The impact of inter-unit variations on small field dosimetry correction factors, with application to the CyberKnife...

Small field dosimetry correction factors are usually determined from calculations or measurements using one specific example of a treatment system. The sensitivity of the corrections to inter-unit variation is therefore not evaluated. We propose two methods for this evaluation that could be applied to any system. We use them to assess the variability in [Formula: see text] for the CyberKnife System caused by design changes between pre-M6 and M6 versions, and to the variability in [Formula: see text] and [Formula: see text] resulting from measured beam-data variations across 139 units. We also perform measurements to investigate the differences in [Formula: see text] reported for microchambers in a CyberKnife-specific study versus TRS-483. The results show that [Formula: see text] is smaller for the M6 version than pre-M6 versions by 0.4% for a Farmer chamber, and 0.1% for shorter chambers. The presence or absence of a lead filter within the treatment head had no significant impact on [Formula: see text]. The beam-data analysis showed inter-unit variations in [Formula: see text] of  ±0.8% (2 s.d.) for Farmer chambers and  ⩽  ±0.5% for shorter cavities (<10 mm) pre-M6, reducing to 0.4% and 0.2% respectively with M6. Inter-unit [Formula: see text] variations for microDiamond and microchambers were  ⩽  ±1% at 5 mm field size, except for microchambers with axis perpendicular to the beam where this was  >  ±2%. Differences of up to 9% were confirmed between Output Factors measured using a microchamber and corrected using TRS-483 [Formula: see text], and a consensus dataset for the same treatment unit determined using multiple detectors and Monte Carlo simulation. A set of practical recommendations for small field dosimetry with the CyberKnife System is derived from these results.