title: Commissioning of volumetric modulated arc therapy (VMAT).
abstract: OBJECTIVE
  Volumetric modulated arc therapy (VMAT) involves the simultaneous use of dynamic multileaf collimator (DMLC) techniques and gantry arcing; appropriate quality assurance is therefore required. This article describes the development and implementation of procedures for commissioning VMAT on a commercial linear accelerator (Elekta PreciseBeam VMAT with MLCi and Beam Modulator heads).
  
  
  METHODS
  Tests for beam flatness and symmetry at the variable dose rates required for VMAT were performed. Multileaf collimator (MLC) calibration was investigated using dynamic prescriptions. The cumulative dose delivered by a sliding window aperture was measured and compared with calculated values. Rotational accuracy was evaluated using dynamic prescriptions which required accurate correlated motion of both gantry and MLC leaves. Finally, measured and calculated dose distributions for complete VMAT treatment plans were compared and evaluated.
  
  
  RESULTS
  Beam symmetry was found to be better than 3% down to dose rates of 75 MU/min. MLC calibration provided continuity of dose at match planes of better than 4%, which was comparable to interleaf leakage effects. Integrated sliding window doses were within 3% of those calculated. Tests for rotational accuracy showed uniformity of peripheral dose mostly within +/-4% of local control point dose, or approximately +/-0.2% of total central dose. A two-arc prostate case showed an absolute dose difference between calculations and measurements of less than 3%, with gamma (3% and 3 mm) of better than 95%.
  
  
  CONCLUSIONS
  VMAT has been successfully commissioned and has been introduced into clinical use. The Elekta DMLC has also been shown to be suitable for sliding window delivery.
authors.affiliation: Joint Department of Physics, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK.
authors.forename: James L
authors.initials: JL
authors.lastname: Bedford
authors.forename: Alan P
authors.initials: AP
authors.lastname: Warrington
mesh_terms: D002138:Calibration; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy; D008297:Male; D010315:Particle Accelerators / Q000592:standards; D055656:Prescriptions; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D011785:Quality Assurance, Health Care; D011786:Quality Control; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies