Helical tomotherapy is a relatively new modality with integrated treatment planning and delivery hardware for radiation therapy treatments. In view of the uniqueness of the hardware design of the helical tomotherapy unit and its implications in routine quality assurance, the Therapy Physics Committee of the American Association of Physicists in Medicine commissioned Task Group 148 to review this modality and make recommendations for quality assurance related methodologies. The specific objectives of this Task Group are: ͑a͒ To discuss quality assurance techniques, frequencies, and tolerances and ͑b͒ discuss dosimetric verification techniques applicable to this unit. This report summarizes the findings of the Task Group and aims to provide the practicing clinical medical physicist with the insight into the technology that is necessary to establish an independent and comprehensive quality assurance program for a helical tomotherapy unit. The emphasis of the report is to describe the rationale for the proposed QA program and to provide example tests that can be performed, drawing from the collective experience of the task group members and the published literature. It is expected that as technology continues to evolve, so will the test procedures that may be used in the future to perform comprehensive quality assurance for helical tomotherapy units.

Independent verification of the dose per monitor unit (MU) to deliver the prescribed dose to a patient has been a mainstay of radiation oncology quality assurance (QA). We discuss the role of secondary dose/MU calculation programs as part of a comprehensive QA program. This report provides guidelines on calculationbased dose/MU verification for intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) provided by various modalities. We provide a review of various algorithms for "independent/second check" of monitor unit calculations for IMRT/VMAT. The report makes recommendations on the clinical implementation of secondary dose/MU calculation programs; on commissioning and acceptance of various commercially available secondary dose/MU calculation programs; on benchmark QA and periodic QA; and on clinically reasonable action levels for agreement of secondary dose/MU calculation programs. | REPORT OF AAPM TASK GROUP 219 ON INDEPENDENT CALCULATION-BASED DOSE/ MU VERIFICATION FOR IMRT

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Purpose With the advent of volumetric modulated arc therapy (VMAT) and intensity‐modulated radiation therapy (IMRT) treatment techniques, the requirement for more elaborate approaches in reviewing linac components’ integrity has become even more stringent. A possible solution to this challenge is to employ the usage of log files generated during treatment. The log files generated by the new generation of Elekta linacs record events at a higher frequency (25 Hz) than their predecessors, which allows for retrospective analysis and identification of subtle changes and provides another means of quality assurance. The ability to track machine components based on log files for each treatment can allow for constant monitoring of fraction consistency in addition to machine reliability. Using Elekta Agility log files, a set of tests were developed to evaluate the reliability and robustness of the multileaf collimators (MLCs). Methods To evaluate Elekta log file utilization for linac MLC QA effectiveness, five MLC test patterns were constructed to review the effects of leaf velocity and acceleration on positional accuracy, including gravitational effects for the Elekta MLC system. Each test was run five times in a particular setting to obtain reproducibility data and statistical averages. This study was performed on two identical Versa HD machines, each delivering a full set of test plans with all possible variations. Plans were delivered using Elekta's iCOMcat software and recorded log files were extracted. Log files were reformatted for readability and automatically analyzed in Matlab®. Results The Elekta Agility MLC system was shown to be capable of obtaining speeds within the range of 5–35 mm/s. MLC step and shoot tests have demonstrated the MLC system's capability of having positional repeatability, averaging 0.03‐ and 0.08‐mm offsets with and without gravitational effects, respectively. The IMRT‐specific tests have shown that gravitational effects are negligible with all positional tests averaging 0.5‐mm offsets. The largest speed root‐mean‐square error (RMSE) for the MLC system was found at the maximum speed of 35 mm/s with an average error of 0.8 mm. For slower speeds, the value was found to be much lower. Conclusion Utilizing log files has demonstrated the feasibility for higher precision of MLC motions to be reviewed, based on the performance tests that were instituted. Log files provide insight on the effects of friction, acceleration, and gravity, with MU's delivered that previously could not be reviewed in such detail. Based on our results, log file‐based QA has enhanced our ability to review performance, functionality, and perform QA on Elekta's MLC system.

The purpose of the present work was to measure the performance characteristics in the penumbra region and on the leaf‐end of an innovative dual‐layer micro multileaf collimator (DmMLC). The DmMLC consists of two orthogonal (upper and lower) layers of leaves; a standard MLC consists of one layer. The DmMLC provides unique performance characteristics in smoothing dose undulation, reducing leaf‐end transmission, and reducing MLC field dependence of the leaf stepping angle. Two standard MLCs (80‐leaf and 120‐leaf versions: Varian Medical Systems, Palo Alto, CA), a DmMLC (AccuKnife: Initia Medical Technology, Canton, MA), and a Cerrobend (Cerro Metal Products, Bellefonte, PA) block were used in performance studies involving a triangular field, a cross leaf‐end field, and a circular field. Measurements were made with 6‐MV X‐rays and extended dose range film at a depth of 5 cm in Solid Water (Gammex rmi, Middleton, WI) at a source–axis distance of 100 cm. The field penumbra width measured between the 20% and 80% isodose lines through the MLC‐80, MLC‐120, DmMLC, and Cerrobend block were 9.0, 5.0, 3.0, and 2.0 mm respectively. The dose undulation amplitude of the 50% isodose line was measured as 5.5, 2.0, and 0.5 mm for the MLC‐80, MLC‐120, and DmMLC respectively. The planar dose difference between the MLC‐80, MLC‐120, and DmMLC against Cerrobend block was measured as ranging at ±52.5normal%,±35.0normal%, and ±20.0normal% respectively. The leaf‐end transmission was measured at 22.4% in maximum and 15.4% in average when closing a single layer of the DmMLC, and at 2.4% in maximum and 2.1% in average when closing both layers. The MLC dependence of the leaf stepping angle with the DmMLC ranged from 45 degrees to 90 degrees. The standard MLC leaf stepping angle ranged from 0 degrees to 90 degrees. In conclusion, the dose undulation, leaf‐end transmission, and MLC field dependence of the leaf stepping angle with the DmMLC were remarkably reduced as compared with those of the standard MLCs. And as compared with Cerrobend block, the DmMLC provided very comparable performance in field‐edge smoothing and in the shaping of complex fields.PACS numbers: 87.56.Jk, 87.56.Nk, 87.56.Nj, 87.57.Nt

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For the planning of multiple brain lesions to be treated with stereotactic radiosurgery, Multiple Metastases Element planning software produced equivalent conformity, homogeneity, dose falloff, and brain V but required significantly lower monitor units, when compared to RapidArc plans.

Purpose: The dosimetric accuracy of the recently released Acuros XB advanced dose calculation algorithm (Varian Medical Systems, Palo Alto, CA) is investigated for single radiation fields incident on homogeneous and heterogeneous geometries, as well as for two arc (VMAT) cases and compared against the analytical anisotropic algorithm (AAA), the collapsed cone convolution superposition algorithm (CCCS) and Monte Carlo (MC) calculations for the same geometries. Methods and Materials: Small open fields ranging from 1 × 1 cm 2 to 5 × 5 cm 2 were used for part of this study. The fields were incident on phantoms containing lung, air, and bone inhomogeneities. The dosimetric accuracy of Acuros XB, AAA and CCCS in the presence of the inhomogeneities was compared against BEAMnrc/DOSXYZnrc calculations that were considered as the benchmark. Furthermore, two clinical cases of arc deliveries were used to test the accuracy of the dose calculation algorithms against MC. Results: Open field tests in a homogeneous phantom showed good agreement between all dose calculation algorithms and MC. The dose agreement was +/−1.5% for all field sizes and energies. Dose calculation in heterogenous phantoms showed that the agreement between Acuros XB and CCCS was within 2% in the case of lung and bone. AAA calculations showed deviation of approximately 5%. In the case of the air heterogeneity, the differences were larger for all calculations algorithms. The calculation in the patient CT for a lung and bone (paraspinal targets) showed that all dose calculation algorithms predicted the dose in the middle of the target accurately; however, small differences (2%-5%) were observed at the low dose region. Overall, when compared to MC, the Acuros XB and CCCS had better agreement than AAA. Conclusions: The Acuros XB calculation algorithm in the newest version of the Eclipse treatment planning system is an improvement over the existing AAA algorithm. The results are comparable to CCCS and MC calculations especially for both stylized and clinical cases. Dose discrepancies were observed for extreme cases in the presence of air inhomogeneities.