Commissioning of a double-focused micro multileaf collimator (muMLC)

Steeper dose gradients resulting from reduced source to target distance-a planning system independent study

Purpose

To quantify the contribution of penumbra in the improvement of healthy tissue sparing at reduced source‐to‐axis distance (SAD) for simple spherical target and different prescription isodoses (PI).

Method

A TPS‐independent method was used to estimate three‐dimensional (3D) dose distribution for stereotactic treatment of spherical targets of 0.5 cm radius based on single beam two‐dimensional (2D) film dosimetry measurements. 1 cm target constitutes the worst case for the conformation with standard Multi‐Leaf Collimator (MLC) with 0.5 cm leaf width. The measured 2D transverse dose cross‐sections and the profiles in leaf and jaw directions were used to calculate radial dose distribution from isotropic beam arrangement, for both quadratic and circular beam openings, respectively. The results were compared for standard (100 cm) and reduced SAD 70 and 55 cm for different PI.

Results

For practical reduction of SAD using quadratic openings, the improvement of healthy tissue sparing (HTS) at distances up to 3 times the PTV radius was at least 6%–12%; gradient indices (GI) were reduced by 3–39% for PI between 40% and 90%. Except for PI of 80% and 90%, quadratic apertures at SAD 70 cm improved the HTS by up to 20% compared to circular openings at 100 cm or were at least equivalent; GI were 3%–33% lower for reduced SAD in the PI range 40%–70%. For PI = 80% and 90% the results depend on the circular collimator model.

Conclusion

Stereotactic treatments of spherical targets delivered at reduced SAD of 70 or 55 cm using MLC spare healthy tissue around the target at least as good as treatments at SAD 100 cm using circular collimators. The steeper beam penumbra at reduced SAD seems to be as important as perfect target conformity. The authors argue therefore that the beam penumbra width should be addressed in the stereotactic studies.

Characteristics and performance of the first commercial multileaf collimator for a robotic radiosurgery system

PURPOSE

The "InCise™ multileaf-collimator (MLC)" is the first commercial MLC to be mounted on a robotic SRS/SBRT platform (CyberKnife). The authors assessed characteristics and performance of this novel device in a preclinical five months test period.

METHODS

Commissioning beam data were acquired with unshielded diodes. EBT3 radiochromic films were employed for measurement of transmission, leaf/bank position accuracy (garden fence) before and after exercising the MLC, for end-to-end testing and further characterization of the beam. The robot workspace with MLC was assessed analytically by transformation to an Euler geometry ("plane," "gantry," and "collimator" angles) and by measuring pointing accuracy at each node. Stability over time was evaluated in picket fence and adapted Winston-Lutz tests (AQA).

RESULTS

Beam penumbrae (80%-20%, with 100% = 2 × dose at inflection point for field sizes ≥ 50 × 50 mm(2)) were 2.2-3.7 mm for square fields in reference condition (source-axis-distance 800 mm, depth 15 mm) and depended on field size and off-axis position. Transmission and leakage did not exceed 0.5%. Accessible clinical workspace with MLC covered non-coplanar gantry angles of [-113°; +112°] and collimator angles of [-100°; +107°], with an average robot pointing accuracy of 0.12 ± 0.09 mm. For vertical beams, garden fence tests exhibited an average leaf positioning error of ≤0.2 mm, which increased by 0.25 and 0.30 mm (banks X1 and X2) with leaves traveling parallel to gravity. After execution of a leaf motion stress routine, garden fence tests showed slightly increased jaggedness and allowed to identify one malfunctioning leaf motor. Total system accuracy with MLC was 0.38 ± 0.05 mm in nine end-to-end tests. Picket fence and AQA tests displayed stable results over the test period.

CONCLUSIONS

The InCise™ MLC for CyberKnife showed high accuracy and adequate characteristics for SRS/SBRT applications. MLC performance after exercise demands specific quality assurance measures.

Implementation of the validation testing in MPPG 5.a "Commissioning and QA of treatment planning dose calculations-megavoltage photon and electron beams"

The AAPM Medical Physics Practice Guideline (MPPG) 5.a provides concise guidance on the commissioning and QA of beam modeling and dose calculation in radiotherapy treatment planning systems. This work discusses the implementation of the validation testing recommended in MPPG 5.a at two institutions. The two institutions worked collaboratively to create a common set of treatment fields and analysis tools to deliver and analyze the validation tests. This included the development of a novel, open‐source software tool to compare scanning water tank measurements to 3D DICOM‐RT Dose distributions. Dose calculation algorithms in both Pinnacle and Eclipse were tested with MPPG 5.a to validate the modeling of Varian TrueBeam linear accelerators. The validation process resulted in more than 200 water tank scans and more than 50 point measurements per institution, each of which was compared to a dose calculation from the institution's treatment planning system (TPS). Overall, the validation testing recommended in MPPG 5.a took approximately 79 person‐hours for a machine with four photon and five electron energies for a single TPS. Of the 79 person‐hours, 26 person‐hours required time on the machine, and the remainder involved preparation and analysis. The basic photon, electron, and heterogeneity correction tests were evaluated with the tolerances in MPPG 5.a, and the tolerances were met for all tests. The MPPG 5.a evaluation criteria were used to assess the small field and IMRT/VMAT validation tests. Both institutions found the use of MPPG 5.a to be a valuable resource during the commissioning process. The validation testing in MPPG 5.a showed the strengths and limitations of the TPS models. In addition, the data collected during the validation testing is useful for routine QA of the TPS, validation of software upgrades, and commissioning of new algorithms.

Depth dependence of the single chamber response function of the I'mRT MatriXX array in a 6 MV photon beam

One of the factors which influence the spatial resolution of a 2D detector array is the size of the single detector, another the transport of the secondary electrons from the walls into the measuring volume. In this study, the single ion chamber dose response function of an I'mRT MatriXX array was determined by comparison between slit beam dose profiles measured with the array and with EBT2 radiochromic film in a solid water-equivalent phantom at a shallow depth of 0.5cm and at a depth of 5cm beyond the depth dose maximum for a 6 MV photon beam. The dose response functions were obtained using two methods, the best fit method and the deconvolution method. At the shallow depth, a Lorentz function and at 5cm depth a Gaussian function, both with the same FWHM of 7.4mm within limits of uncertainty, were identified as the best suited dose response functions of the 4.5mm diameter single array chamber. These dose response functions were then tested on various dose profiles whose true shape had been determined with EBT2 film and with the IC03 ionization chamber. By convolving these with the Lorentz kernel (at shallow depth) and the Gaussian kernel (at 5cm depth) the signal profiles measured with the I'mRT MatriXX array were closely approximated. Thus, the convolution of TPS-calculated dose profiles with these dose response functions can minimize the differences between calculation and measurement which occur due to the limited spatial resolution of the I'mRT MatriXX detector.

Dosimetric and mechanical characteristics of a commercial dynamic microMLC used in SRS

PURPOSE

The aim of this work is to carry out mechanical and dosimetric assessments on a commercial dynamic micromulti leaf collimator system to be used for stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT). Mechanical parameters such as leaf position accuracy with different gantry angles and leaf position reproducibility were measured. Also dosimetric measurements of the interleaf leakage, intraleaf transmission, penumbra width, and light field alignment were carried out. Furthermore, measurements of output factors (Sep) and in-air factors (Se) for the microMLC system will be reported.

METHODS

EBT2 films were used to assess the leaf position error with gantry angle and after stress test, penumbra width and light field alignment. Leaf leakage was quantified using both EBT2 film and a pinpoint ion chamber. With regard to output factors, the pinpoint chamber was placed in a water phantom at 10 cm depth and 100 cm SSD. For in-air output factor measurements, 0.2 cm of brass was placed above the photon diode as build-up.

RESULTS

Measurements of mechanical parameters gave values of 0.05 cm (SD 0.035) for the average leaf position accuracy for different gantry angles and after stress test. Dosimetric measurements, yielded values of 0.22 +/- 0.01 and 0.24 +/- 0.01 cm, respectively, for side and head leaf penumbras. Also, average leaf abutting, leakage and transmission were found to be 0.65, 0.91, and 0.20%, respectively.

CONCLUSIONS

(a) The add-on microMLC system in combination with our LINAC has been commissioned to be used for clinical purposes and showed good agreement with published results for different ,MLC types. (b) This work has lead to the recommendation that leaves should be recalibrated after ten static beams or after each dynamic arc.