The step-and-shoot IMRT overshooting phenomenon: a novel method to mitigate patient overdosage

Three corrections for overshoot effect improved the dose for step-and-shoot intensity-modulated radiation therapy

We measured the overshoot effect in a linac and reduced it using block correction, reverse-sequence correction, and index correction. A StarTrack detector was used on a Varian iX. Five segments, 1 × 10 cm2 in area, were designed; the centers were at -4, -2, 0, 2, and 4 cm on the x axis for measuring the overshoot effect on a 10 × 10 cm2 collimator setting. Block correction was applied to two segments. The first was on the new first segment at -6 cm, and the other was on the new last segment at 6 cm. Both two new segments were obtained from the 10 × 10 cm2 collimator setting. The order of segments was reversed in reverse-sequence correction. Reverse-sequence correction averages the dose at every segment after two irradiations. When we used MLC Shaper, index correction reduced the first segment's index (cumulative radiation occupation) by 60% and increased the last segment's radiation occupation by 60% in a new MLC.log file. As for relative dose, the first segment had an overdose of 52.4% and the last segment had an underdose of 48.6%, when irradiated at 1 MU at 600 MU/min. The relative doses at the first segment, irradiated at 1 MU, after block correction, reverse-sequence correction, and index correction were applied decreased from 152.5% to 95.1%, 104.8%, and 100.1%, respectively. The relative doses at the last segment, irradiated at 1 MU, after block correction, reverse-sequence correction, and index correction were applied increased from 48.6% to 97.3%, 91.1%, and 95.9%, respectively. The overshoot effect depended on the speed of irradiation. High irradiation speeds resulted in notable overdosing and underdosing at the first and last segments, respectively. The three corrections mitigated the overshoot effect on dose. To save time and effort, the MLC.log file should be edited with a program in the future.