Standard Multileaf Collimator Research Articles

A multi-centre stereotactic radiosurgery planning study of multiple brain metastases using isocentric linear accelerators with 5 and 2.5mm width multi-leaf collimators, CyberKnife and Gamma Knife.

This study compared plans of high definition (HD), 2.5 mm width multi-leaf collimator (MLC), to standard, 5 mm width, isocentric linear accelerator (linacs), CyberKnife (CK), and Gamma Knife (GK) for stereotactic radiosurgery (SRS) techniques on multiple brain metastases. Eleven patients undergoing SRS for multiple brain metastases were chosen. Targets and organs at risk (OARs) were delineated and optimized SRS plans were generated and compared. The linacs delivered similar conformity index (CI) values, but the gradient index (GI) for HD MLCs was significantly lower (P-value <.001). Half the OARs received significantly lower dose using HD MLCs. CK delivered a significantly lower CI than HD MLC linac (P-value <.001), but a significantly higher GI (P-value <.001). CI was significantly improved with the HD MLC linac compared to GK (P-value = 4.591 × 10-3), however, GK delivered a significantly lower GI (P-value <.001). OAR dose sparing was similar for the HD MLC TL, CK, and GK. Comparing linacs for SRS, the preferred choice is HD MLCs. Similar results were achieved with the HD MLC linac, CK, or GK, with each delivering significant improvements in different aspects of plan quality. This article is the first to compare HD and standard width MLC linac plans using a combination of single isocentre volumetric modulated arc therapy and multi-isocentric dynamic conformal arc plans as required, which is a more clinically relevant assessment. Furthermore, it compares these plans with CK and GK, assessing the relative merits of each technique.

Radiosurgical treatment of solitary brain metastases using virtual cones with a standard multileaf collimator.

The virtual cone has been previously introduced as a novel technique for generating small, spherical dose distributions using a high-definition multileaf collimator (MLC) for functional radiosurgery applications. There has been no reported investigation into adapting this technique to a standard MLC for the treatment of solitary intracranial metastases as an alternative to physical stereotactic cones. This study characterizes the virtual cone technique adapted to a standard 5mmleaf-width MLC (VCSD ). VCSD dose distributions using MLC leaf gaps of 2-5mmwere generated and isodose sphericity metrics, peak dose gradients, optimal normalization ranges, and achievable field widths were compared to those of 5.0-12.5mmdiameter physical cones. Target sizes feasible to treat were identified and planned for comparison against established techniques using Paddick conformity index (PCI) and dose volume metrics. End-to-end validation of the VCSD technique was performed. VCSD and physical cones sphericity metrics agree within 3.5% and VCSD plans achieved a dose gradient of 21.3%mm-1 , comparable to 10.0-12.5mmdiameter physical cones. Normalization within the 50%-77% range preserves the optimal dose gradient within 2%⋅mm-1 and enables the treatment of 5-11mmdiameter planning target volumes (PTVs). Mean PCI for virtual and physical cones was 0.957 and 0.949, which compared favorably against conformal arc and VMAT (0.899 and 0.926). VCSD outperformed conformal arc and VMAT for all dose volume metrics, and the mean 50% dose volume differed from physical cones by<0.5cc for PTVs as small as 5mm.Validationmeasurementsshowed100% of points passing a 2% / 0.5mmgamma test for all plans. The VCSD technique efficiently generates spherical dose distributions for the treatment of small brain metastases. Characteristics of the VCSD dose distributions are sufficiently comparable to those of physical cones to support VCSD as an alternative for the treatment of spherical PTVs as small as 5mmin diameter.

On the MLC leaves alignment in the direction orthogonal to movement.

The main focus of the recommended spatial accuracy tests for the multi‐leaf collimators (MLC) is calibration of the leaf position along the movement direction and overall alignment to the radiation isocenter. No explicit attention was typically paid to the alignment of the leaves from the opposing banks in the direction orthogonal to movement. This paper is a case study demonstrating that verification of such alignment at the time of acceptance testing is prudent. The original standard MLC (SMLC) on an MRIdian MRI‐guided linac (ViewRay Inc., Mountain View, CA, USA) was upgraded to a high‐speed MLC (HSMLC), which is supposed to be mechanically identical to the SMLC except for the higher drive screw pitch. The results of the end‐to‐end IMRT tests demonstrated unacceptable dosimetric results exemplified by an average and maximum ion chamber (IC) point dose error in the high‐dose low‐gradient region of 2.5 ± 1.4% and 4.6%, respectively. Before the upgrade, those values were 0.3 ± 0.7% and 0.9%, respectively. An exhaustive analysis of possible failure modes eventually zeroed in on the average misalignment of about 1 mm in the Y (along the couch) direction between the right and left upper MLC banks. The MLC was replaced, reducing the Y‐direction misalignment to 0.4 mm. As a result, the average and maximum IC dose‐errors became acceptable 1.0 ± 0.7% and 1.6%, respectively. Simple film and/or chamber array tests during acceptance testing can easily detect Y‐direction misalignments between opposing leaves banks measuring a fraction of a mm at isocenter. Left undetected, such misalignment can cause nontrivial dosimetric consequences.

Assessment of single isocenter linear accelerator radiosurgery for metastases and base of skull lesions.

Newer technology for stereotactic radiosurgery (SRS) should be assessed for different multi-leaf collimators (MLC). Assess plan quality of an automated, frameless, linear accelerator based (linac) planning and delivery system (HyperArc) for SRS using both standard MLC (SMLC) and high definition MLC (HDMLC) compared to a cobalt-60 based SRS system (Gamma Knife, GK). We re-planned twenty GK Perfexion-treated SRS patients (27 lesions) for HyperArc using SMLC and HDMLC. We assessed plan quality using the following metrics: gradient index (GI), Paddick and RTOG conformity indices (CIPaddick, CIRTOG), volume receiving half of prescription isodose (PIVhalf) and maximum dose to 0.03cc for brainstem, optic chiasm and optic nerves, and V12Gy for brain-GTV. Linac plans had better conformity with HDMLC being most conformal. GK exhibited better GI. PIVhalf demonstrated no statistically significant difference between HDMLC and GK, and SMLC was nominally worse than GK. Mean PIVhalf was generally 0.85cc larger for SMLC than HDMLC. For TV>1.0cc, the relative differences in CIRTOG, GI, and PIVhalf for SMLC vs. HDMLC were less than 21%. For TV less than<1.0cc, there were more obvious relative differences for SMLC vs. HDMLC in CIRTOG (mean 146%, max 700%), GI (mean 49%, max 162%), and PIVhalf (mean 77%, max 522%). Organ at risk doses were met in all plans. New linac-based plans positively compare to GK plans overall. HDMLC should be strongly considered for treatment of lesions<1.0cc given the significant improvements in conformity and PIVhalf over SMLC.

SU‐F‐T‐629: Effect of Multi‐Leaf Collimator (MLC) Width On Plan Quality of Single‐Isocenter VMAT Intracranial Stereotactic Radiosurgery for Multiple Metastases

Purpose:Single‐isocenter VMAT has been shown able to create high quality plans for complex intracranial multiple metastasis SRS cases. Linacs capable of the technique are typically outfitted with an MLC that consists of a combination of 5 mm and 10 mm leaves (standard) or 2.5 mm and 5 mm leaves (high‐definition). In this study, we test the hypothesis that thinner collimator leaves are associated with improved plan quality.Methods:Ten multiple metastasis cases were identified and planned for VMAT SRS using a 10 MV flattening filter free beam. Plans were created for a standard (std) and a high‐definition (HD) MLC. Published values for leaf transmission factor and dosimetric leaf gap were utilized. All other parameters were invariant. Conformity (plan and individual target), moderate isodose spill (V50%), and low isodose spill (mean brain dose) were selected for analysis.Results:Compared to standard MLC, HD‐MLC improved overall plan conformity (median: Paddick CI_HD = 0.83, Paddick CI_std = 0.79; p = 0.004 and median: RTOG CI_HD =1.18, RTOG CI_std =1.24; p = 0.01), improved individual lesion conformity (median: Paddick CI_HD,i =0.77, Paddick CI_std,i =0.72; p &lt; 0.001 and median: RTOG CI_HD,i = 1.28, RTOG CI_std,i =1.35; p &lt; 0.001), improved moderate isodose spill (median: V50%_HD = 37.0 cc, V50%_std = 45.7 cc; p = 0.002), and improved low dose spill (median: dmean_HD = 2.90 Gy, dmean_std = 3.19 Gy; p = 0.002).Conclusion:For the single‐isocenter VMAT SRS of multiple metastasis plans examined, use of HD‐MLC modestly improved conformity, moderate isodose, and low isodose spill compared to standard MLC. However, in all cases we were able to generate clinically acceptable plans with the standard MLC. More work is need to further quantify the difference in cases with higher numbers of small targets and to better understand any potential clinical significance.This research was supported in part by Varian Medical Systems.

Dosimetric comparison of different multileaf collimators in volumetric modulated arc therapy for malignant pleural mesothelioma

Abstract Objective The aiom of the study was to compare the impacts of two types of multileaf collimators (MLC) [standard MLC with a width of 10 mm (sMLC) and micro-MLC with a width of 5 mm (mMLC)] on volumetric modulated arc therapy (VMAT) planning for malignant pleural mesothelioma. Methods VMAT for ten patients with inoperable malignant pleural mesotheliomas was retrospectively planned with the sMLC and mMLC. Histogram-based dose-volume parameters of the planning target volume (PTV) [conformity index (CI) and homogeneous index (HI)] and organs-at-risk were compared for VMAT plans with sMLC (sMLC-VMAT) and mMLC (mMLC-VMAT). Results The mMLC-VMAT plans were more efficient (average delivery time: 2.67±1.49 min) than the sMLC-VMAT plans (average delivery time: 4.21 ± 2.03 min; P &lt; 0.05). Moreover, compared to the sMLC plans, the mMLC plans demonstrated advantages in the dose coverage of the PTV (CI 0.75 ± 0.08 vs 0.73 ± 0.09; HI 1.09 ± 0.02 vs 1.10 ± 0.02), although the difference was not statistically significant (P &gt; 0.05). In addition, significant dose sparing in the fraction of the ipsilateral lung volume receiving &gt; 20 Gy (V20; 54.72 ± 27.08 vs 58.52 ± 29.30) and &gt; 30 Gy (V30; 42.74 ± 27.86 vs 46.86 ± 31.49) radiation, respectively, was observed for the mMLC plans (P &lt; 0.05). Conclusion Comparing sMLC-VMAT and mMLC-VMAT not only demonstrated the higher efficiency and better optimal target coverage of mMLC-VMAT, but also considerably improved the dose sparing of the ipsilateral lung in the VMAT plans for malignant pleural mesothelioma.

Dosimetric effect of Elekta Beam Modulator micromultileaf in three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for prostate cancer

The purpose of this study is to analyze the dosimetric effect of Elekta Beam Modulator in 3-dimensional conformal radiation therapy (3DCRT) and in intensity-modulated radiation therapy (IMRT) for localized prostate cancer. We compared treatment plans developed with 2 different Elekta multileaf collimators (MLC): Beam Modulator micro-MLC (mMLC) (4-mm leaf width at the isocenter) and standard MLC (10-mm leaf width at the isocenter). The comparison was performed for 15 patients with localized prostate cancer in 3DCRT and IMRT delivery; a total of 60 treatment plans were processed. The dose-volume histograms were used to provide the quantitative comparison between plans. In particular, we analyzed differences between rectum and bladder sparing in terms of a set of appropriate Vx (percentage of organ at risk [OAR] volume receiving the x dose) and differences between target conformity and coverage in terms of coverage factor and conformation number. Our analysis demonstrates that in 3DCRT there is an advantage in the use of Elekta Beam Modulator mMLC in terms of organ sparing; in particular, a significant decrease in rectal V60 and V50 (p = 0.001) and in bladder V70 and V65 (p = 0.007 and 0.002, respectively) was found. Moreover, a better target dose conformity was obtained (p = 0.002). IMRT plans comparison demonstrated no significant differences between the use of the 4 or 10-mm MLCs. Our analysis shows that in 3DCRT the use of the Elekta Beam Modulator mMLC gives a gain in target conformity and in OARs dose sparing whereas in IMRT plans there is no advantage.

Dosimetric comparison of different multileaf collimator leaves in treatment planning of intensity-modulated radiotherapy for cervical cancer

To study the effect of multileaf collimator (MLC) leaf widths (standard MLC [sMLC] width of 10mm and micro-MLC [mMLC] width of 4mm) on intensity-modulated radiotherapy (IMRT) for cervical cancer. Between January 2010 and August 2010, a retrospective analysis was conducted on 12 patients with cervical cancer. The treatment plans for all patients were generated with the same machine setup parameters and optimization methods in a treatment planning system (TPS) based on 2 commercial Elekta MLC devices. The dose distribution for the planning tumor volume (PTV), the dose sparing for organs at risk (OARs), the monitor units (MUs), and the number of IMRT segments were evaluated. For the delivery efficiency, the MUs were significantly higher in the sMLC-IMRT plan than in the mMLC-IMRT plan (802 ± 56.9 vs 702 ± 56.7; p < 0.05). The number of segments in the plans were 58.75 ± 1.8 and 59 ± 1.04 (p > 0.05). For the planning quality, the conformity index (CI) between the 2 paired IMRT plans with the mMLC and the sMLC did not differ significantly (average: 0.817 ± 0.024 vs 0.810 ± 0.028; p > 0.05). The differences of the homogeneity index (HI) between the 2 paired plans were statistically significant (average: 1.122 ± 0.010 vs 1.132 ± 0.014; p < 0.01). For OARs, the rectum, bladder, small intestine, and bony pelvis were evaluated in terms of V10, V20, V30, and V40, percentage of contoured OAR volumes receiving 10, 20, 30, and 40Gy, respectively, and the mean dose (Dmean) received. The IMRT plans with the mMLC protected the OARs better than the plans with the sMLC. There were significant differences (p < 0.05) in evaluated parameters between the 2 paired IMRT plans, except for V30 and V40 of the rectum and V10, V20, V40, and Dmean of the bladder. IMRT plans with the mMLC showed advantages over the plans with the sMLC in dose homogeneity for targets, dose sparing of OARs, and fewer MUs in cervical cancer.

SU‐F‐500‐05: MRI‐Linac Systems: Can a Standard MLC Be Incorporated Into Such a Device?

Purpose: Integrated MRI‐linac systems for real‐time image guidance are currently under development to master intrafraction tumor motion. As the multileaf collimator (MLC) is a crucial component of such systems, this study is aimed to answer if a standard MLC can be incorporated based on (a) its impact on the MRI field homogeneity and (b) the electromagnetic force acting on the MLC in the MRI field. Methods: A 1.0 T split‐bore magnet and the key ferromagnetic components of a Varian Millennium 120 MLC, namely the leaves and motors, were modelled using the finite element method (FEM). In this work both the parallel and perpendicular configuration for such a system were investigated, i.e. the linac treatment beam was orientated parallel and perpendicular to the MRI field direction. Simulations were performed for isocentre distances in the range from 100 to 200 cm. From the resultant magnetic field distributions, the introduced field distortion over the MRI imaging volume, a 30 cm diameter sphere volume (DSV) around the isocentre, and the net electromagnetic force acting on the MLC were evaluated. Results: For all distances of 140 cm or larger, the field distortion was below 300 ppm which is commonly referred to as maximum pre‐shim inhomogeneity of MRI devices. The total force pulling the MLC towards the MRI magnet was found to be maximum at a 120 cm isocentre distance with 1706 N and 3499 N in parallel and perpendicular configuration, respectively, and to decrease for larger distances. Conclusion: The theoretical results suggest that the distortion introduced by a standard MLC can be corrected for by shimming for isocentre distances of 140 cm or larger. Appropriate mounting of the MLC to withstand the electromagnetic forces is considered mechanically challenging and may require an isocentre distance larger than 140 cm. NHMRC Australia Fellowship, Australian Endeavour Research Fellowship

Dosimetric comparison using different multileaf collimeters in intensity-modulated radiotherapy for upper thoracic esophageal cancer

PurposeTo study the impacts of multileaf collimators (MLC) width [standard MLC width of 10 mm (sMLC) and micro-MLC width of 4 mm (mMLC)] in the intensity-modulated radiotherapy (IMRT) planning for the upper thoracic esophageal cancer (UTEC).Methods and materials10 patients with UTEC were retrospectively planned with the sMLC and the mMLC. The monitor unites (MUs) and dose volume histogram-based parameters [conformity index (CI) and homogeneous index (HI)] were compared between the IMRT plans with sMLC and with mMLC.ResultsThe IMRT plans with the mMLC were more efficient (average MUs: 703.1 ± 68.3) than plans with the sMLC (average MUs: 833.4 ± 73.8) (p < 0.05). Also, compared to plans with the sMLC, the plans with the mMLC showed advantages in dose coverage of the planning gross tumor volume (Pgtv) (CI 0.706 ± 0.056/HI 1.093 ± 0.021) and the planning target volume (PTV) (CI 0.707 ± 0.029/HI 1.315 ± 0.013) (p < 0.05). In addition, the significant dose sparing in the D5 (3260.3 ± 374.0 vs 3404.5 ± 374.4)/gEUD (1815.1 ± 281.7 vs 1849.2 ± 297.6) of the spinal cord, the V10 (33.2 ± 6.5 vs 34.0 ± 6.7), V20 (16.0 ± 4.6 vs 16.6 ± 4.7), MLD (866.2 ± 174.1 vs 887.9 ± 172.1) and gEUD (938.6 ± 175.2 vs 956.8 ± 171.0) of the lungs were observed in the plans with the mMLC, respectively (p < 0.05).ConclusionsComparing to the sMLC, the mMLC not only demonstrated higher efficiencies and more optimal target coverage, but also considerably improved the dose sparing of OARs in the IMRT planning for UTEC.

Impacts of Multileaf Collimators Leaf Width on Intensity-Modulated Radiotherapy Planning for Nasopharyngeal Carcinoma: Analysis of Two Commercial Elekta Devices

We compared the impacts of multileaf collimator (MLC) widths (standard MLC width of 10 mm [SMLC] and micro-MLC width of 4 mm [MMLC]) on intensity-modulated radiotherapy (IMRT) planning for nasopharyngeal carcinoma (NPC). Ten patients with NPC were recruited in this study. In each patient's case, plans were generated with the same machine setup parameter and optimizing methods in a treatment planning system according to 2 commercial Elekta MLC devices. All of the parameters were collected from dose-volume histograms of paired plans and evaluated. The average conformity index (CI) and homogeneous index (HI) for the planning gross target volume in IMRT plans with MMLC were 0.790 ± 0.036 and 1.062 ± 0.011, respectively. Data in plans with SMLC were 0.754 ± 0.038 and 1.070 ± 0.010, respectively. The differences were statistically significant ( p < 0.05). Compared with CI and HI for planning target volume in paired plans, data with MMLC obviously were better than those with SMLC (CI: 0.858 ± 0.026 vs. 0.850 ± 0.021, p < 0.05; and HI: 1.185 ± 0.011 vs. 1.195 ± 0.011, p < 0.05). However, there was no statistical significance between evaluated parameters (Dmean, Dmax, D 5, gEUD, or NTCP) for organs at risk (OARs) in the 2 paired IMRT plans. According to these two kinds of Elekta MLC devices, IMRT plans with the MMLC have significant advantages in dose coverage for the targets, with more efficiency in treatment for NPC but fail to improve dose sparing of the OARs.

Phase-II study on stereotactic radiotherapy of locally advanced pancreatic carcinoma

Background and purposeThe majority of patients with pancreatic cancer have advanced disease at the time of diagnosis and are not amenable for surgery. Stereotactic radiotherapy (SRT) may be an alternative treatment for patients with locally advanced disease. The effect of SRT was investigated in the present phase-II trial. Patients and methodsTwenty-two patients with locally advanced and surgically non-resectable, histological proven pancreatic carcinoma were included into the trial. The patients were immobilized by the Elekta stereotactic body frame (SBF) or a custom made body frame. SRT was given on standard LINAC with standard multi-leaf collimator. Central dose was 15Gy×3 within 5–10 days. ResultsEvaluation of response was found to be very difficult due to radiation and tumour related tissue reaction. Only two patients (9%) were found to have a partial response (PR), the remaining had no change (NC) or progression (PD) after treatment. Six patients had local tumour progression, but only one patient had an isolated local failure without simultaneous distant metastasis. Median time to local or distant progression was 4.8 months. Median survival time was 5.7 months and only 5% were alive 1 year after treatment. Acute toxicity reported 14 days after treatment was pronounced. There was a significant deterioration of performance status (P=0.008), more nausea (P=0.001) and more pain (P=0.008) after 14 days compared with base-line. However, 8 of 12 patients (66%) improved in performance status, scored less nausea, pain, or needed less analgesic drugs at 3 months after treatment. Four patients suffered from severe mucositis or ulceration of the stomach or duodenum and one of the patients had a non-fatal ulcer perforation of the stomach. ConclusionsSRT was associated with poor outcome, unacceptable toxicity and questionable palliative effect and cannot be recommended for patients with advanced pancreatic carcinoma.

Impact of IMRT and leaf width on stereotactic body radiotherapy of liver and lung lesions

The present study explored the impact of intensity-modulated radiotherapy (IMRT) on stereotactic body RT (SBRT) of liver and lung lesions. Additionally, because target dose conformity can be affected by the leaf width of a multileaf collimator (MLC), especially for small targets and stereotactic applications, the use of a micro-MLC on "uniform intensity" conformal and intensity-modulated SBRT was evaluated. The present study included 10 patients treated previously with SBRT in our institution (seven lung and three liver lesions). All patients were treated with 3 x 12 Gy prescribed to the 65% isodose level. The actual MLC-based conformal treatment plan served as the standard for additional comparison. In total, seven alternative treatment plans were made for each patient: a standard (actual) plan and an IMRT plan, both calculated with Helax TMS (Nucletron) using a pencil beam model; and a recalculated standard and a recalculated IMRT plan on Helax TMS using a point dose kernel approach. These four treatment plans were based on a standard MLC with 1-cm leaf width. Additionally, the following micro-MLC (central leaf width 3 mm)-based treatment plans were calculated with the BrainSCAN (BrainLAB) system: standard, IMRT, and dynamic arc treatments. For each treatment plan, various target parameters (conformity, coverage, mean, maximal, and minimal target dose, equivalent uniform doses, and dose-volume histogram), as well as organs at risk parameters (3 Gy and 6 Gy volume, mean dose, dose-volume histogram) were evaluated. Finally, treatment efficiency was estimated from monitor units and the number of segments for IMRT solutions. For both treatment planning systems, no significant difference could be observed in terms of target conformity between the standard and IMRT dose distributions. All dose distributions obtained with the micro-MLC showed significantly better conformity values compared with the standard and IMRT plans using a regular MLC. Dynamic arc plans were characterized by the steepest dose gradient and thus the smallest V(6 Gy) values, which were on average 7% smaller than the standard plans and 20% lower than the IMRT plans. Although the Helax TMS IMRT plans show about 18% more monitor units than the standard plan, BrainSCAN IMRT plans require approximately twice the number of monitor units relative to the standard plan. All treatment plans optimized with a pencil beam model but recalculated with a superposition method showed significant qualitative, as well as quantitative, differences, especially with respect to conformity and the dose to organs at risk. Standard conformal treatment techniques for SBRT could not be improved with inversely planned IMRT approaches. Dose calculation algorithms applied in optimization modules for IMRT applications in the thoracic region need to be based on the most accurate dose calculation algorithms, especially when using higher energy photon beams.

Inherent smoothness of intensity patterns for intensity modulated radiation therapy generated by simultaneous projection algorithms

The efficient delivery of intensity modulated radiation therapy (IMRT) depends on finding optimized beam intensity patterns that produce dose distributions, which meet given constraints for the tumour as well as any critical organs to be spared. Many optimization algorithms that are used for beamlet-based inverse planning are susceptible to large variations of neighbouring intensities. Accurately delivering an intensity pattern with a large number of extrema can prove impossible given the mechanical limitations of standard multileaf collimator (MLC) delivery systems. In this study, we apply Cimmino's simultaneous projection algorithm to the beamlet-based inverse planning problem, modelled mathematically as a system of linear inequalities. We show that using this method allows us to arrive at a smoother intensity pattern. Including nonlinear terms in the simultaneous projection algorithm to deal with dose–volume histogram (DVH) constraints does not compromise this property from our experimental observation. The smoothness properties are compared with those from other optimization algorithms which include simulated annealing and the gradient descent method. The simultaneous property of these algorithms is ideally suited to parallel computing technologies.

892 Partial volume irradiation in 3D conformal radiotherapy for the treatment of prostate adenocarcinoma: a poor man's solution to rectum sparing

The purpose of this study is to analyze the dosimetric effect of Elekta Beam Modulator in 3-dimensional conformal radiation therapy (3DCRT) and in intensity-modulated radiation therapy (IMRT) for localized prostate cancer. We compared treatment plans developed with 2 different Elekta multileaf collimators (MLC): Beam Modulator micro-MLC (mMLC) (4-mm leaf width at the isocenter) and standard MLC (10-mm leaf width at the isocenter). The comparison was performed for 15 patients with localized prostate cancer in 3DCRT and IMRT delivery; a total of 60 treatment plans were processed. The dose-volume histograms were used to provide the quantitative comparison between plans. In particular, we analyzed differences between rectum and bladder sparing in terms of a set of appropriate Vx (percentage of organ at risk [OAR] volume receiving the x dose) and differences between target conformity and coverage in terms of coverage factor and conformation number. Our analysis demonstrates that in 3DCRT there is an advantage in the use of Elekta Beam Modulator mMLC in terms of organ sparing; in particular, a significant decrease in rectal V60 and V50 (p = 0.001) and in bladder V70 and V65 (p = 0.007 and 0.002, respectively) was found. Moreover, a better target dose conformity was obtained (p = 0.002). IMRT plans comparison demonstrated no significant differences between the use of the 4 or 10-mm MLCs. Our analysis shows that in 3DCRT the use of the Elekta Beam Modulator mMLC gives a gain in target conformity and in OARs dose sparing whereas in IMRT plans there is no advantage.

The effect of leaf width and sampling distance on the “stair-stepping” of field borders defined by multileaf collimators

Standard multileaf collimators (MLCs) are now available with 1.0 and 0.5 cm leaf widths. The aim of this work is to compare the dose-undulation and effective penumbra of field edges formed by these MLC leaf widths and to determine how reducing the sampling distance (centre-to-centre distance between adjacent MLC leaves) for the 1.0 cm leaf width compares to the smaller leaf width. The undulation of the 50% isodose line and the 80-20% and 80-30% effective penumbra were compared for a field edge angled at 45 degrees to the MLC leaf motion direction at 8 cm depth. The larger leaf width field was also segmented to form field edges with 0.5, 0.33 and 0.2 cm sampling distance. Random setup variation of 2 mm standard deviation was also incorporated. Dose undulation was 1.5 mm for the 0.5 cm MLC leaf width compared to 4.5 mm for the 1.0 cm width. The 80-20% effective penumbra was 2 mm less for the 0.5 cm leaf width and the 80-30% effective penumbra was approximately 3 mm less. When random setup variation was incorporated the 0.5 cm leaf width isodoses were straight compared with approximately 3 mm undulation for the larger MLC. Reducing the sampling distance for the 1.0 cm MLC leaf width to 0.33 cm resulted in penumbra only slightly greater than the 0.5 cm leaf width and removed the undulation. Effective penumbra and dose undulation are reduced for the 0.5 cm leaf width compared to a 1.0 cm leaf width. Reducing the sampling distance for the 1.0 cm MLC leaf can approximate the 0.5 cm leaf width, at the expense of longer treatment times, and increased quality assurance investment.

Dynamic intensity modulated electron arc therapy using standard multi-leaf collimators

Dynamic intensity modulated electron arc therapy using standard multi-leaf collimators

Intensity modulation using multileaf collimators: current status

Intensity-modulated radiation therapy (IMRT) extends the capability of 3D conformal methods (3D-CRT). Studies show that these methods can clinically reduce complications and can allow a larger safety margin for dose escalation. The ultimate goal is improved survival and improved quality of life. IMRT methods typically require more fields, or segments, and more monitor units for a given dose, as compared to conventional CRT methods. Because of this, some multileaf collimator (MLC) parameters take on more importance. A review of current standard MLC configurations are discussed, along with the concept of integral dose. An effective quality assurance (QA) program for IMRT involves more than dose modeling of the MLC. Integrity of data flowing from 3D radiograph databases to treatment planning to delivery sequencing files to verify-and-record function is required. End users need to be aware of differences in commercial availability vs. in-house developments for configuring a system. Great strides have been made in streamlining the whole process. This is evidenced by the first major symposium on community-based IMRT. Research continues to improve accuracy and productivity.

The treatment planning of segmental, conformal stereotactic radiosurgery utilizing a standard multileaf collimator

Over a period of approximately 3 years, our institution has implemented and refined a system of Stereotactic Radiosurgery (SRS) which utilizes the standard multi leaf collimator (MLC) of the Scanditronix MM50 Racetrack Microtron and treats in an arrangement of segmental “pseudo-arcs.” This system employs a commercial BRW-based stereotactic frame which is mounted to the treatment table. With the exception of the table-mounted frame hardware there have been no modifications to the treatment machine to accommodate these treatments. By use of standard evaluation parameters (e.g., treatment time, planning time, dose conformance and dose heterogeneity ratios) this system compares quite favorably with reported data from institutions treating SRS with either a GammaKnife or a standard linear accelerator with tertiary collimators.