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Electromagnetic guided couch and multileaf collimator tracking on a TrueBeam accelerator.

Rune Hansen1, Thomas Ravkilde1, Esben Schjødt Worm1

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Couch and MLC tracking significantly improve radiation therapy accuracy for VMAT plans. MLC tracking offers faster dynamics, while couch tracking excels with slow-moving targets like the prostate.

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Image-Guided Therapy

Background:

  • Real-time motion compensation is crucial for accurate radiation therapy delivery.
  • Couch and multileaf collimator (MLC) tracking are promising techniques for motion management.
  • Direct comparisons of couch versus MLC tracking for volumetric modulated arc therapy (VMAT) are limited.

Purpose of the Study:

  • To directly compare the performance of couch tracking and MLC tracking for VMAT plans.
  • To evaluate geometric and dosimetric accuracy using a prototype tracking system on a Varian TrueBeam accelerator.

Main Methods:

  • Characterized tracking system latency using sinusoidal target motion and MV portal imaging.
  • Measured geometric tracking error using motion phantoms with embedded gold markers.
  • Quantified dosimetric tracking error via gamma analysis (2%/2 mm) for VMAT plans with realistic tumor trajectories.

Main Results:

  • MLC tracking latency was ~146 ms; couch tracking latency increased with faster motion (187-246 ms).
  • Mean geometric errors were lower with MLC tracking (0.52-1.14 mm) compared to couch tracking (0.66-0.80 mm).
  • Dosimetric accuracy (gamma failure rate) was significantly improved by both methods, with couch tracking excelling for prostate motion (0.1%) and MLC tracking for lung motion (2.4%).

Conclusions:

  • Both couch and MLC tracking substantially enhance geometric and dosimetric accuracy in VMAT delivery.
  • Couch tracking is effective for slow targets (e.g., prostate), while MLC tracking demonstrates superior dynamics for faster-moving targets (e.g., lung).
  • MLC tracking offers advantages in speed, patient comfort, and potential for tracking complex target motion like rotations and deformations.