title: Dosimetric evaluation of multi-pattern spatially fractionated radiation therapy using a multi-leaf collimator and collapsed cone convolution superposition dose calculation algorithm.
abstract: OBJECTIVE
  In this paper, we present an alternative to the originally proposed technique for the delivery of spatially fractionated radiation therapy (GRID) using multi-leaf collimator (MLC) shaped fields. We employ the MLC to deliver various pattern GRID treatments to large solid tumors and dosimetrically characterize the GRID fields.
  
  
  METHODS
  The GRID fields were created with different open to blocked area ratios and with variable separation between the openings using a MLC. GRID designs were introduced into the Pinnacle(3) treatment planning system, and the dose was calculated in a water phantom. Ionization chamber and film measurements using both Kodak EDR2 and Gafchromic EBT film were performed in a SolidWater phantom to determine the relative output of each GRID design as well as its spatial dosimetric characteristics.
  
  
  RESULTS
  Agreement within 5.0% was observed between the Pinnacle(3) predicted dose distributions and the measurements for the majority of experiments performed. A higher magnitude of discrepancy (15%) was observed using a high photon beam energy (18MV) and small GRID opening. Skin dose at the GRID openings was higher than the corresponding open field by a factor as high as three for both photon energies and was found to be independent of the open-to-blocked area ratio.
  
  
  CONCLUSIONS
  In summary, we reaffirm that the MLC can be used to deliver spatially fractionated GRID therapy and show that various GRID patterns may be generated. The Pinnacle(3) TPS can accurately calculate the dose of the different GRID patterns in our study to within 5% for the majority of the cases based on film and ion chamber measurements. Disadvantages of MLC-based GRID therapy are longer treatment times and higher surface doses.
authors.affiliation: Department of Radiation Oncology, University of Texas Health Science Center San Antonio, San Antonio, TX 78229, USA. stathakis@uthscsa.edu
authors.forename: Sotirios
authors.initials: S
authors.lastname: Stathakis
authors.forename: Carlos
authors.initials: C
authors.lastname: Esquivel
authors.forename: Alonso N
authors.initials: AN
authors.lastname: Gutiérrez
authors.forename: ChengYu
authors.initials: C
authors.lastname: Shi
authors.forename: Niko
authors.initials: N
authors.lastname: Papanikolaou
mesh_terms: D000465:Algorithms; D004867:Equipment Design; D006801:Humans; D011874:Radiometry / Q000295:instrumentation* / Q000379:methods; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D012867:Skin / Q000528:radiation effects