SU-F-T-284: The Effect of Linear Accelerator Output Variation On the Quality of Patient Specific Rapid Arc Verification Plans




The aim of the current study is to investigate the effect of machine output variation on the delivery of the RapidArc verification plans.


Three verification plans were generated using Eclipse™ treatment planning system (V11.031) with plan normalization value 100.0%. These plans were delivered on the linear accelerators using ArcCHECK− device, with machine output 1.000 cGy/MU at calibration point. These planned and delivered dose distributions were used as reference plans. Additional plans were created in Eclipse− with normalization values ranging 92.80%–102% to mimic the machine output ranging 1.072cGy/MU-0.980cGy/MU, at the calibration point. These plans were compared against the reference plans using gamma indices (3%, 3mm) and (2%, 2mm). Calculated gammas were studied for its dependence on machine output. Plans were considered passed if 90% of the points satisfy the defined gamma criteria.


The gamma index (3%, 3mm) was insensitive to output fluctuation within the output tolerance level (2% of calibration), and showed failures, when the machine output exceeds ≥3%. Gamma (2%, 2mm) was found to be more sensitive to the output variation compared to the gamma (3%, 3mm), and showed failures, when output exceeds ≥1.7%. The variation of the gamma indices with output variability also showed dependence upon the plan parameters (e.g. MLC movement and gantry rotation). The variation of the percentage points passing gamma criteria with output variation followed a non-linear decrease beyond the output tolerance level.


Data from the limited plans and output conditions showed that gamma (2%, 2mm) is more sensitive to the output fluctuations compared to Gamma (3%,3mm). Work under progress, including detail data from a large number of plans and a wide range of output conditions, may be able to conclude the quantitative dependence of gammas on machine output, and hence the effect on the quality of delivered rapid arc plans.