title: Treating patients with Dynamic Wave Arc: First clinical experience.
abstract: Dynamic Wave Arc (DWA) is a system-specific noncoplanar arc technique that combines synchronized gantry-ring rotation with D-MLC optimization. This paper presents the clinical workflow, quality assurance program, and reports the geometric and dosimetric results of the first patient cohort treated with DWA.
  
  
  
  The RayStation TPS was clinically integrated on the Vero SBRT platform for DWA treatments. The first 15 patients treated with DWA represent a broad range of treatment sites: breast boost, prostate, lung SBRT and bone metastases, which allowed us to explore the potentials and assess the limitations of the current DWA site-specific template solution. For the DWA verification a variety of QA equipment was used, from 3D diode array to an anthropomorphic end-to-end phantom. The geometric accuracy of each arc was verified with an independent orthogonal fluoroscopy method.
  
  
  
  The average beam-on delivery time was 3min, ranging from 1.22min to 8.82min. All patient QAs passed our institutional clinical criteria of gamma index. For both EBT3 film and Delta4 measurements, DWA planned versus delivered dose distributions presented an average agreement above 97%. An overall mean gantry-ring geometric deviation of -0.03°±0.46° and 0.18°±0.26° was obtained, respectively.
  
  
  
  For the first time, DWA has been translated into the clinic and used to treat various treatment sides. DWA has been successfully added to the noncoplanar rotational IMRT techniques arsenal, allowing additional flexibility in dose shaping while preserving dosimetrically robust delivery.
authors.affiliation: Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Department of Radiotherapy, Belgium; Brainlab AG, Feldkirchen, Germany; Babes Bolyai University, Faculty of Physics, Cluj-Napoca, Romania. Electronic address: manuela.buleteanu@yahoo.com.
authors.forename: Manuela
authors.initials: M
authors.lastname: Burghelea
authors.affiliation: GZA Ziekenhuizen, Sint Augustinus - Iridium Kankernetwerk Antwerpen, VUB, Faculty of Medicine and Pharmacy, Brussels, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Verellen
authors.affiliation: Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Department of Radiotherapy, Belgium.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Dhont
authors.affiliation: Brainlab AG, Feldkirchen, Germany.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Hung
authors.affiliation: Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Department of Radiotherapy, Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Gevaert
authors.affiliation: Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Department of Radiotherapy, Belgium.
authors.forename: Robbe
authors.initials: R
authors.lastname: Van den Begin
authors.affiliation: Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Department of Radiotherapy, Belgium.
authors.forename: Christine
authors.initials: C
authors.lastname: Collen
authors.affiliation: Department of Radiation Oncology, University Hospitals Leuven, Belgium.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Poels
authors.affiliation: Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Department of Radiotherapy, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Tournel
authors.affiliation: Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Department of Radiotherapy, Belgium.
authors.forename: Marlies
authors.initials: M
authors.lastname: Boussaer
authors.affiliation: Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Department of Radiotherapy, Belgium.
authors.forename: Cyril
authors.initials: C
authors.lastname: Jaudet
authors.affiliation: Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Department of Radiotherapy, Belgium.
authors.forename: Truus
authors.initials: T
authors.lastname: Reynders
authors.affiliation: Babes Bolyai University, Faculty of Physics, Cluj-Napoca, Romania.
authors.forename: Viorica
authors.initials: V
authors.lastname: Simon
authors.affiliation: Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Department of Radiotherapy, Belgium.
authors.forename: Mark
authors.initials: M
authors.lastname: de Ridder
mesh_terms: D000465:Algorithms; D001859:Bone Neoplasms / Q000532:radiotherapy*; D001943:Breast Neoplasms / Q000532:radiotherapy*; D015331:Cohort Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D008297:Male; D056888:Patient Positioning / Q000379:methods; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011785:Quality Assurance, Health Care / Q000379:methods; D011874:Radiometry / Q000379:methods; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*
keywords: Clinical implementation; Dynamic Wave Arc; Noncoplanar rotational IMRT