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Dose verification of intensity-modulated arc therapy using an ERGO++ treatment planning system and Elekta internal multileaf collimators is described. Prostate intensity-modulated arc therapy was planned using the arc modulation optimization algorithm inverse planning module of ERGO++. After transferring the plan to Elekta Synergy's controller (Elekta Ltd, Crawley, UK), the isocentre dose was measured and compared with a calculated dose using a pinpoint chamber and a water phantom in a cylindrical acrylic enclosure. Subsequently, an EDR2 film was placed inside a multilayer plastic phantom, and total dose distributions were measured in three axial planes as well as in the coronal and sagittal planes to compare the actual dose with the calculated dose. The dose discrepancy at the isocentre was 1.7%. The calculated gamma indices were less than 1 over 90% of the three axial planes, as well as in the coronal and sagittal planes, having a dose greater than 50% of the maximum target dose.

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Linac parameters such as the multi-leaf collimator (MLC) position and jaw position, cumulative monitor units (MUs), and the corresponding gantry angle were recorded during the clinical delivery of volumetric modulated arc therapy for prostate, lung, and head/neck cancer patients. Then, linac parameters were converted into the beam-data format used in the treatment planning system, and the dose distribution was reconstructed. The dose-volume histogram and the dose difference (DD) were compared with the corresponding values in the treatment plan. A reproducible error of in-treatment linac parameters was observed when a sudden change of beam intensity or MLC/jaw speed occurred. The maximum cumulative MU error was more than 4 MU for lung cancer cases, and the maximum MLC position exceeded 5 mm for prostate and head/neck cancer patients. However, these errors were quickly compensated for at the next control point. All treatments analyzed in the present study were delivered within 0.4% accuracy at the planning target volume. The cumulative dose agreed with that of the plan within 3% of the prescribed dose. The 1% DD was 93.9, 99.9, and 93.4% of the prescription dose for prostate, lung, and head/neck cancer patients, respectively.

SummaryMulti-detector computed tomography (MDCT) has rapidly evolved and is increasingly used for treatment simulation of thoracic and abdominal radiotherapy. A 320-detector row CT scanner has recently become available that allows axial volumetric scanning of a 16-cm-long range in a patient without table movement. Current radiotherapy techniques require a generous margin around the presumed gross tumor volume (GTV) to account for uncertainties such as tumor motion and set up error. Motion analysis is useful to evaluate the internal margin of a moving target due to respiration and to improve therapeutic precision. The purpose of this study is to propose a method using phase-only correlation to automatically detect the target and to assess the motion of the target in numerical phantoms and patients. Free-breathing scans using 320-detector row CT were acquired for 4 patients with lung tumor(s). The proposed method was feasible for motion analysis of all numerical phantoms and patients. The results reproduced the facts that the motion of tumors in the patients varied in orbits during the respiratory cycle and exhibited hysteresis. The maximum distance between peak exhalation and inhalation increased as the tumors approached the diaphragm. The proposed method detected the three-dimensional position of the targets automatically and analyzed the trajectories. The tumor motion due to respiration differed by region and was greatest for the lower lobe.