SU-E-T-100: An Approach to Improving the Dynamic Delivery Accuracy for Breast IMRT




A method is established to improve the accuracy of the IMRT dose delivery for the treatment of breast and chest wall tumors when the higher dose gradient is delivered at the end of the leaf sequence.


Dynamic MLC deliveries on Varian Linacs are achieved through the motion of the leaves from X1 to X2 direction. If the higher dose gradient is at the end of the leaf motion sequence, this can Result in an increased error in the overall dose delivery. Such errors have been observed in Lateral beams for Left-sided and Medial beams for Right-sided treatments. To evaluate and resolve this issue we adopted an approach where the fluence for such beams was geometrically flipped (mirrored) to treat the higher end of the dose gradient first.


Using this method, it was possible to deliver the optimized dose map to the area of interest still using only the X1–X2 direction of the leaf motion. The accuracy of this method was tested on different beam as part of our pre-treatment QA program on both Varian delivery systems. With this approach we found that there was significant improvement in delivery accuracy on both 21EX and TrueBeam systems. Beams of initial Gamma index (3% and 3mm) 89–93% were increased to 98–99%. We also observed superior delivery accuracy with TB compared to the 21EX


This work demonstrate the need for a delivery sequence option from X2–X1 in situations where the MLC sequence indicates higher dose gradient component is being delivered at the end of the sequence. Results from this work can be considered in the IMRT beam optimization in the treatment planning systems. Further work will be required to establish the application of this approach in clinical setting.