Implementation of respiratory-gated VMAT on a Versa HD linear accelerator

Jeffrey E Snyder; Ryan T Flynn; Daniel E Hyer

doi:10.1002/acm2.12160

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Implementation of respiratory-gated VMAT on a Versa HD linear accelerator

Journal article

Open access

Peer reviewed

Implementation of respiratory-gated VMAT on a Versa HD linear accelerator

Jeffrey E Snyder, Ryan T Flynn and Daniel E Hyer

Journal of applied clinical medical physics, Vol.18(5), pp.152-161

09/2017

DOI: 10.1002/acm2.12160

PMCID: PMC5875827

PMID: 28834109

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Abstract

The accurate delivery of respiratory-gated volumetric modulated arc therapy (VMAT) treatment plans presents a challenge since the gantry rotation and collimator leaves must be repeatedly stopped and set into motion during each breathing cycle. In this study, we present the commissioning process for an Anzai gating system (AZ-733VI) on an Elekta Versa HD linear accelerator and make recommendations for successful clinical implementation. The commissioning tests include central axis dose consistency, profile consistency, gating beam-on/off delay, and comparison of gated versus nongated gamma pass rates for patient-specific quality assurance using four clinically commissioned photon energies: 6 MV, 6 FFF, 10 MV, and 10 FFF. The central axis dose constancy between gated and nongated deliveries was within 0.6% for all energies and the analysis of open field profiles for gated and nongated deliveries showed an agreement of 97.8% or greater when evaluated with a percent difference criteria of 1%. The measurement of the beam-on/off delay was done by evaluating images of a moving ball-bearing phantom triggered by the gating system and average beam-on delays of 0.22-0.29 s were observed. No measurable beam-off delay was present. Measurements of gated VMAT dose distributions resulted in decrements as high as 9% in the gamma passing rate as compared to nongated deliveries when evaluated against the planned dose distribution at 3%/3 mm. By decreasing the dose rate, which decreases the gantry speed during gated delivery, the gamma passing rates of gated and nongated treatments can be made equivalent. We present an empirically derived formula to limit the maximum dose rate during VMAT deliveries and show that by implementing a reduced dose rate, a gamma passing rate of greater than 95% (3%/3 mm) was obtained for all plan measurements.

Humans

Radiotherapy, Intensity-Modulated - methods

Phantoms, Imaging

Respiration

Radiotherapy Planning, Computer-Assisted

Radiotherapy, Intensity-Modulated - instrumentation

Particle Accelerators

Details

Title: Subtitle: Implementation of respiratory-gated VMAT on a Versa HD linear accelerator
Creators: Jeffrey E Snyder - Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
Ryan T Flynn - Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
Daniel E Hyer - Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
Resource Type: Journal article
Publication Details: Journal of applied clinical medical physics, Vol.18(5), pp.152-161
DOI: 10.1002/acm2.12160
PMID: 28834109
PMCID: PMC5875827
NLM abbreviation: J Appl Clin Med Phys
ISSN: 1526-9914
eISSN: 1526-9914
Publisher: United States
Grant note: P30 CA086862 / NCI NIH HHS
Language: English
Date published: 09/2017
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiation Oncology
Record Identifier: 9984047777802771

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