title: Treatment planning to improve delivery accuracy and patient throughput in helical tomotherapy.
abstract: OBJECTIVE
  To investigate delivery quality assurance (DQA) discrepancies observed for a subset of helical tomotherapy patients.
  
  
  METHODS
  Six tomotherapy patient plans were selected for analysis. Three had passing DQA ion chamber (IC) measurements, whereas 3 had measurements deviating from the expected dose by more than 3.0%. All plans used similar parameters, including: 2.5 cm field-width, 15-s gantry period, and pitch values ranging from 0.143 to 0.215. Preliminary analysis suggested discrepancies were associated with plans having predominantly small leaf open times (LOTs). To test this, patients with failing DQA measurements were replanned using an increased pitch of 0.287. New DQA plans were generated and IC measurements performed. Exit fluence data were also collected during DQA delivery for dose reconstruction purposes.
  
  
  RESULTS
  Sinogram analysis showed increases in mean LOTs ranging from 29.8% to 83.1% for the increased pitch replans. IC measurements for these plans showed a reduction in dose discrepancies, bringing all measurements within +/-3.0%. The replans were also more efficient to deliver, resulting in reduced treatment times. Dose reconstruction results were in excellent agreement with IC measurements, illustrating the impact of leaf-timing inaccuracies on plans having predominantly small LOTs.
  
  
  CONCLUSIONS
  The impact of leaf-timing inaccuracies on plans with small mean LOTs can be considerable. These inaccuracies result from deviations in multileaf collimator latency from the linear approximation used by the treatment planning system and can be important for plans having a 15-s gantry period. The ability to reduce this effect while improving delivery efficiency by increasing the pitch is demonstrated.
authors.affiliation: Department of Medical Physics, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705-2275, USA. westerly@wisc.edu
authors.forename: David C
authors.initials: DC
authors.lastname: Westerly
authors.forename: Emilie
authors.initials: E
authors.lastname: Soisson
authors.forename: Quan
authors.initials: Q
authors.lastname: Chen
authors.forename: Katherine
authors.initials: K
authors.lastname: Woch
authors.forename: Leah
authors.initials: L
authors.lastname: Schubert
authors.forename: Gustavo
authors.initials: G
authors.lastname: Olivera
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Mackie
mesh_terms: D006801:Humans; D009369:Neoplasms / Q000532:radiotherapy*; D010315:Particle Accelerators / Q000295:instrumentation; D011786:Quality Control; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods* / Q000592:standards; D050397:Radiotherapy, Intensity-Modulated / Q000295:instrumentation / Q000379:methods* / Q000592:standards