of 2-dimensional Dosimetric Leaf Gap Distribution Using Electric Portal Imaging Device

The dosimetric leaf gap (DLG) is a critical parameter for accurate delivery of intensity modulated radiation therapy using sliding window (SW) and volumetric modulated arc therapy. It has been recently reported that the two-dimensional DLG (2D-DLG) can be obtained with integrated images using electric portal imaging devise (EPID), and with direct measurement using one-dimensional diode array detector. We assume that direct measurement of the 2D-DLG using EPID will be more useful in that it will enable a decrease in time for measurement.

Verification of dosimetric accuracy on the TrueBeam STx: Rounded leaf effect of the high definition MLC

The dosimetric leaf gap (DLG) in the Varian Eclipse treatment planning system is determined during commissioning and is used to model the effect of the rounded leaf-end of the multileaf collimator (MLC). This parameter attempts to model the physical difference between the radiation and light field and account for inherent leakage between leaf tips. With the increased use of single fraction high dose treatments requiring larger monitor units comes an enhanced concern in the accuracy of leakage calculations, as it accounts for much of the patient dose. This study serves to verify the dosimetric accuracy of the algorithm used to model the rounded leaf effect for the TrueBeam STx, and describes a methodology for determining best-practice parameter values, given the novel capabilities of the linear accelerator such as flattening filter free (FFF) treatments and a high definition MLC (HDMLC). During commissioning, the nominal MLC position was verified and the DLG parameter was determined using MLC-defined field sizes and moving gap tests, as is common in clinical testing. Treatment plans were created, and the DLG was optimized to achieve less than 1% difference between measured and calculated dose. The DLG value found was tested on treatment plans for all energies (6 MV, 10 MV, 15 MV, 6 MV FFF, 10 MV FFF) and modalities (3D conventional, IMRT, conformal arc, VMAT) available on the TrueBeam STx. The DLG parameter found during the initial MLC testing did not match the leaf gap modeling parameter that provided the most accurate dose delivery in clinical treatment plans. Using the physical leaf gap size as the DLG for the HDMLC can lead to 5% differences in measured and calculated doses. Separate optimization of the DLG parameter using end-to-end tests must be performed to ensure dosimetric accuracy in the modeling of the rounded leaf ends for the Eclipse treatment planning system. The difference in leaf gap modeling versus physical leaf gap dimensions is more pronounced in the more recent versions of Eclipse for both the HDMLC and the Millennium MLC. Once properly commissioned and tested using a methodology based on treatment plan verification, Eclipse is able to accurately model radiation dose delivered for SBRT treatments using the TrueBeam STx.

EPID‐based verification of the MLC performance for dynamic IMRT and VMAT

In advanced radiotherapy treatments such as intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT), verification of the performance of the multileaf collimator (MLC) is an essential part of the linac QA program. The purpose of this study is to use the existing measurement methods for geometric QA of the MLCs and extend them to more comprehensive evaluation techniques, and to develop dedicated robust algorithms to quantitatively investigate the MLC performance in a fast, accurate, and efficient manner. The behavior of leaves was investigated in the step-and-shoot mode by the analysis of integrated electronic portal imaging device (EPID) images acquired during picket fence tests at fixed gantry angles and arc delivery. The MLC was also studied in dynamic mode by the analysis of cine EPID images of a sliding gap pattern delivered in a variety of conditions including different leaf speeds, deliveries at fixed gantry angles or in arc mode, and changing the direction of leaf motion. The accuracy of the method was tested by detection of the intentionally inserted errors in the delivery patterns. The algorithm developed for the picket fence analysis was able to find each individual leaf position, gap width, and leaf bank skewness in addition to the deviations from expected leaf positions with respect to the beam central axis with sub-pixel accuracy. For the three tested linacs over a period of 5 months, the maximum change in the gap width was 0.5 mm, the maximum deviation from the expected leaf positions was 0.1 mm and the MLC skewness was up to 0.2°. The algorithm developed for the sliding gap analysis could determine the velocity and acceleration∕deceleration of each individual leaf as well as the gap width. There was a slight decrease in the accuracy of leaf performance with increasing leaf speeds. The analysis results were presented through several graphs. The accuracy of the method was assessed as 0.01 mm for both the gap size and peak position determination. This study provides fast, easy, and accurate test methods for routine QA of the MLC performance and helps in faster troubleshooting of MLC problems in both IMRT and VMAT treatments.

Quality assurance of MLC leaf position accuracy and relative dose effect at the MLC abutment region using an electronic portal imaging device

We investigated an electronic portal image device (EPID)-based method to see whether it provides effective and accurate relative dose measurement at abutment leaves in terms of positional errors of the multi-leaf collimator (MLC) leaf position. A Siemens ONCOR machine was used. For the garden fence test, a rectangular field (0.2 × 20 cm) was sequentially irradiated 11 times at 2-cm intervals. Deviations from planned leaf positions were calculated. For the nongap test, relative doses at the MLC abutment region were evaluated by sequential irradiation of a rectangular field (2 × 20 cm) 10 times with a MLC separation of 2 cm without a leaf gap. The integral signal in a region of interest was set to position A (between leaves) and B (neighbor of A). A pixel value at position B was used as background and the pixel ratio (A/B × 100) was calculated. Both tests were performed at four gantry angles (0, 90, 180 and 270°) four times over 1 month. For the nongap test the difference in pixel ratio between the first and last period was calculated. Regarding results, average deviations from planned positions with the garden fence test were within 0.5 mm at all gantry angles, and at gantry angles of 90 and 270° tended to decrease gradually over the month. For the nongap test, pixel ratio tended to increase gradually in all leaves, leading to a decrease in relative doses at abutment regions. This phenomenon was affected by both gravity arising from the gantry angle, and the hardware-associated contraction of field size with this type of machine.

Poster - Thur Eve - 40: Dynamic arc sliding window tests for checking MLC gap consistency in rapid arc delivery.

MLC gap control is critical for dosimetric accuracy in rotational IMRT (RapidArc, VMAT) treatments. Systematic MLC gap change of 1 mm may cause 3-4% change of EUD to PTV for a typical H&N RapidArc plan. Therefore it is important to monitor MLC gap through QC procedures. For this purpose, we have created dynamic arc sliding window (SW) plans with fixed width MLC slits sliding across a jaw defined field. Plans with MLC slit widths of 5, 10, 15, and 20 mm, respectively, and the same length of 20 cm (in Y direction) were created with 6MV photons in a single arc of gantry angles from 182° to 178°. Dose delivered from these SW plans was measured using an ion chamber in a cylindrical phantom placed at isocentre, and values for dosimetric leaf gap (DLG) were derived based on relative dose measurements. DLG measured in dynamic arc SW tests agrees with that measured in fixed gantry angle SW fields to within 0.02 mm. We also extracted the MLC leaf gaps during MLC travels in these dynamic arc SW deliveries from MLC positions recorded in dynalog files, and compared to the MLC gaps in fixed gantry SW fields. We found that MLC leaf gaps were maintained excellently constant whether in dynamic arc or fixed gantry angle SW delivery, with typical standard deviation of MLC gaps of only ∼0.01mm for all involved leaf pairs. We believe these dynamic arc SW tests are very useful for checking MLC leaf constancy for RapidArc delivery.

Sci-Thur AM: Planning - 05: Lung SBRT: Dosimetric accuracy of the Analytical Anisotropic Algorithm (AAA) for 6MV FFF RapidArc planning.

Stereotactic Body Radiation Therapy (SBRT) requires the delivery of a high biologically effective dose in only a few fractions. These large doses per fraction can necessitate long treatment times. The Varian Truebeam is capable of RapidArc delivery and also has the optional Flattening Filter Free (FFF) modes which greatly increase the dose rate. We have commissioned the 6MV FFF beam (1400 MU/min) for RapidArc lung SBRT, and verified heterogeneous dose calculations with Monte Carlo (MC). The standard commissioning data was acquired for Varian's Analytical Anisotropic Algorithm (AAA) beam model. Measurements were acquired with the IBA Blue Phantom, using the CC13 and CC01 ion chambers and PTW diode. MLC-defined fields were also acquired for model verification. The Dosimetric Leaf Gap (DLG) was measured and then optimized using RapidArc lung SBRT plans, matching Eclipse with ion chamber measurements. Heterogeneous dose calculations were independently verified using MC. There were some discrepancies regarding leaf transmission and penumbra, but the AAA model was generally well within 2% and 2 mm. A nominal DLG value of 1.6 mm was chosen. A representative lung SBRT case utilizing FFF RapidArc was calculated with MC. For the high dose region, 99% matched Eclipse within 3% and 3 mm. The mean dose difference of the PTV was 0.7%. Although we have observed some minor infield discrepancies between the AAA and Monte Carlo calculations in heterogeneous media, the Eclipse AAA is reasonably accurate for complex FFF, RapidArc, SBRT lung planning.

Poster - Thur Eve - 30: Comparison of treatment planning and delivery performance of VMAT versus IMRT.

The purpose of this study was to determine whether VMAT (Varian RapidArc ™) treatment planning and delivery performance is in compliance with accepted quality assurance tolerances developed for sliding window IMRT. We present an analysis of data for over 1300 patients treated with VMAT and IMRT over a period of three years. Data was acquired on 6 dosimetrically matched linacs for sites including head and neck, brain, gynaecological, and a variety of other cancer cases treated with 6 MV. We have demonstrated that it is possible to dosimetrically match multiple Varian iX linacs with the millennium series MLC using a sliding gap and intercept test. QA is performed by Monte Carlo simulation and ion chamber measurement comparisons with Varian Eclipse TPS as well as linac log file analysis of MLC positions, gantry angles and monitor units on each patient. Point dose and 3D gamma analysis indicate that agreement between Eclipse and measurement or Monte Carlo calculation is site specific, with the dosimetric leaf gap parameter in Eclipse optimized for the most frequently treated site Point dose agreement within 2% and gamma pass rate of > 95% (3%/ 3 mm) is achievable for all sites for both IMRT and VMAT. Linac log file analysis indicates that planned MLC positions are achieved within 2 mm >99.7% of the time for both sliding window IMRT and VMAT. Planned gantry angles are achieved within 0.6 mm 99.8% of the time and planned MU's within 0.1 mm are achieved 99.8% of the time for VMAT.

Poster - Thur Eve - 47: Evaluation of the ArcCHECK device for commissioning and patient-specific QA.

The most promising method of accurately verifying VMAT treatments is by direct dose measurement over the three dimensions of irradiated volume. ArcCHECK device (Sun Nuclear, Melbourne, FL) have the potential to detect delivery errors on the treatment machine due to mechanical problems resulting from gantry and MLC motion. The estimation of the dosimetric leaf gap (DLG) parameter for Varian MLC (Varian Medical Systems, Palo Alto, CA) was attempted using ArcCHECK. Finding the optimal DLG value for use in TPS requires a measuring device like ArcCHECK to be employed especially in highly intensity modulated fields. In addition, ArcCHECK was used to assess the effect of positional error of MLC leaf in a given VMAT plan. Patient-specific QA tests were performed using the ArcCHECK device. QA results of patient plans that failed considering portal dosimetry technique were reassessed with ArcCHECK measurements for IMRT plans. The preliminary test results and performance of the ArcCHECK device were very encouraging. VMAT plans for head and neck cases were generated and their delivery was evaluated using ArcCHECK. Results have shown a success rate greater than 90% in the quality assurance of individual plans. Optimal DLG value was detected using ArcCHECK. Also, the device showed enough sensitivity to identify failed QA plans. Moreover, MLC central leaf pair position offset in a VMAT plan of the order of 1mm was fairly distinguished by ArcCHECK measurements.

SU‐C‐BRCD‐01: Spatial Variation of Dosimetric Leaf Gap and the Impact in Dose Delivery

Purpose: To evaluate the variation of dosimetric leaf‐gap (DLG) along the travel path of each MLC leaf pairs. Furthermore, dosimetric implication of this variation is studied for several dynamic MLC fields. Methods: During dose calculation, the treatment planning systems (TPS) retracts the MLC leaf positions by half of the DLG value (measured at CA) for all leaf positions in a Dynamic MLC plan to accurately model the rounded leaf ends. The 6 MV DLG values were measured, for all leaf pairs, in increment of 0.5 cm at Dmax, in the direction of leaf motion. The measurements were performed on three Varian Linacs, employing the Millennium 120‐leaf MLCs. Measurements were performed using both the Sun Nuclear MapCheck device and the PTW pinpoint ion chamber. Measurements with an ion chamber were also performed with varying leaf gaps to determine % change in dose with leaf gap discrepancy. Results: The measured DLGs for all leaf pairs were very similar along the in‐plane direction; varying maximally only by 0.3 mm. But in the in the leaf travel direction, the DLG increases gradually from CA to 6.0 cm off‐axis, reaching to a maximum variation of 1.6 mm for a particular leaf pair. Varying gap measurements indicate that DLG deviation of about 1 mm can cause a dose difference of about 5.0 % for a fluence with 1.5 cm leaf width sweeps and significantly increases to about 12.5 % difference for 0.5 cm sweeps. Conclusions: The spatial variation in DLG is caused by the variation in beam spectrum as well as MLC motion across the field. Fields with dynamic MLC centered on the CAX would not be affected since DLG does not vary as much; but any field residing significantly off‐axis with narrow sweeping leafs can exhibit significant dose differences due to large DLG differences.

SU-E-T-119: Evaluation of New VMAT and IMRT Planning QA Devices: Portal Dosimetry Vs Compass.

Wide spread clinical use of advanced radiation treatment delivery techniques such as volumetric modulated arc therapy (VMAT) and IMRT needs an easy-to-use, well-defined, and effective quality assurance (QA) system to ensure the accuracy of dose delivery. The comprehensive evaluation of two delivery QA systems (DQA) (Portal Dosimetry and Compass) for the advanced radiation delivery techniques is necessary for the clinical setting. Portal Dosimetry QA system with Varian PortalVision (PV) provides a quantitative comparison of measured electronic dose profile to a predicted dose profile with Varian's Eclipse™ treatment planning system (TPS) for the VMAT and IMRT plans. Quantitative comparisons of the two images, including dose difference, gamma analysis, points dose measurements, and line profiles are easily acquired in two dimensions. Meanwhile, Compass system with MatriXX can provide an accurate three-dimensional quantitative analysis of dose delivery. We applied the two planning QA systems to our RapidArc patient- specific QAs. Validation of the Compass and Portal Dosimetry systems were performed with ionization chamber measurements for absolute dosimetry and film measurements for gamma index calculations for phantom and patient treatment plans. Compass system was very sensitive to the MLC leaf gap variations in three dimensional gamma analyses. However, Compass system was not enough to fix the errors in dosimetric leaf gap by itself. DQA process with Portal Dosimetry took approximately 6 minutes for the two Arcs VMAT plan. Compass took about 40 minutes for the same plan in our first clinical trial. For the three typical IMRT and VMAT plans, the two systems showed the same passing rates in 95% pixels passing gamma criteria 3%/3mm. Portal Dosimetry DQA system has the advantages of effectiveness and practicality in the clinical setting. On the other hand, Compass was the next supportive system because of its accuracy and reality with patient's anatomy.

SU‐E‐T‐357: Error Detection with a 3D Patient Specific QA System

Purpose: To determine if our in‐house patient specific QA process, which utilizes the COMPASS (v2.1, IBA‐Dosimetry) system, can detect delivery errors introduced in clinical IMRT plans. Methods: The COMPASS system consists of a 2D chamber array mounted in the gantry, an independent gantry angle sensor and associated software. Patient specific QA at our clinic involves the creation of two QA structures, one consisting of all clinical PTVs, the other generated from the 20% isodose line. The gamma agreement index (GAI) within the two QA structures is used to compare 3D COMPASS reconstructed dose with planned dose distributions. Ten clinical DMLC‐IMRT plans (5 prostate, 5 head & neck) were included in this study. Plans were modified by systematically shifting leaf pair positions so that that all nonzero leaf gaps were increased by 2.0 mm and 1.0 mm for the two sites, respectively. Verification plans were created for both the original and modified plans in order to quantify the dosimetric effect of the introduced errors via in‐phantom ion chamber measurements. Finally, plans were delivered to COMPASS and 3D dose distributions were reconstructed on both the phantom and patient CT datasets. Reconstructed doses on the patient CT were analyzed as per our QA procedure. Results: On average, measured ion chamber values for the modified plans deviated from the original planning doses by 3.1 ± 1.2% (Range: 1.0%–5.3%). For each of the six modified plans in which this metric exceeded 3%, GAI values for at least one of the QA structures were below 95%, which would be flagged by our QA process. Only one of the other modified and none of the original plans had GAI values <95%. Conclusions: Gamma analysis of patient specific QA with COMPASS can effectively detect dosimetrically significant delivery errors introduced by systematically increasing leaf gaps in clinical IMRT plans. CancerCare Manitoba has a research agreement with IBA‐Dosimetry.

SU-E-T-385: Accelerated Beam Delivery with MLC Gaps in IMRT Fields.

By default, the 4-mm wide leaf-pairs of the Elekta Beam Modulator MLC not used for field shaping are moved to under the primary collimator to minimize the leakage dose. The trade-off is the increased beam delivery time in the case of IMRT. This study examines the dosimetric impact and improved delivery efficiency by allowing the unused leaf-pair as 2mm gap to stay within the PTV aperture during beam-on. The capability of the treatment planning system (Pinnacle) in modeling the central and off-axis dose through 2mm MLC gaps, respectively, was investigated. EBT film measurement performed in a solid water phantom was compared with the computed dose. For two representative IMRT cases, the dosimetric features of treatment plans generated with and without MLC gaps in the field were compared. Similarly, the delivery times for 13 IMRT cases with and without MLC gaps were compared. The peak dose of the leaf gap computed with Pinnacle was dependent on dose grid resolution. The difference between a 0.5mm and 2mm dose grid was about 16.5% for 6MV and 15MV beam respectively. Using a 0.5mm dose grid, the maximum difference between measured and calculated dose was < 1% for a central axis gap, and < 3% for an off-axis gap. The maximum dose through a 2mm×4mm leaf gap was estimated < 10cGy for a typical IMRT plan. DVH comparison showed an increase of target dose up to 2% for the IMRT plans with gap, with minimal dose change to all critical structures. For the 13 IMRT cases, the beam delivery times were reduced by 27+/-9.7%, from 8.7+/-4.5 minutes to 6.5+/-4.0 minutes. The beam delivery is accelerated by utilizing minimal gaps in the IMRT fields. The increased dose to the target is acceptable and is minimal to all critical structures.

SU-E-T-84: TrueBeam Commissioning: A Multi-Institutional Experience

Purpose: Latest generation linear accelerators (linacs), TrueBeam (Varian Medical Systems, Palo Alto, CA) and its stereotactic counterpart, TrueBeam STx, have several unique features, including high-dose-rate flattening-filter-free (FFF) photon modes, reengineered electron modes with new scattering foil geometries, updated imaging hardware/software, and a novel control system. We have performed a comprehensive evaluation of three TrueBeam linacs at three different institutions and report on our commissioning experience. Methods: Acceptance and commissioning data were analyzed for three TrueBeam linacs equipped with 120 leaf (5 mm width) MLCs at three different institutions. Dosimetric data and mechanical parameters were compared. These included measurements of photon beam profiles (6X, 6XFFF, 10X, 10XFFF, 15X), photon and electron percent depth dose (PDD)curves (6MeV, 9MeV, 12MeV), relative photon output factors (Scp),electron cone factors, mechanical isocenter accuracy, MLC transmission, and dosimetric leaf gap (DLG). Results: Gantry/collimator isocentricity measurements were similar (0.27–0.28mm), with overall couch/gantry/collimator values of 0.46–0.68mm across the three institutions. Dosimetric data showed good agreement between machines. The largestdiscrepancy was observed with measured MLC DLG (for 6, 10 and 15 MV photons, average DLGs were 1.95 ± 1.15mm, 2.22 ± 1.30 mm, and 2.20 ± 1.24mm, respectively). Photon and electron PDDs were comparable for all energies. 6, 15 and 10 MV photon beam quality, %dd(10)x varied less than 0.3% for all machines. Electron beam quality specifier (R50) showed less than 1.7% variation for all energies. Output factors (Scp) and electron cone factors agreed within 0.27%, on average; largest variations were observed for small field sizes (0.77% variation, 2×2cm2) and small cone sizes (0.39% variation, 6×6 cm2 cone), respectively. Conclusions: Overall, strong agreement was observed in TrueBeam commissioning data. This comprehensive set of multi-institutional data may serve as a benchmark for other institutions embarking on TrueBeam commissioning, ultimately improving the safety/quality of beam commissioning

WE-E-BRB-08: Establishing Comprehensive Quality Assurance Program for Volumetric Modulated Arc Therapy - Clinical Study Using Control Point Analysis Software.

to validate the clinical effectiveness of Control Point Analysis (CPA) software and establish a comprehensive quality assurance (QA) program for Volumetric Modulated Arc Therapy (VMAT) treatment. The comparison and gamma analysis of ArcCHECK™ measurement and treatment planning system (TPS) is considered one of the common methods for VMAT QA procedure. However, questions like 'how QA discrepancies affect patient treatment† and † what are the sources of discrepancies† cannot be answered. In this study, 3DVH™ and recently developed CPA software were tested for eight cases, including prostate, brain, head&neck, and TGI 19 phantom cases. All VMAT plans used two arcs, with various settings of couch rotation, collimator rotation, and splitting fields. Each single arc was equally divided into 24 sub-arcs and doses of sub-arcs were exported for CPA analysis. Gamma analyses (3mm/3%) were compared using the ArcCHECK dose, single arc doses, sub-arc doses, and 3DVH patient's dose estimated by Planned Dose Perturbation™ (PDP) algorithm. ArcCHECK composite dose analyses were consistent with CPA sub-arc analysis for most cases. 3DVH generally showed higher passing rate in dose voxel-by-voxel comparison. Cases with failed QA were further analyzed by CPA for each sub-arc to reveal the sources of dose discrepancies, whether they are mechanical errors (i.e. leaf motion failure) or dosimetric modeling errors (i.e. elongated beam spot size or incorrect dynamic leaf gap). CPA analysis showed values for cases with passed QA to detect small discrepancies caused by failed MLC which was otherwise smeared out in the composite dose comparison. CPA analysis expands QA process to a greater level of details without additional work by users. With the additions of CPA analysis and 3DVH™, one can establish a comprehensive VMAT QA program with detailed mapping of composite dose passing rate, the estimated effect of discrepancies on patients, and possible sources of discrepancies.

Clinical commissioning and use of the Novalis Tx linear accelerator for SRS and SBRT

The purpose of this study was to perform comprehensive measurements and testing of a Novalis Tx linear accelerator, and to develop technical guidelines for commissioning from the time of acceptance testing to the first clinical treatment. The Novalis Tx (NTX) linear accelerator is equipped with, among other features, a high‐definition MLC (HD120 MLC) with 2.5 mm central leaves, a 6D robotic couch, an optical guidance positioning system, as well as X‐ray‐based image guidance tools to provide high accuracy radiation delivery for stereotactic radiosurgery and stereotactic body radiation therapy procedures. We have performed extensive tests for each of the components, and analyzed the clinical data collected in our clinic. We present technical guidelines in this report focusing on methods for: (1) efficient and accurate beam data collection for commissioning treatment planning systems, including small field output measurements conducted using a wide range of detectors; (2) commissioning tests for the HD120 MLC; (3) data collection for the baseline characteristics of the on‐board imager (OBI) and ExacTrac X‐ray (ETX) image guidance systems in conjunction with the 6D robotic couch; and (4) end‐to‐end testing of the entire clinical process. Established from our clinical experience thus far, recommendations are provided for accurate and efficient use of the OBI and ETX localization systems for intra‐ and extracranial treatment sites. Four results are presented. (1) Basic beam data measurements: Our measurements confirmed the necessity of using small detectors for small fields. Total scatter factors varied significantly (30% to approximately 62%) for small field measurements among detectors. Unshielded stereotactic field diode (SFD) overestimated dose by ~ 2% for large field sizes. Ion chambers with active diameters of 6 mm suffered from significant volume averaging. The sharpest profile penumbra was observed for the SFD because of its small active diameter (0.6 mm). (2) MLC commissioning: Winston Lutz test, light/radiation field congruence, and Picket Fence tests were performed and were within criteria established by the relevant task group reports. The measured mean MLC transmission and dynamic leaf gap of 6 MV SRS beam were 1.17% and 0.36 mm, respectively. (3) Baseline characteristics of OBI and ETX: The isocenter localization errors in the left/right, posterior/anterior, and superior/inferior directions were, respectively, −0.2±0.2 mm, −0.8±0.2 mm, and −0.8±0.4 mm for ETX, and 0.5±0.7 mm, 0.6±0.5 mm, and 0.0±0.5 mm for OBI cone‐beam computed tomography. The registration angular discrepancy was 0.1±0.2°, and the maximum robotic couch error was 0.2°. (4) End‐to‐end tests: The measured isocenter dose differences from the planned values were 0.8% and 0.4%, measured respectively by an ion chamber and film. The gamma pass rate, measured by EBT2 film, was 95% (3% DD and 1 mm DTA). Through a systematic series of quantitative commissioning experiments and end‐to‐end tests and our initial clinical experience, described in this report, we demonstrate that the NTX is a robust system, with the image guidance and MLC requirements to treat a wide variety of sites — in particular for highly accurate delivery of SRS and SBRT‐based treatments.PACS numbers: 87.55.Qr, 87.53.Ly, 87.59.‐e

前立腺3DCRTおよびIMRTにおける High-definition Multileaf Collimatorの影響

The focus of this work is to evaluate the dosimetric impact of treatment planning for three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) of prostate cancer using Varian/BrainLAB 120-leaf high-definition multileaf collimator (HD120 MLC) with 2.5 mm leaf width and Varian 120-leaf millennium multileaf collimator (M120 MLC) with 5 mm leaf width. We measured the leaf transmission and dosimetric leaf gap (DLG) of two multileaf collimator (MLC) systems using Farmer ionization chamber. The dosimetric impact of treatment planning for 3DCRT and IMRT of prostate cancer for ten clinical cases using two MLC systems was evaluated quantitatively. 3DCRT was divided to 3DCRT(middle) as fitting at middle of leaf tip and 3DCRT(outside) as fitting at outside of leaf tip. The leaf transmission factor and DLG of HD120 MLC for 6 and 10 MV X-ray decreased by 0.2% and 1 mm, respectively, compared to M120 MLC. The mean conformity index of PTV of treatment planning for prostate 3DCRT(middle), 3DCRT(outside) , and IMRT decreased by 0.9%, 6.6%, and 0.9% and the mean homogeneity index increased 2.3%, 13.0%, and 4.2%, respectively. The mean V20, V40, and V65 decreased by 2.4%, 6.6%, and 4.5% for bladder and 3.3%, 6.1%, and 5.9% for rectum, respectively. The results of this work demonstrated that the dose conformity of PTV improved and the dose of bladder and rectum decreased for 3DCRT and IMRT of prostate cancer using HD120 MLC compared to M120 MLC, because of reduction of leaf width, leaf transmission, and rounded leaf end transmission.

Accuracy of Acuros XB and AAA dose calculation for small fields with reference to RapidArc® stereotactic treatments

To assess the accuracy against measurements of two photon dose calculation algorithms (Acuros XB and the Anisotropic Analytical algorithm AAA) for small fields usable in stereotactic treatments with particular focus on RapidArc(®). Acuros XB and AAA were configured for stereotactic use. Baseline accuracy was assessed on small jaw-collimated open fields for different values for the spot sizes parameter in the beam data: 0.0, 0.5, 1, and 2 mm. Data were calculated with a grid of 1 × 1 mm(2). Investigated fields were: 3 × 3, 2 × 2, 1 × 1, and 0.8 × 0.8 cm(2) with a 6 MV photon beam generated from a Clinac2100iX (Varian, Palo Alto, CA). Profiles, PDD, and output factors were measured in water with a PTW diamond detector (detector size: 4 mm(2), thickness 0.4 mm) and compared to calculations. Four RapidArc test plans were optimized, calculated and delivered with jaw settings J3 × 3, J2 × 2, and J1 × 1 cm(2), the last was optimized twice to generate high (H) and low (L) modulation patterns. Each plan consisted of one partial arc (gantry 110° to 250°), and collimator 45°. Dose to isocenter was measured in a PTW Octavius phantom and compared to calculations. 2D measurements were performed by means of portal dosimetry with the GLAaS method developed at authors' institute. Analysis was performed with gamma pass-fail test with 3% dose difference and 2 mm distance to agreement thresholds. Open square fields: penumbrae from open field profiles were in good agreement with diamond measurements for 1 mm spot size setting for Acuros XB, and between 0.5 and 1 mm for AAA. Maximum MU difference between calculations and measurements was 1.7% for Acuros XB (0.2% for fields greater than 1 × 1 cm(2)) with 0.5 or 1 mm spot size. Agreement for AAA was within 0.7% (2.8%) for 0.5 (1 mm) spot size. RapidArc plans: doses were evaluated in a 4 mm diameter structure at isocenter and computed values differed from measurements by 0.0, -0.2, 5.5, and -3.4% for Acuros XB calculations (1 mm spot size), and of -0.1, 0.3, 6.7, and -1.2% for AAA, respectively for J3 × 3, J2 × 2, J1 × 1H, J1 × 1L RapidArc plans. Gamma Agreement Index from 2D dose analysis was higher than 95% for J3 × 3 and J2 × 2 plans, being around 80% for J1 × 1 maps. Sensitivity with respect to the dosimetric leaf gap and transmission factor MLC parameters was evaluated in the four RapidArc plans, showing the need to properly set the dosimetric leaf gap for accurate calculations. Acuros XB and AAA showed acceptable characteristics for stereotactic small fields if adequate tuning of configuration parameters is performed. Dose calculated for RapidArc stereotactic plans showed an acceptable agreement against point and 2D measurements. Both algorithms can therefore be considered safely applicable to stereotactic treatments.

Leaf Gap Leakage and Dosimetric Accuracy for SBRT Treatment on the TrueBeam STx

Leaf Gap Leakage and Dosimetric Accuracy for SBRT Treatment on the TrueBeam STx

Direct impact analysis of multi-leaf collimator leaf position errors on dose distributions in volumetric modulated arc therapy: a pass rate calculation between measured planar doses with and without the position errors**This work was presented in part at the 52nd Annual Meeting of the American Society for Therapeutic Radiology and Oncology in San Diego on 1 November 2010.

We propose a new method for analyzing the direct impact of multi-leaf collimator (MLC) leaf position errors on dose distributions in volumetric modulated arc therapy (VMAT). The technique makes use of the following processes. Systematic leaf position errors are generated by directly changing a leaf offset in a linac controller; dose distributions are measured by a two-dimensional diode array; pass rates of the dose difference between measured planar doses with and without the position errors are calculated as a function of the leaf position error. Three different treatment planning systems (TPSs) were employed to create VMAT plans for five prostate cancer cases and the pass rates were compared between the TPSs under various leaf position errors. The impact of the leaf position errors on dose distributions depended upon the final optimization result from each TPS, which was explained by the correlation between the dose error and the average leaf gap width. The presented method determines leaf position tolerances for VMAT delivery for each TPS, which may facilitate establishing a VMAT quality assurance program in a radiotherapy facility.

Fractal analysis for assessing the level of modulation of IMRT fields

To investigate the potential of three fractal dimension (FD) analysis methods (i.e., the variation, power spectrum, and variogram methods) as metrics for quantifying the degree of modulation in planned intensity modulated radiation therapy (IMRT) treatment fields, and compare the most suitable FD method to the number of monitor units (MUs), the average leaf gap, and the 2D modulation index (2D MI) for assessing modulation. The authors implemented, validated, and compared the variation, power spectrum, and variogram methods for computing the FD. Validation of the methods was done using mathematical fractional Brownian surfaces of known FD that ranged in size from 128 × 128 to 512 × 512. The authors used a test set consisting of seven head and neck carcinoma plans (50 prescribed treatment fields) to choose an FD cut-point that ensures no false positives (100% specificity) in distinguishing between moderate and high degrees of field modulation. The degree of field modulation was controlled by adjusting the fluence smoothing parameters in the Eclipse™ treatment planning system (Varian Medical Systems, Palo Alto, CA). The moderate modulation fields were representative of the degree of modulation used clinically at the authors' institution. The authors performed IMRT quality assurance (QA) on the 50 test fields using the MapCHECK™ device. The FD cut-point was applied to a validation set consisting of four head and neck plans (28 fields). The area under the curve (AUC) from receiver operating characteristic (ROC) analysis was used to compare the ability of FD, number of MUs, average leaf gap, and the 2D MI for distinguishing between the moderate and high modulation fields. The authors found the variogram FD method to be the most suitable for assessing the modulation complexity of IMRT fields for head and neck carcinomas. Pass rates as measured by the gamma criterion for the MapCHECK™ IMRT field measurements were higher for the moderately modulated fields, and a gamma criterion with 1 mm distance-to-agreement and 1% dose difference showed a clear separation between the 94% pass rates of the moderate and high modulation groups. From the ROC analysis of the test set, the authors found the AUC of the variogram FD, number of MUs, average leaf gap, and 2D MI methods to be 0.99 (almost perfect), 0.91 (excellent), 0.91 (excellent), and 0.92 (excellent), respectively. A cut-point of FD > 2.25 correctly identified 92.8% of the high modulation fields and 100% of the moderately modulated fields in the validation set, satisfying the condition of no false positives. Of the three FD methods investigated, the variogram method is the most accurate and precise metric for identifying high modulation treatment fields. It is also more accurate and precise than the number of MUs, the average leaf gap, and the 2D MI. Although MapCHECK™ IMRT QA does a reasonable job at identifying high modulation fields, the variogram FD method provides one with the opportunity to quantitatively and accurately assess modulation and adjust overly modulated fields at the treatment planning stage before they are sent to the treatment machine for QA or patient treatment.