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|July 29, 2015

Summary

Optimizing the dosimetric leaf gap (DLG) in treatment planning systems improves quality assurance (QA) for intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans. Using linac-specific DLG values ensures plans meet QA criteria, enhancing treatment delivery accuracy.

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Irradiator Commissioning and Dosimetry for Assessment of LQ α and β Parameters, Radiation Dosing Schema, and in vivo Dose Deposition

Published on: March 11, 2021

Area of Science:

Medical Physics
Radiation Oncology
Radiotherapy Planning

Background:

Individual quality assurance (QA) is crucial for intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans.
Treatment plans sometimes fail to meet institutional QA criteria, necessitating optimization strategies.
The complexity of multileaf collimator (MLC) systems, including small field dosimetry and tongue-and-groove (T&G) effects, can impact dose accuracy.

Purpose of the Study:

To investigate the impact of linac-specific optimal dosimetric leaf gap (DLG) values on the QA pass rates of IMRT/VMAT plans.
To evaluate the effectiveness of using test fields for determining optimal DLG values in treatment planning systems (TPS).
To assess the influence of optimal DLG on dose distributions and the agreement between planned and delivered doses.

Main Methods:

Determined linac-specific optimal DLG values using dedicated test fields for three MLC systems across five linear accelerators.
Reoptimized over 20 patient plans using the optimal DLG values within the Eclipse TPS.
Analyzed the distribution of MLC gaps and T&G extensions, and evaluated QA pass rates (DTA and gamma tests) and dose-volume histograms (DVHs).

Main Results:

All reoptimized patient plans successfully passed institutional QA criteria (95% in DTA or gamma test) when using the optimal DLG.
Most plans initially failed QA with original or TPS-optimized DLG values.
DVHs for targets and organs at risk remained similar regardless of the DLG optimization method used.

Conclusions:

Tuning the dosimetric leaf gap (DLG) to linac-specific optimal values is a practical method to improve the accuracy of IMRT/VMAT dose delivery.
The use of optimal DLG values significantly enhances the QA pass rate for complex radiotherapy plans.
This approach addresses inherent complexities in MLC systems, leading to more reliable radiation treatments.