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RapidArc radiotherapy dose calculations can be inaccurate for small targets due to subfield usage. This study highlights significant dose discrepancies, especially with older software versions and larger grid spacings, impacting treatment accuracy.

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Radiotherapy Quality Assurance

Background:

  • RapidArc radiotherapy is increasingly used, but its reliance on multiple subfields poses challenges for small target volume (0.4 cm(3)) treatments.
  • Accurate dose calculation is critical for effective radiotherapy, particularly for small targets requiring precise dose delivery.

Purpose of the Study:

  • To investigate the accuracy of dose calculations for small static fields and RapidArc/conventional plans using different versions of the Eclipse treatment planning system.
  • To evaluate the performance of EPIQA and Delta4 QA systems in detecting dose calculation discrepancies in RapidArc treatments.

Main Methods:

  • Measured doses from static fields (1-4 MLC leaves wide) and RapidArc/conventional plans for 0.4 cm(3) and 9.9 cm(3) targets.
  • Utilized EPIQA, gafchromic film (EBT2), and Delta4 phantom system for dose verification.
  • Compared measurements with Eclipse v8.6 and v8.9 calculations using 1.25 mm and 2.50 mm grid spacings on a Varian HD linac.

Main Results:

  • Eclipse v8.6 with 2.5 mm grid underestimated dose by up to 53% for narrow static fields and 30% for fields with blocked central MLCs.
  • Significant dose discrepancies (up to 10% underdose for conventional, 10% overdose for RapidArc) were observed for the 0.4 cm(3) target.
  • Eclipse consistently overestimated penumbra width by ~100%; smaller grid sizes and newer Eclipse versions reduced but did not eliminate errors.

Conclusions:

  • The use of small subfields or fields with blocked MLCs in RapidArc can lead to substantial dose calculation errors, particularly for small targets.
  • Detector systems vary in their ability to identify these discrepancies; EPIQA indicated overmodulation in measured dose profiles compared to calculations.
  • While improved with newer software and smaller grids, dose calculation inaccuracies persist, necessitating careful quality assurance for small target treatments.