title: RapidArc patient specific mechanical delivery accuracy under extreme mechanical limits using linac log files.
abstract: OBJECTIVE
  To assess the accuracy of RapidArc (RA) delivery for treatment machine operation near allowable mechanical limits in dynamic multileaf collimator (DMLC) leaf velocities, gantry speeds, and dose rates.
  
  
  METHODS
  Thirty RA patient plans were created for treatment of lung, gastrointestinal, and head and neck cancers on a Trilogy unit. For each patient, three RA plans were generated; one with medium MLC velocities, highest gantry speeds, and dose rates (case A); one with maximal allowable MLC leaf velocities (case B); and one with lowest gantry speeds (case C). Combinations of dose rates (140-600 MU/min), gantry speeds (2-5.4°/s), and DMLC leaf velocities (1.3-2.4 cm/s) were utilized to test the RapidArc delivery accuracy. Linac delivery log files were acquired after delivery of each plan. In-house developed software was used to read in the original RapidArc DICOM plan and update the plan to reflect the delivered plan by using the leaf position (L), gantry position (G), and MU dose values (D) extracted from the linac log files. This modified DICOM RT plan was imported back to ECLIPSE and the delivered 3D dose map recomputed. Finally, the planned and delivered 3D isodose maps were compared under three criteria to evaluate the dosimetric differences: maximum percentage dose difference, 3D gamma analysis criteria for 3%/3mm DTA, number of dose voxels having a dose difference that is greater than 1%, 2%, or 3% of the maximum dose, and their respective percentages.
  
  
  RESULTS
  For the three cases indicated above, MLC leaf position discrepancies between planned and delivered values are 0.8 ± 0.2, 1.2 ± 0.2, and 0.8 ± 0.2 mm; the maximum gantry position discrepancies are 0.9° ± 0.2°, 0.9° ± 0.2°, and 0.6° ± 0.1°, and the maximum differences in delivered MU per control point are 0.2 ± 0.1, 0.2 ± 0.1, and 0.04 ± 0.01, respectively. Maximum percentage dose difference observed is 6.7%, for a case where 1 cm MLC leaves were used with high MLC leaf velocity. Maximum number (percentage) of dose voxels having a dose difference that is greater than 1%, 2%, and 3% of the maximum dose were 4761 (0.35%), 897 (0.07%), and 188 (0.01%). This also corresponds to the plan utilizing the most number of 1 cm MLC leaves. The 3D Gamma factor acceptance rates are better than 99%.
  
  
  CONCLUSIONS
  This work shows that the accuracy of RapidArc delivery holds across the full range of gantry speeds, leaf velocities, and dose rates with small dosimetric uncertainties for 0.5 cm MLC leaves. However, caution should be exercised when using large MLC leaves in RapidArc. A novel technique to obtain the delivered 3D dose distributions using machine log files is also presented.
authors.affiliation: Department of Radiation Oncology, University of Virginia, Charlottesville, VA 22908-0375, USA. kw5wx@virginia.edu
authors.forename: Krishni
authors.initials: K
authors.lastname: Wijesooriya
authors.forename: Eric
authors.initials: E
authors.lastname: Aliotta
authors.forename: Stanley
authors.initials: S
authors.lastname: Benedict
authors.forename: Paul
authors.initials: P
authors.lastname: Read
authors.forename: Tyvin
authors.initials: T
authors.lastname: Rich
authors.forename: James
authors.initials: J
authors.lastname: Larner
mesh_terms: D000465:Algorithms; D017076:Computer-Aided Design; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006801:Humans; D008954:Models, Biological; D015233:Models, Statistical; D009369:Neoplasms / Q000532:radiotherapy*; D010315:Particle Accelerators / Q000295:instrumentation*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000295:instrumentation* / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012984:Software