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The conventional approach to intensity-modulated radiation therapy treatment planning involves two distinct strategies: optimizing an evaluation function while accounting for dose constraints, and solving feasibility problems using feasibility-seeking projection methods that incorporate inequality constraints. This paper introduces a novel iterative scheme within the framework of continuous dynamical systems, wherein constraint conditions dynamically evolve to enhance the optimization process. The validity of dynamically varying dose constraints is theoretically established through the foundation of continuous-time dynamical systems theory. In particular, we formalize a system of differential equations, with both beam coefficients and dose constraints modeled as state variables. The asymptotic stability of the system's equilibrium is rigorously proven, ensuring convergence to a solution. In practical terms, we leverage a discretized iteration formula derived from the continuous-time system to achieve rapid computational speed. The mathematical structure of the proposed approach, which directly incorporates dose-volume constraints into the objective function, facilitates significant computational efficiency and solution refinement. The proposed method has an inherent dynamics that approaches more desirable solutions within the set of solutions when the solution to the optimization problem is not an isolated point. This property guarantees the identification of optimal solutions that respect the prescribed dose-volume constraints while enhancing accuracy when such constraints are feasible. By treating dose constraints as variables and concurrently solving the optimization problem with beam coefficients, we can achieve more accurate results when compared with using fixed values for prescribed dose conditions. [ABSTRACT FROM AUTHOR]

Recently electronic portal image devices (EPIDs) have been widely used for quality assurance and dose verification. However there are no reports describing EPID dosimetry for Elekta volumetric modulated arc therapy (VMAT). We have investigated EPID dosimetry during VMAT delivery using a commercial software EPIDose with an Elekta Synergy linac. Dose rate dependence and the linac system sag during gantry rotation were measured. Gamma indices were calculated between measured doses using an EPID and calculation made by a treatment planning system for prostate VMAT test plans. The results were also compared to gamma indices using films and a two-dimensional detector array, MapCHECK2. The pass rates of the gamma analysis with a criterion of 3% and 2 mm for the three methods were over 96% with good consistency. Our results have showed that EPID dosimetry is feasible for Elekta VMAT.

Stereotactic radiotherapy requires a quality assurance (QA) program that ensures the mechanical accuracy of a radiation field center. We have proposed a QA method for achieving the above requirement by conducting the Winston Lutz test using an electronic portal image device (EPID). An action limit was defined as three times the standard deviation. Then, the action limits for mean deviations of the radiation field center during collimator rotation, gantry rotation, and couch rotation in clockwise and counterclockwise resulted in 0.11 mm, 0.52 mm, 0.37 mm, and 0.41 mm respectively. Two years after the QA program was launched, the mean deviation of the radiation field center during gantry rotation exceeded the above action limit. Consequently, a mechanical adjustment for the gantry was performed, thereby restoring the accuracy of the radiation field center. A field center shift of 0.5 mm was also observed after a micro multi-leaf collimator was unmounted.

The tolerance of the Backup diaphragm (Backup JAW) setting in Elekta linac was specified as 2 mm according to the AAPM TG-142 report. However, the tolerance and the quality assurance procedure for volumetric modulated arc therapy (VMAT) was not provided. This paper describes positional accuracy and quality assurance procedure of the Backup JAWs required for VMAT. It was found that a gap-width error of the Backup JAW by a sliding window test needed to be less than 1.5 mm for prostate VMAT delivery. It was also confirmed that the gap-widths had been maintained with an error of 0.2 mm during the past one year.

Mechanical accuracy of a stereotactic irradiation system using a micro multi-leaf collimator (mMLC), Elekta DMLC, has been evaluated. Measurements were made to obtain transmission, leakage, penumbra, and positioning accuracy of the DMLC leaf for a 6 MV photon beam. Mechanical accuracy and long term stability of a linac isocenter was also evaluated. The resulting transmission, along a line perpendicular to the leaf movement, was 0.31±0.01%, and the leakage from the closed opposing leaf pairs was 0.39±0.01%. The measured penumbra, at a depth incurring maximum dose, was 2.37±0.16 mm toward the leaf end and 2.14±0.18 mm toward the leaf side for various field sizes. The leaf gap width error, of 0.10±0.08 mm, was obtained by analyzing picket fence test results. The maximum leaf positioning error, of 0.14±0.06 mm, was obtained by analyzing the log file for a various gantry angles during an arc delivery. The isocenter accuracy was within a radius of 1 mm, without any recalibration for two years. In conclusion, our stereotactic irradiation system using DMLC was capable of providing accurate stereotactic treatment.

An optical interference-pattern, a moire artifact, is produced during the film scanning process using a flatbed scanner. Images with moire artifacts include optical density fluctuations thereby leading to inaccuracy of measurement. In this study, we proposed two methods for removing moire artifacts from radiochromic film and compared dose response and profile as well as image resolution and size between our proposed methods versus the conventional process. The proposed methods could remove the artifacts without impairing dosimetric performance. It is expected that the proposed methods facilitate more accurate film dosimetry with reflective radiochromic films.