Optimization of primary jaw settings for stereotactic radiosurgery/radiotherapy

The primary goal of stereotactic radiosurgery/radiotherapy is to provide a technique by which the dose to a target volume can be maximized while minimizing the dose to uninvolved structures. Initially, circular apertures were applied through the use of multiple arcs and one or more isocenters in an effort to achieve these goals. Advances in field-shaping techniques, such as more elaborate cerrobend shaping and micromultileaf collimators, have allowed for improved target conformality with further reductions in dose to normal tissues. The shape of these secondary collimation devices is usually set at the precise size and shape necessary to encompass only the volume of interest with a small margin. Often, however, the primary collimators are set at a default setting that may be much larger than required to encompass the treatment area. This results in unnecessary transmission through the secondary collimators and added dose to the uninvolved tissues. This paper compares the dose delivered to normal tissues surrounding the target volume when a "standard" collimator setting is used to dose delivered when the primary collimator setting is optimized to only that necessary to encompass the treatment volume.