Patterns of quality assurance and treatment planning for stereotactic body radiation therapy in India - A survey.

AIM: The use of stereotactic body radiation therapy (SBRT) is an increasing trend in the country. The aim of this study is to gain knowledge on patterns of quality assurance (QA) and treatment planning (TP) aspects with respect to SBRT. MATERIALS AND METHODS: A questionnaire with multiple choice was designed to determine practices of SBRT covering areas such as years of experience, type of linear accelerator, tumor-motion strategies, calculation algorithm used in the TP system (TPS), the protocol used for small field dosimetry, the detector used for small field dosimetry and QA, respiratory management during delivery. The survey was sent to all radiotherapy institutes in the country having a minimum of one linear accelerator, and responses were analyzed. RESULTS: From June 2022 to December 2022, 265 responses to the SBRT survey were received with response rate as 60.4%. The most common reason for not adopting SBRT was reported as a lack of capability of treatment machines to deliver SBRT (61.6%). Lung (81.1%) was the most practiced site. The most common delivery unit was a conventional linear accelerator (83%); 6 MV FFF (85.7%) was mostly used energy; volumetric-modulated arc radiotherapy (VMAT) (91.5%) was mostly used delivery technique; most of the equipment (more than 91.5%) used multileaf collimator (MLC) leaf width ≤5 mm. The most popular methods used for motion strategies during computed tomography (CT) were motion-encompassing and breath-hold techniques used by 65 (62.5%) and 62 (59.6%) respondents, respectively. The most popular method used for respiratory management during delivery was breath-hold by 55 (52.4%) respondents. Most TPS are equipped with either Type-C or Type-B algorithms. Heterogeneity was observed in the QA protocol and acceptance criteria for analysis of patient-specific QA. CONCLUSION: The survey resulted in heterogeneity in QA and TP aspects among users of SBRT and demands for harmonizing the dosimetric aspects of SBRT in the country.

Monte Carlo simulation based study of a proposed multileaf collimator for a telecobalt machine.

PURPOSE: The objective of the present work was to propose a design of a secondary multileaf collimator (MLC) for a telecobalt machine and optimize its design features through Monte Carlo simulation. METHODS: The proposed MLC design consists of 72 leaves (36 leaf pairs) with additional jaws perpendicular to leaf motion having the capability of shaping a maximum square field size of 35 × 35 cm(2). The projected widths at isocenter of each of the central 34 leaf pairs and 2 peripheral leaf pairs are 10 and 5 mm, respectively. The ends of the leaves and the x-jaws were optimized to obtain acceptable values of dosimetric and leakage parameters. Monte Carlo N-Particle code was used for generating beam profiles and depth dose curves and estimating the leakage radiation through the MLC. A water phantom of dimension 50 × 50 × 40 cm(3) with an array of voxels (4 × 0.3 × 0.6 cm(3) = 0.72 cm(3)) was used for the study of dosimetric and leakage characteristics of the MLC. Output files generated for beam profiles were exported to the PTW radiation field analyzer software through locally developed software for analysis of beam profiles in order to evaluate radiation field width, beam flatness, symmetry, and beam penumbra. RESULTS: The optimized version of the MLC can define radiation fields of up to 35 × 35 cm(2) within the prescribed tolerance values of 2 mm. The flatness and symmetry were found to be well within the acceptable tolerance value of 3%. The penumbra for a 10 × 10 cm(2) field size is 10.7 mm which is less than the generally acceptable value of 12 mm for a telecobalt machine. The maximum and average radiation leakage through the MLC were found to be 0.74% and 0.41% which are well below the International Electrotechnical Commission recommended tolerance values of 2% and 0.75%, respectively. The maximum leakage through the leaf ends in closed condition was observed to be 8.6% which is less than the values reported for other MLCs designed for medical linear accelerators. CONCLUSIONS: It is concluded that dosimetric parameters and the leakage radiation of the optimized secondary MLC design are well below their recommended tolerance values. The optimized design of the proposed MLC can be integrated into a telecobalt machine by replacing the existing adjustable secondary collimator for conformal radiotherapy treatment of cancer patients.

Effects of alignment of adjustable collimator on dosimetric parameters of a telecobalt machine.

The objectives of this study was to investigate the most appropriate hinge point for the alignment of adjustable collimators/trimmer bars in a telecobalt machine for obtaining acceptable dosimetric parameters of a telecobalt machine. Variations of relative output of the telecobalt machine with selection of different hinge points were also investigated. MCNP code was used for the present the study. A water phantom of dimension 50 x 50 x 40 cm(3) having voxels each of volume 0.72 cm(3) was used in our study for generating beam profiles and depth dose curves. When hinge points are selected at the periphery of the source bottom and the source top, flatness, symmetry and penumbra were found to be well within the recommended tolerance limits whereas values are far beyond with the hinge points selected at the centre of source bottom or the source top. Moreover, it was observed that the relative output of a telecobalt machine with hinge points at centre of the source bottom and the source top are appreciably lower than that of at periphery of source bottom particularly for smaller field sizes. This effect is due to the blockage of the part of the source volume in the radiation field. Therefore, hinge point for the alignment of adjustable collimators/trimmer bars should be selected either at periphery of source bottom or the source top for obtaining clinically acceptable flatness, symmetry and penumbra. However, selecting hinge point at the periphery of the source bottom for the alignment of the adjustable collimators/trimmer bars would be more appropriate as height of the source will vary depending on activity of the source used in the source capsule for given specific activity.