Investigation on the impact of the leaf trailing effect using the Halcyon integrated platform system.

PURPOSE: The double-stacked design of the Halcyon multileaf collimator (MLC) presents new challenges for treatment planning systems (TPSs). The leaf trailing effect has recently been described as the result of the interplay between the fluence transmitted through the leaf tip ends of each MLC layer. This effect makes the dosimetric leaf gap (DLG) dependent on the distance between the leaves of different layers (trailing distance) and is not adequately modeled by the Eclipse TPS. The purpose of our study was to investigate and report the dose discrepancies produced by these limitations in clinical plans and to explore how these discrepancies can be mitigated and avoided. METHODS: The integrated platform with the Halcyon v2 system, Eclipse and Aria v15.6, was used. The dose discrepancies were obtained with electronic portal imaging device (EPID) images and the portal dosimetry software and validated using radiochromic film dosimetry. The results for the AIDA commissioning test and for nine selected clinical beams with the sliding window intensity modulated radiotherapy (dIMRT) technique were thoroughly analyzed and presented. First, the digital imaging and communications in medicine radiotherapy (DICOM RT) plans were exported and the fluences were computed using different leaf tip models, and then were compared. Second, the detailed characteristics of the corresponding leaf sequences were investigated. Finally, modified DICOM RT plans were created in which the noncollimating (backup) leaves were retracted 2 mm to increase the leaf trailing distance, the modified plans were imported back into the TPS and the measurements were repeated. Dedicated in-house tools were developed in Python to carry out all analyses. RESULTS: Dose discrepancies greater than 10% and regions of gamma failure were found in both the AIDA test and clinical beams using static-gantry dIMRT. Fluence analysis highlighted that the discrepancies were due to limitations in the MLC model implemented in the TPS. Analysis of leaf sequences indicated that regions of failure were associated with very low leaf speeds and virtually motionless leaves within the beam aperture. Some of these discrepancies were mitigated by increasing the trailing distance of the noncollimating leaves without affecting the beam aperture, but this strategy was not possible in regions where the leaves from both layers actively defined the beam aperture. CONCLUSIONS: Current limitations of the MLC model in Eclipse produced discrepancies between calculated and delivered doses in clinical beams that caused plan-specific quality assurance failures and interruptions in the clinical workflow. Careful evaluation of the clinical plans produced by Eclipse for the Halcyon is recommended, especially for static gantry dIMRT treatments. Some characteristics of leaf sequences are problematic and should be avoided in clinical plans and, in general, a better leaf tip model is needed. This is particularly important in adaptive radiotherapy treatments, where the accuracy and reliability of TPS dose calculations are of the utmost importance.

Improving the gamma analysis comparison using an unbinned multivariate test.

In this study, we present a new procedure for the comparison of two dose matrices by means of a statistical test. A statistical distance is proposed to decide whether the difference between the two matrices is statistically significant. This statistical test is based on the square difference between the experimental and expected gamma matrix results. The expected gamma matrix is calculated by simulating the measurement process. For comparison purposes, the significance level of the test was chosen to give the same statistical significance as 90% of gamma-pass rate. The performance of the statistical distance is checked against 53 VMAT. The power of the presented test was compared using simulations with the 90% gamma-pass rate criteria for two cases in which intentional errors are introduced. In both cases, the test is uniformly more powerful. According to the test, two of the measured plans have a significant difference with calculated matrices, although the gamma pass rate measured was always greater than 90%.

Evaluation of MLC performance in VMAT and dynamic IMRT by log file analysis.

PURPOSE: This multi-institution study assessed the positioning accuracy of multileaf collimators (MLC) by analyzing log files. It determined the main machine parameters that affect MLC positioning errors for pre-TrueBeam (Clinac) and TrueBeam linacs. METHODS: Around 30,000 dIMRT and VMAT log files belonging to 6 linacs from 4 different centers were analyzed. An in-house software was used to calculate 95th percentile and RMS error values and their correlation with certain parameters such as maximum leaf speed, mean leaf speed and gantry angle. The effect of MLC communication delay on error statistics was assessed in Clinac linacs. To that end MLC positioning error statistics were calculated with and without the delay effect. RESULTS: For dIMRT treatments in Clinac linacs the mean leaf RMS error was 0.306mm with and 0.030mm without the delay effect. Leaf RMS error was closely linked to maximum and mean leaf speeds, but without the delay effect that link was weaker. No trend was observed between bank RMS error and gantry angle. Without the delay effect larger bank RMS errors were obtained for gantry angles with leaf movements against gravity. For VMAT treatments in TrueBeam linacs the mean leaf RMS error was 0.038mm. A link was also observed between leaf RMS error and maximum and mean leaf speeds. CONCLUSION: TrueBeam MLC positioning errors are substantially lower than those of Clinac linacs. In Clinac machines the analysis of dynalogs without the delay effect allows us to study the influence of factors that are masked by the delay effect.

Reply to Comment on 'A new method to measure electron density and effective atomic number using dual-energy CT images'.

In this note, we would like to respond to the comments made by Professor Bouchard on our recent published work and clarify some aspects of it.

Polarized dosimetry method for Gafchromic EBT3.

PURPOSE: To analyze the changes in the polarization state of the flatbed scanner light caused by the EBT3 films and to propose a new method for correcting the lateral effects. METHODS AND MATERIALS: The polarization changes induced by radiochromic films are analyzed using linear polarizing film. Based on the results, the linear polarizing films are used in the scanning process of the EBT3 films. This method is tested against the conventional EBT3 dosimetry using a series of simple regular beams and 21 cases of IMRT. RESULTS: The mean results are statically different from the conventional dosimetry with EBT3. Depending on the transmission axis of the polarizing sheet, the results are better or worse compared to conventional dosimetry EBT3 film. When the transmission axis of the polarizing sheet is parallel to the coating direction, the dosimetry results are better and its variability is smaller. However, when the polarizer transmission axis is perpendicular to the coating direction, results are worse as well as its variability. CONCLUSION: Using a polarized film with the polarization axis parallel to the coating direction of the radiochromic film, and preferably above it, significantly improves the dosimetry results and is an easy and inexpensive way to correct the lateral artifacts of the conventional EBT3 dosimetry.

A method for multichannel dosimetry with EBT3 radiochromic films.

PURPOSE: An improved method for multichannel dosimetry is presented. This method explicitly takes into account the information provided by the unexposed image of the film. METHODS: The method calculates the dose by applying a couple of perturbations to the scanned dose, one dependent and the other independent on the color channel. The method has been compared with previous multichannel and two single channel methods (red and green) against measurements using two different tests: first, five percentage depth dose profiles covering a wide range of doses; second, the dose map perpendicular to the beam axis for a 15 × 15 cm(2) square field. Finally, the results of 30 IMRT quality assurances tests are presented. All tests have been evaluated using the gamma analysis. RESULTS: The coefficient of variation was found to be similar for all methods in a wide range of doses. The results of the proposed method are more in agreement with the experimental measurements and with the treatment planning system. Furthermore, the differences in the mean gamma pass rates are statistically significant. CONCLUSIONS: The improved multichannel dosimetric method is able to remove many of the common disturbances usually present in radiochromic films and improves the gamma analysis results compared with the other three methods.