The assessment of the clinical impact of using a single set of radiotherapy planning data for two kilovoltage therapy units.

Kilovoltage therapy units are used for superficial radiotherapy treatment delivery. Peer reviewed studies for MV linear accelerators describe tolerances to dosimetrically match multiple linear accelerators enabling patient treatment on any matched machine. There is an absence of literature on using a single planning data set for multiple kilovoltage units which have limited ability for beam adjustment. This study reviewed kilovoltage dosimetry and treatment planning scenarios to evaluate the feasibility of using ACPSEM annual QA tolerances to determine whether two units (of the same make and model) were dosimetrically matched. The dosimetric characteristics, such as measured half value layer (HVL), percentage depth dose (PDD), applicator factor and output variation with stand-off distance for each kV unit were compared to assess the agreement. Independent planning data based on the measured HVL for each beam energy from each kV unit was prepared. Monitor unit (MU) calculations were performed using both sets of planning data for approximately 200 clinical scenarios and compared with an overall agreement between units of < 2%. Additionally, a dosimetry measurement comparison was completed at each site for a subset of nine scenarios. All machine characterisation measurements were within the ACPSEM Annual QA tolerances, and dosimetric testing was within 2.5%. This work demonstrates that using a single set of planning data for two kilovoltage units is feasible, resulting in a clinical impact within published uncertainty.

MLC positioning verification for small fields: a new investigation into automatic EPID-based verification methods.

Multileaf-collimator (MLC) defined small fields in radiotherapy are used in high dose, ultra-conformal techniques such as stereotactic radiotherapy and stereotactic radiosurgery. Proximity to critical structures and irreversible damage arising from inaccurate delivery mean that correct positioning of the MLC system is of the utmost importance. Some of the existing techniques for MLC positioning quality assurance make use of electronic portal imaging device (EPID) images. However, conventional collimation verification algorithms based on the full width at half maximum (FWHM) fail when applied to small field images acquired by an EPID due to overlapping aperture penumbrae, lateral electron disequilibrium and radiation source occlusion. The objective of this study was to investigate sub-pixel edge detection and other techniques with the aim of developing an automatic and autonomous EPID-based method suitable for MLC positional verification of small static fields with arbitrary shapes. Methods investigated included derivative interpolation, Laplacian of Gaussian (LoG) and an algorithm based on the partial area effect hypothesis. None of these methods were found to be suitable for MLC positioning verification in small field conditions. A method is proposed which uses a manufacturer-specific empirically modified FWHM algorithm which shows improvement over the conventional techniques in the small field size range. With a measured mean absolute difference from planned position for Varian linacs of 0.01 ± 0.26 mm, compared with the erroneous FWHM value of 0.70 ± 0.51 mm. For Elekta linacs the proposed algorithm returned 0.26 ± 0.25 mm, in contrast to the FWHM result of 1.79 ± 1.07 mm.