RESUMO
PURPOSE: The dual-layer multi-leaf collimator (MLC) in Halcyon involves further complexities in the dose calculation process, because the leaf-tip transmission varies according to the leaf trailing pattern. For the volumetric modulated arc therapy (VMAT) treatment, the prescribed dose for the target volume can be sensitive to the leaf-tip transmission change. This report evaluates the dosimetric consequence due to the uncertainty of the dual-layer MLC model in Eclipse through the dose verifications for clinical VMAT. Additionally, the Halcyon leaf-tip model is empirically adjusted for the VMAT dose calculation with the Acuros XB. MATERIALS AND METHODS: For this evaluation, an in-house program that analyzes the leaf position in each layer was developed. Thirty-two clinical VMAT plans were edited into three leaf sequences: dual layer (original), proximal single layer, or distal single layer. All leaf sequences were verified using Delta4 according to the dose difference (DD) and the global gamma index (GI). To improve the VMAT dose calculation accuracy, the dosimetric leaf gap (DLG) was adjusted to minimize the DD in single-layer leaf sequences. RESULTS: The mean of DD were -1.35%, -1.20%, and -1.34% in the dual-layer, proximal single-layer, and distal single-layer leaf sequences, respectively. The changes in the mean of DD between leaf sequences were within 0.2%. However, the calculated doses differed from the measured doses by approximately 1% in all leaf sequences. The tuned DLG was increased by 0.8 mm from the original DLG in Eclipse. When the tuned DLG was used in the dose calculation, the mean of DD neared 0% and GI with a criterion of 2%/2 mm yielded a pass rate of more than 98%. CONCLUSION: No significant change was confirmed in the dose calculation accuracy between the leaf sequences. Therefore, it is suggested that the dosimetric consequence due to the leaf trailing was negligibly small in clinical VMAT plans. The DLG tuning for Halcyon can be useful for reducing the dose calculation uncertainties in Eclipse VMAT and required in the commissioning for Acuros XB.
