Stereotactic fields shaped with a micro-multileaf collimator: systematic characterization of peripheral dose

Despite the highly localized doses that may be delivered via stereotactic radiotherapy, a small dose is nonetheless delivered to out-of-field regions, which may cause detriment to the patient. In this work, a systematic set of dose measurements have been undertaken up to a distance of 45 cm from the isocentre, for stereotactic fields shaped by a BrainLAB mini-multileaf collimator (MMLC) mounted on a Varian 600C linear accelerator. A range of treatment parameters were varied so as to determine the factors of greatest influence and establish relationships with dose. The commercial treatment planning software (TPS) miscalculates the dose to out-of-field regions. Measured dose decreases consistently out to 45 cm, whereas the TPS decreases out to 10-15 cm, at which point the predicted dose is constant. At the 5-10 cm off-axis distance (OAD), measurements indicate doses of about 5-10% of the dose at the isocentre, 1% at 15 cm OAD and 0.1% at 45 cm OAD. There are several observed trends. Greater MMLC field sizes (with static jaw) result in higher out-of-field dose, as do shallower depths. The source-to-surface distance does not greatly influence peripheral dose. However, the results given in this work do indicate that simple treatment arrangements, such as preferable collimator rotation, would in certain cases reduce out-of-field dose by an order of magnitude. Peripheral dose raises questions of treatment optimization, particularly in cases where patients have a long life expectancy in which secondary effects may become manifest, such as in the treatment of paediatric patients or those with a non-malignant primary. For instance, for a 20 Gy hypo-fractionated treatment, dose to out-of-field regions is of the order of cGy-a substantial dose in radiation protection terms.