title: The sensitivity of patient specific IMRT QC to systematic MLC leaf bank offset errors.
abstract: OBJECTIVE
  Patient specific IMRT QC is performed routinely in many clinics as a safeguard against errors and inaccuracies which may be introduced during the complex planning, data transfer, and delivery phases of this type of treatment. The purpose of this work is to evaluate the feasibility of detecting systematic errors in MLC leaf bank position with patient specific checks.
  
  
  METHODS
  9 head and neck (H&N) and 14 prostate IMRT beams were delivered using MLC files containing systematic offsets (+/- 1 mm in two banks, +/- 0.5 mm in two banks, and 1 mm in one bank of leaves). The beams were measured using both MAPCHECK (Sun Nuclear Corp., Melbourne, FL) and the aS1000 electronic portal imaging device (Varian Medical Systems, Palo Alto, CA). Comparisons with calculated fields, without offsets, were made using commonly adopted criteria including absolute dose (AD) difference, relative dose difference, distance to agreement (DTA), and the gamma index.
  
  
  RESULTS
  The criteria most sensitive to systematic leaf bank offsets were the 3% AD, 3 mm DTA for MAPCHECK and the gamma index with 2% AD and 2 mm DTA for the EPID. The criterion based on the relative dose measurements was the least sensitive to MLC offsets. More highly modulated fields, i.e., H&N, showed greater changes in the percentage of passing points due to systematic MLC inaccuracy than prostate fields.
  
  
  CONCLUSIONS
  None of the techniques or criteria tested is sufficiently sensitive, with the population of IMRT fields, to detect a systematic MLC offset at a clinically significant level on an individual field. Patient specific QC cannot, therefore, substitute for routine QC of the MLC itself.
authors.affiliation: Department of Medical Physics, Tom Baker Cancer Centre, 1331-29 Street NW Calgary, Alberta T2N 4N2, Canada. alejandra.rangelbaltazar@albertahealthservices.ca
authors.forename: Alejandra
authors.initials: A
authors.lastname: Rangel
authors.forename: Gesa
authors.initials: G
authors.lastname: Palte
authors.forename: Peter
authors.initials: P
authors.lastname: Dunscombe
mesh_terms: D016477:Artifacts; D005240:Feasibility Studies; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006801:Humans; D008297:Male; D057285:Precision Medicine; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D011786:Quality Control; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods / Q000592:standards*