Key result
VMAT MLC speed does not affect positional error, which exceeds tolerance in ~5% of scenarios.
Why the study?
The study aimed to determine multileaf collimator positional errors during VMAT delivery by evaluating time-dependent multileaf collimator velocity across mathematically derivable trajectories.
MLC positional error during VMAT delivery is not a function of MLC speed and rarely exceeds tolerance values in modern machines.
Indicates MLC speed need not inform VMAT error tolerances; leaves open multi-institutional validation before protocol changes.
Aim: To determine the multileaf collimator positional error (MLC-PE) during volumetric modulated arc therapy (VMAT) delivery by studying the time-dependent MLC velocity in mathematically derivable trajectories such as straight line and conic sections. Materials and Methods: VMAT delivery is planned in a way that MLCs are moving in a locus which can be defined by mathematical functions such as linear, parabolic, or circular velocity (PV or CV). The VMAT delivery was interrupted either once or multiple times during the delivery and projection images of the same were acquired in electronic portal imaging device. MLC-PE was then analyzed as a function of dose rate (DR), and MLC speed (SP) and number of interruptions in treatment delivery. In VMAT delivery with linear MLC motion, the delivery was interrupted either once (linear motion single interruption) or multiple (three) times (linear motion multiple interruptions). For PV and CV MLC velocity, the MLC motions are interrupted multiple times. Results: The maximum individual error obtained (DR of 35 MU/min, SP of 2.0 cm/s) was 1.96 ± 0.1 mm. Only 4.4% of MLCs showed ≥ ±1 mm positional error. When the treatment delivery is interrupted multiple times in VMAT delivery, the influence of interruption in MLC-PE overwhelmed the influence by DR and SP. For a sub-group analysis of independent and dependent variables, the mean MLC-PE was 0.18 ± 0.4 mm 0.19 ± 0.42 mm, respectively. Conclusion: Determination of MLC-PEs using a mathematical function without approximation indicates that MLC-PE is not a function of MLC speed. In less than 5% of the studied scenarios, the MLC-PE exceeds its tolerance value (±1 mm). The MLC-PE is significantly less in modern machines due to advancements in the delivery mechanism.
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Roy et al. (2021) studied this question. Volumetric modulated arc therapy (VMAT) delivery parameters (dose rate, speed, interruptions) was evaluated on Multileaf collimator positional error (MLC-PE). Multileaf collimator positional error during VMAT delivery is not a function of MLC speed, and exceeded the ±1 mm tolerance value in less than 5% of the studied scenarios.
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