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Multileaf collimator end leaf leakage: implications for wide-field IMRT.

N Hardcastle1, P Metcalfe, A Ceylan

  • 1Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522, Australia. ngh54@uow.edu.au

Physics in Medicine and Biology
|October 24, 2007
PubMed
Summary

Intensity modulated radiotherapy (IMRT) with wide fields using the Millennium multi-leaf collimator (MLC) can cause significant end leaf leakage. This unintended dose, underestimated by planning systems, requires careful verification for safe patient treatment.

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Radiotherapy Technology

Background:

  • The Millennium multi-leaf collimator (MLC) has a 14.5 cm leaf extension limit, necessitating specific strategies for wider intensity modulated radiotherapy (IMRT) fields.
  • Rounded leaf ends in MLC designs can lead to end leaf leakage, introducing unwanted radiation dose within the treatment field.

Purpose of the Study:

  • To characterize the end leaf leakage of the Millennium MLC for 6 MV photons.
  • To evaluate the accuracy of the Pinnacle radiotherapy planning system in predicting this leakage for wide IMRT fields.
  • To assess the clinical impact of end leaf leakage in IMRT treatments.

Main Methods:

  • Characterization of end leaf leakage using gafchromic and radiographic film for various leaf gap settings.
  • Verification of the radiotherapy planning system's predictions against measured leakage data.
  • Analysis of dose contribution from end leaf leakage in clinical IMRT fields.

Main Results:

  • Maximum measured leakage was 0.39 cGy/MU for a 0 mm leaf gap and 0.51 cGy/MU for a 0.6 mm leaf gap.
  • End leaf leakage contributed an additional 2-3 Gy over the course of a clinical IMRT treatment.
  • The planning system underestimated end leaf leakage by 20-40% compared to measurements.

Conclusions:

  • While wide field IMRT with the Millennium MLC enhances treatment efficiency and flexibility, it introduces significant, often underestimated, end leaf leakage dose.
  • Independent verification of predicted end leaf leakage is crucial before delivering wide field IMRT treatments.
  • Caution is advised when implementing wide field IMRT due to the potential for substantial unintended dose from leaf end leakage.