Purpose: Elekta accelerators controlled by the current clinically used accelerator control system, Desktop 7.01 (D7), uses binned variable dose rate (BVDR) for volumetric modulated arc therapy (VMAT). The next version of the treatment control system (Integrity) supports continuously variable dose rate (CVDR) as well as BVDR. Using CVDR opposed to BVDR for VMAT has the potential of reducing the treatment time but may lead to lower dosimetric accuracy due to faster moving accelerator parts. Using D7 and a test version of Integrity, differences in ability to control the accelerator, treatment efficiency, and dosimetric accuracy between the two systems were investigated.
Methods: Single parameter tests were designed to expose differences in the way the two systems control the movements of the accelerator. In these tests, either the jaws, multi leaf collimators (MLCs), or gantry moved at constant speed while the dose rate was changed in discrete steps. The positional errors of the moving component and dose rate were recorded using the control systems with a sampling frequency of 4 Hz. The clinical applicability of Integrity was tested using 15 clinically used VMAT plans (5 prostate, 5 H&N, and 5 lung) generated by the SmartArc algorithm in PINNACLE. The treatment time was measured from beam-on to beam-off and the accuracy of the dose delivery was assessed by comparing DELTA4 measurements and PINNACLE calculated doses using gamma evaluation.
Results: The single parameter tests showed that Integrity had an improved feedback between gantry motion and dose rate at the slight expense of MLC control compared to D7. The single parameter test did not reveal any significant differences in the control of either jaws or backup jaws between the two systems. These differences in gantry and MLC control together with the use of CVDR gives a smoother Integrity VMAT delivery compared to D7 with less abrupt changes in accelerator motion. Gamma evaluation (2% of 2 Gy and 2 mm) of the calculated doses and DELTA4 measured doses corrected for systematic errors showed an average pass rate of more than 97.8% for both D7, Integrity BVDR, and Integrity CVDR deliveries. Direct comparisons between the measured doses using strict gamma criteria of 0.5% and 0.5 mm showed excellent agreement between D7 and Integrity delivered doses with average pass rates above 95.7%. Finally, the Integrity control system resulted in a significant 35% (55 +/- 13 s) reduction in treatment time, on average.
Conclusions: Single parameter tests showed that the two control systems differed in their feedbac loops between MLC, gantry, and dose rate. These differences made the VMAT deliveries more smooth using the new Integrity treatment control system, compared to the current Desktop 7.01. Together with the use of CVDR, which results in less abrupt changes in dose rate, this further increases the smoothness of the delivery. The use of CVDR for VMAT with the Integrity desktop results in a significant reduction in treatment time compared to BVDR with an average reduction of 35%. This decrease in delivery time was achieved without compromising the dosimetric accuracy.