Purpose:The calculation accuracy of treatment planning systems (TPSs) drops drastically when the points outside the field edges are considered. The real accuracy of a TPS and linear accelerator (linac) combination for regions outside the field edge is a subject which demands more study. In this study, the accuracy of out-of-field dose calculated by a TPS, used with a TrueBeam® (TB) linac, is quantified.Materials and Methods:For dose calculation, Eclipse™ version 13.7 commissioned for TB machine was used. For comparison, Monte Carlo (MC) methods, as well as the measurements, were used. The VirtuaLinac, a Geant 4-based MC program which is offered as a cloud solution, is used for the generation of input phase-space (PS) files. This PS file was imported into PRIMO (PENELOPE based MC program) for the simulation of out-of-field dose.Results:In this study, the accuracy of the out-of-field dose calculated by a TPS for a TB linac was estimated. As per the results in comparison with MC simulations, the TPS underestimated the dose by around 45% on an average for the off-axis-distance range considered in this study. As the off-axis distance increased, the underestimation of the dose also increased.Conclusion:In this work, it was observed that the TPS underestimates doses beyond the edges of treatment fields for a clinical treatment executed on a TB machine. This indicates that the out-of-field dose from TPSs should only be used with a clear understanding of the inaccuracy of dose calculations beyond the edge of the field.

Purpose: This study aims to evaluate dosimetric parameters like percentage depth dose, dosimetric field size, depth of maximum dose surface dose, penumbra and output factors measured using IBA CC01 pinpoint chamber, IBA stereotactic field diode (SFD), PTW microDiamond against Monte Carlo (MC) simulation for 6 MV flattening filter-free small fields. Materials and Methods: The linear accelerator used in the study was a Varian TrueBeam® STx. All field sizes were defined by jaws. The required shift to effective point of measurement was given for CC01, SFD and microdiamond for depth dose measurements. The output factor of a given field size was taken as the ratio of meter readings normalised to 10 × 10 cm2 reference field size without applying any correction to account for changes in detector response. MC simulation was performed using PRIMO (PENELOPE-based program). The phase space files for MC simulation were adopted from the MyVarian Website. Results and Discussion: Variations were seen between the detectors and MC, especially for fields smaller than 2 × 2 cm2 where the lateral charge particle equilibrium was not satisfied. Diamond detector was seen as most suitable for all measurements above 1 × 1 cm2. SFD was seen very close to MC results except for under-response in output factor measurements. CC01 was observed to be suitable for field sizes above 2 × 2 cm2. Volume averaging effect for penumbra measurements in CC01 was observed. No detector was found suitable for surface dose measurement as surface ionisation was different from surface dose due to the effect of perturbation of fluence. Some discrepancies in measurements and MC values were observed which may suggest effects of source occlusion, shift in focal point or mismatch between real accelerator geometry and simulation geometry. Conclusion: For output factor measurement, TRS483 suggested correction factor needs to be applied to account for the difference in detector response. CC01 can be used for field sizes above 2 × 2 cm2 and microdiamond detector is suitable for above 1 × 1 cm2. Below these field sizes, perturbation corrections and volume averaging corrections need to be applied.

Purpose: The objective of this article is to evaluate the dosimetric efficacy of volumetric modulated arc therapy (VMAT) in comparison to dynamic conformal arc therapy (DCAT) and 3D conformal radiotherapy (3DCRT) for very small volume (≤1 cc) and small volume (≤3 cc) tumours for flattened (FF) and unflattened (FFF) 6 MV beams. Materials and methods: A total of 21 patients who were treated with single-fraction stereotactic radiosurgery, using either VMAT, DCAT or 3DCRT, were included in this study. The volume categorisation was seven patients each in <1, 1–2 and 2–3 cc volume. The treatment was planned with 6 MV FF and FFF beams using three different techniques: VMAT/Rapid Arc (RA) (RA_FF and RA_FFF), dynamic conformal arc therapy (DCA_FF and DCA_FFF) and 3DCRT (Static_FF and Static_FFF). Plans were evaluated for target coverage (V100%), conformity index, homogeneity index, dose gradient for 50% dose fall-off, total MU and MU/dose ratio [intensity-modulated radiotherapy (IMRT) factor], normal brain receiving >12 Gy dose, dose to the organ at risk (OAR), beam ON time and dose received by 12 cc of the brain. Result: The average target coverage for all plans, all tumour volumes (TVs) and delivery techniques is 96·4 ± 4·5 (range 95·7 ± 6·1–97·5 ± 2·9%). The conformity index averaged over all volume ranges <1, 2, 3 cc> varies between 0·55 ± 0·08 and 0·68 ± 0·04 with minimum and maximum being exhibited by DCA_FFF for 1 cc and Static_FFF/RA_FFF for 3 cc tumours, respectively. Mean IMRT factor averaged over all volume ranges for RA_FF, DCA_FF and Static_FF are 3·5 ± 0·8, 2·0 ± 0·2 and 2·0 ± 0·2, respectively; 50% dose fall-off gradient varies in the range of 0·33–0·42, 0·35–0·40 and 0·38–0·45 for 1, 2 and 3 cc tumours, respectively. Conclusion: This study establishes the equivalence between the FF and FFF beam models and different delivery techniques for stereotactic radiosurgery in small TVs in the range of ≤1 to ≤3 cc. Dose conformity, heterogeneity, dose fall-off characteristics and OAR doses show no or very little variation. FFF could offer only limited time advantage due to excess dose rate over an FF beam.

Introduction: Achieving high positional and dosimetric accuracy in small fields is very challenging due to the imbalance of charged particle equilibrium (CPE), occlusion of the primary radiation source, and overlapping penumbra regions. These factors make the choice of the detector for Stereotactic Radiosurgery (SRS) patient-specific quality assurance (PSQA) difficult. The aim of the study is to compare the suitability of EBT3 Gafchromic film against CC01 pinpoint chamber for the purpose of SRS and stereotactic Radiotherapy (SRT) dose verification.Material and Method: EBT3 Gafchromic film was calibrated against Treatment Planning System (TPS) doses (1 Gy – 35 Gy). CC01 pinpoint chamber and EBT3 film was used to verify Patient-Specific point doses of 21 intracranial lesions each planned with Static, Dynamic Conformal Arc (DCA), and Volumetric Arc Therapy (VMAT) using Varian TrueBeam Accelerator 6MV Flattening Filter (FF) and 6MV Flattening Filter Free (FFF) beams. The lesion sizes varied from 0.4 cc to 2.9 cc. The lesions were categorized into <1cc, 1cc-2cc and 2cc-3cc.Results: High variations in measured doses from TPS calculated dose were observed with small lesion volumes irrespective of the dosimeter. As the sizes decreased high uncertainty was observed in ion chamber results. CC01 was observed under-responding to film in small lesion sizes (<1cc), where nearly 50% of results under-responded in comparison with Film results. Film results were more or less consistent for static and DCA plans. Static and DCA plans were consistent passing more than 73% of the plans of the smallest lesion size category. VMAT showed very poor PSQA agreement for all three volumes (32.1% for <1cc, 14.3% for 2cc-3cc and 39.3% for 2cc-3cc). No significant difference was observed between 6MVFF and 6MVFFF beams from the chi-squared test.Conclusion: EBT3 Film was observed to be a more suitable detector for small lesion sizes less than 1cc, compared to CC01. As the volume increases, the response of CC01 and EBT3 film have no significant difference in performing PSQA for intracranial SRS/SRT. VMAT techniques for intra cranial SRS shows deviation from TPS planned dose for both EBT3 film and CC01 and should not be preferred choice of verification tools.

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