title: Volumetric modulated arc therapy with dynamic collimator rotation for improved multileaf collimator tracking of the prostate.
abstract: To improve MLC tracking of prostate VMAT plans by dynamic rotation of the collimator to align the MLC leaves with the dominant prostate motion direction.
  
  
  
  For 22 prostate cancer patients, two dual arc VMAT plans were made with (1) fixed collimators (45° and 315°) and (2) a rotating collimator that aligned the MLC leaves with the dominant prostate motion direction (population-based first principal component). The fixed and rotating collimator plan quality was compared using selected dose-volume indices. Next, MLC tracking treatments were simulated with 695 patient-measured prostate traces. The MLC exposure error (under- and overexposed MLC area in beam's eye view) was calculated as a surrogate for the MLC tracking error. Finally, motion including dose reconstruction was performed for 35 motion traces for one patient, and the root-mean-square dose error was compared with the MLC exposure error.
  
  
  
  Rotating collimator VMAT plans were of similar quality as the fixed collimator plans, but significantly improved MLC tracking with 33% lower MLC exposure errors (p≪0.0001). The reductions in MLC exposure error correlated significantly with dose error reductions.
  
  
  
  Prostate VMAT plans with rotating collimator were of similar quality as fixed collimator plans, but more suitable for MLC tracking with significantly better agreement between planned and delivered dose distributions. MLC tracking for prostate cancer patients can therefore be improved without the requirement of additional efforts or hardware changes.
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark; Department of Physics, International Islamic University, Islamabad, Pakistan.
authors.forename: Ghulam
authors.initials: G
authors.lastname: Murtaza
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Toftegaard
authors.affiliation: Department of Physics, International Islamic University, Islamabad, Pakistan; Muslim Youth University, Islamabad, Pakistan.
authors.forename: Ehsan Ullah
authors.initials: EU
authors.lastname: Khan
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark. Electronic address: per.poulsen@rm.dk.
authors.forename: Per Rugaard
authors.initials: PR
authors.lastname: Poulsen
mesh_terms: D006801:Humans; D008297:Male; D010315:Particle Accelerators; D019047:Phantoms, Imaging; D011467:Prostate; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D012399:Rotation
keywords: IGRT; MLC tracking; Prostate motion