Evaluating Monaco 6.2.2 in complex radiotherapy across matched LINACs: improved MLC modelling and dose accuracy with...

This study assesses the updated Monaco TPS virtual source model (VSM) 2.0, which removes multileaf collimator (MLC) and jaw characterization as editable factors from the MLC geometry section within Monaco. The focus is on the impact of changes to stereotactic radiotherapy (SRT) cases for spinal and intracranial treatments for two beam matched linear accelerators. A validated custom VSM 1.6 model optimized for SRT was compared with the Elekta Accelerated Go Live 6 MV flattening filter-free (FFF) and VSM 2.0. Evaluations included measured MLC characteristics with a high-resolution detector, measured output factors (OPF), ion chamber fields in the thorax phantom, and recalculations of clinically relevant SRT cases. VSM 2.0 improves MLC modelling. Ion chamber measurements for IAEA TD1583 measurements were found to be within expected tolerances. Gamma pass rates for two matched LINACs evidenced improvement at 1%, 1 mm and 10% threshold for single and multi-SRS brain and SABR Spine treatments. VSM 2.0 represents a meaningful advancement in beam modelling within a Monte Carlo-based TPS environment, offering improved dosimetric performance and operational simplicity. Commercially available detectors were used to demonstrate that VSM 2.0 enhances agility MLC modelling, supporting more precise SRT and SABR delivery for matched LINACs. Removing configurable dependencies from the beam model will result in more consistent high quality beam models, an improves workflows for commissioning of the Monaco TPS.