Quality assurance of non-coplanar, volumetric-modulated arc therapy employing a C-arm linear accelerator, featuring continuous patient couch rotation

Hideaki Hirashima,
Mitsuhiro NakamuraEmail author,
Yuki Miyabe,
Nobutaka Mukumoto,
Tomohiro Ono,
Hiraku Iramina and
Takashi Mizowaki

Radiation Oncology201914:62

https://doi.org/10.1186/s13014-019-1264-6

Received: 5 November 2018
Accepted: 27 March 2019
Published: 11 April 2019

Abstract

Purpose

To perform quality assurance of non-coplanar, volumetric-modulated arc therapy featuring continuous couch rotation (CCR-VMAT) using a C-arm linear accelerator.

Methods

We planned and delivered CCR-VMAT using the TrueBeam Developer Mode. Treatment plans were created for both a C-shaped phantom and five prostate cancer patients using seven CCR trajectories that lacked collisions; we used RayStation software (ver. 4.7) to this end. Subsequently, verification plans were generated. The mean absolute error (MAE) between the center of an MV-imaged steel ball and the radiation field was calculated using the Winston–Lutz test. The MAEs between planned and actual irradiation values were also calculated from trajectory logs. In addition, correlation coefficients (r values) among the MAEs of gantry angle, couch angle, and multi-leaf collimator (MLC) position, and mechanical parameters including gantry speed, couch speed, MLC speed, and beam output, were estimated. The dosimetric accuracies of planned and measured values were also assessed using ArcCHECK.

Results

The MAEs ±2 standard deviations as revealed by the Winston–Lutz test for all trajectories were 0.3 ± 0.3 mm in two dimensions. The MAEs of the gantry, couch, and MLC positions calculated from all trajectory logs were within 0.04°, 0.08°, and 0.02 mm, respectively. Deviations in the couch angle (r = 0.98, p < 0.05) and MLC position (r = 0.86, p < 0.05) increased significantly with speed. The MAE of the beam output error was less than 0.01 MU. The mean gamma passing rate ± 2 SD (range) of the 3%/3 mm, 3%/1 mm, and 5%/1 mm was 98.1 ± 1.9% (95.7–99.6%), 87.2 ± 2.8% (80.2–96.7%), and 96.3 ± 2.8% (93.9–99.6%), respectively.

Conclusions

CCR-VMAT delivered via the TrueBeam Developer Mode was associated with high-level geometric and mechanical accuracy, thus affording to high dosimetric accuracy. The CCR-VMAT performance was stable regardless of the trajectory chosen.