title: Multileaf collimator performance monitoring and improvement using semiautomated quality control testing and statistical process control.
abstract: OBJECTIVE
  High-quality radiation therapy using highly conformal dose distributions and image-guided techniques requires optimum machine delivery performance. In this work, a monitoring system for multileaf collimator (MLC) performance, integrating semiautomated MLC quality control (QC) tests and statistical process control tools, was developed. The MLC performance monitoring system was used for almost a year on two commercially available MLC models. Control charts were used to establish MLC performance and assess test frequency required to achieve a given level of performance. MLC-related interlocks and servicing events were recorded during the monitoring period and were investigated as indicators of MLC performance variations.
  
  
  METHODS
  The QC test developed as part of the MLC performance monitoring system uses 2D megavoltage images (acquired using an electronic portal imaging device) of 23 fields to determine the location of the leaves with respect to the radiation isocenter. The precision of the MLC performance monitoring QC test and the MLC itself was assessed by detecting the MLC leaf positions on 127 megavoltage images of a static field. After initial calibration, the MLC performance monitoring QC test was performed 3-4 times/week over a period of 10-11 months to monitor positional accuracy of individual leaves for two different MLC models. Analysis of test results was performed using individuals control charts per leaf with control limits computed based on the measurements as well as two sets of specifications of ± 0.5 and ± 1 mm. Out-of-specification and out-of-control leaves were automatically flagged by the monitoring system and reviewed monthly by physicists. MLC-related interlocks reported by the linear accelerator and servicing events were recorded to help identify potential causes of nonrandom MLC leaf positioning variations.
  
  
  RESULTS
  The precision of the MLC performance monitoring QC test and the MLC itself was within ± 0.22 mm for most MLC leaves and the majority of the apparent leaf motion was attributed to beam spot displacements between irradiations. The MLC QC test was performed 193 and 162 times over the monitoring period for the studied units and recalibration had to be repeated up to three times on one of these units. For both units, rate of MLC interlocks was moderately associated with MLC servicing events. The strongest association with the MLC performance was observed between the MLC servicing events and the total number of out-of-control leaves. The average elapsed time for which the number of out-of-specification or out-of-control leaves was within a given performance threshold was computed and used to assess adequacy of MLC test frequency.
  
  
  CONCLUSIONS
  A MLC performance monitoring system has been developed and implemented to acquire high-quality QC data at high frequency. This is enabled by the relatively short acquisition time for the images and automatic image analysis. The monitoring system was also used to record and track the rate of MLC-related interlocks and servicing events. MLC performances for two commercially available MLC models have been assessed and the results support monthly test frequency for widely accepted ± 1 mm specifications. Higher QC test frequency is however required to maintain tighter specification and in-control behavior.
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Ontario M5G 2M9, Canada and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5S 3E2, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Létourneau
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Ontario M5G 2M9, Canada.
authors.forename: An
authors.initials: A
authors.lastname: Wang
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Ontario M5G 2M9, Canada.
authors.forename: Md Nurul
authors.initials: MN
authors.lastname: Amin
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Ontario M5G 2M9, Canada.
authors.forename: Jim
authors.initials: J
authors.lastname: Pearce
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Ontario M5G 2M9, Canada and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5S 3E2, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: McNiven
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Ontario M5G 2M9, Canada and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5S 3E2, Canada.
authors.forename: Harald
authors.initials: H
authors.lastname: Keller
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Ontario M5G 2M9, Canada.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Norrlinger
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Ontario M5G 2M9, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5S 3E2, Canada; and Department of Medical Biophysics, University of Toronto, Toronto, Ontario M5G 1L7, Canada.
authors.forename: David A
authors.initials: DA
authors.lastname: Jaffray
mesh_terms: D000465:Algorithms; D055592:Biophysical Phenomena; D002138:Calibration; D006801:Humans; D011786:Quality Control; D020266:Radiotherapy, Conformal / Q000592:standards* / Q000706:statistics & numerical data; D061089:Radiotherapy, Image-Guided / Q000592:standards / Q000706:statistics & numerical data; D050397:Radiotherapy, Intensity-Modulated / Q000592:standards / Q000706:statistics & numerical data