title: Commissioning of a commercially available system for intensity-modulated radiotherapy dose delivery with dynamic multileaf collimation.
abstract: OBJECTIVE
  To commission commercially available equipment for intensity-modulated radiotherapy (IMRT) using dynamic multileaf collimation (DMLC).
  
  
  METHODS
  First, the stability in leaf positioning and in realized IMRT profiles on a Varian 2300 C/D machine were determined as a function of time and gantry angle, and as a result of treatment interrupts. Second, dose distributions calculated with the CadPlan (Varian) treatment planning system, using leaf trajectories calculated with the leaf motion calculator (LMC) algorithm, were compared with distributions realized at the 2300 C/D unit.
  
  
  RESULTS
  Day-to-day and gantry angle variations in leaf positioning and dose delivery were very small (less than 0.1-0.2 mm and 2%). The effect of treatment interrupts on measured dose distributions was less than 2%. The agreement between the final dose distribution calculated by CadPlan and the measured dose was generally within 2%, or 2 mm at steep dose gradients, using a leaf transmission value of 1.8% and a leaf separation value of 2 mm in LMC. For narrow peaks, deviations of up to 6% were observed. LMC does not synchronize adjacent leaf trajectories resulting in tongue-and-groove underdosages of up to 29% for extreme cases.
  
  
  CONCLUSIONS
  The 2300 C/D machine is suitable for accurate and reproducible DMLC treatments. The agreement between dose predictions with LMC and CadPlan, and realized doses at this unit is clinically acceptable for most cases. However, differences between calculated and actual dose values may exist in peaked fluences or due to tongue-and-groove effects. Therefore, pretreatment dosimetric verification for each patient is recommended.
authors: Department of Radiation Oncology, Division of Clinical Physics, University Hospital Rotterdam/Daniel den Hoed Cancer Center, PO BOX 5201, 3008 AE, Rotterdam, The Netherlands.
authors: M
authors: M
authors: Essers
authors: M
authors: M
authors: de Langen
authors: M L
authors: ML
authors: Dirkx
authors: B J
authors: BJ
authors: Heijmen
mesh_terms: D003198:Computer Simulation; D006801:Humans; D011874:Radiometry; D011879:Radiotherapy Dosage / Q000592:standards*; D011880:Radiotherapy Planning, Computer-Assisted / Q000295:instrumentation* / Q000706:statistics & numerical data; D020266:Radiotherapy, Conformal / Q000295:instrumentation*; D015203:Reproducibility of Results