title: Re-examining TG-142 recommendations in light of modern techniques for linear accelerator based radiosurgery.
abstract: OBJECTIVE
  The recent development of multifocal stereotactic radiosurgery (SRS) using a single isocenter volumetric modulated arc theory (VMAT) technique warrants a re-examination of the quality assurance (QA) tolerances for routine mechanical QA recommended by the American Association of Physicists in Medicine Task Group Report Number 142. Multifocal SRS can result in targets with small volumes being at a large off-axis distance from the treatment isocenter. Consequently, angular errors in the collimator, patient support assembly (PSA), or gantry could have an increased impact on target coverage.
  
  
  METHODS
  The authors performed a retrospective analysis of dose deviations caused by systematic errors in PSA, collimator, and gantry angle at the tolerance level for routine linear accelerator QA as recommended by TG-142. Dosimetric deviations from multifocal SRS plans (N = 10) were compared to traditional single target SRS using dynamic conformal arcs (N = 10). The chief dosimetric quantities used in determining clinical impact were V100%and D99%of the individual planning target volumes and V12Gyof the healthy brain.
  
  
  RESULTS
  Induced errors at tolerance levels showed the greatest change in multifocal SRS target coverage for collimator rotations (±1.0°) with the average changes to V100%and D99%being 5% and 6%, respectively, with maximum changes of 33% and 20%. A reduction in the induced error to half the TG-142 tolerance (±0.5°) demonstrated similar changes in coverage loss to traditional single target SRS assessed at the recommended tolerance level. The observed change in coverage for multifocal SRS was reduced for gantry errors (±1.0°) at 2% and 4.5% for V100%and D99%, respectively, with maximum changes of 18% and 12%. Minimal change in coverage was noted for errors in PSA rotation.
  
  
  CONCLUSIONS
  This study indicates that institutions utilizing a single isocenter VMAT technique for multifocal disease should pay careful attention to the angular mechanical tolerances in designing a robust and complete QA program.
authors: Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710.
authors: Austin M
authors: AM
authors: Faught
authors: Medical Physics Graduate Program, Duke University, Durham, North Carolina 27710.
authors: Michael
authors: M
authors: Trager
authors: Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710.
authors: Fang-Fang
authors: FF
authors: Yin
authors: Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710.
authors: John
authors: J
authors: Kirkpatrick
authors: Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710.
authors: Justus
authors: J
authors: Adamson
mesh_terms: D006801:Humans; D010315:Particle Accelerators; D011785:Quality Assurance, Health Care; D016634:Radiosurgery / Q000295:instrumentation* / Q000592:standards*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D012955:Societies, Medical / Q000592:standards*