Fluence-weighted average subfield size in helical TomoTherapy

Introduction Helical TomoTherapy allows a highly conformal dose distribution to complex target geometries with a good protection of organs at risk. However, the small field sizes associated with this method are a possible source of dosimetrical uncertainties. The IAEA has published detector-specific field output correction factors for static fields of the TomoTherapy in the TRS483. This work investigates the average subfield size of helical TomoTherapy plans. Material and methods A new parameter for helical TomoTherapy was defined – the fluence-weighted average subfield size. The subfield sizes were extracted from the leaf-opening time sinograms in the RT-plan files for 30 clinical prostate and head and neck plans and were put in relation to Delat4 Phantom+ measurement results. Additionally the influence of planning parameters on the subfield size was studied by varying the modulation factor, number of iterations and pitch in the dose optimization and calculation for three different clinical indications H&N, prostate and rectum cancer . Selected plans were dosimetrically verified by Delta4 measurements to examine the reliability in dependence of the average subfield size. Furthermore, the impact of the planning parameters on a) the dose distribution, with regard to the planning target volume and regions at risks, and b) machine characteristics such as delivery time, actual modulation factor and leaf-opening times were evaluated. Results The average equivalent square subfield lengths ( s ¯ e q ) of the two investigated indications did not differ significantly – prostate plans: 2.75 ± 0.14 cm and H&N plans: 2.70 ± 0.16 cm, both with a jaw width of 2.5 cm. No correlation between field size and measured dose deviation was detected. The number of iterations and the modulation factor have a considerable influence on the average subfield size. The higher the planned modulation factor and the more iterations are used during optimization, the smaller is the subfield size. In our pilot study plans were calculated with field sizes s ¯ e q between 4.2 cm and 1.7 cm, with a jaw width of 2.5 cm. Again, the measurement results of Delta4 showed no significant deviation from the doses calculated by the TomoTherapy planning system for the whole range of subfield sizes, and no significant correlation between field sizes and dose deviations was found. As expected, the clinical dose distribution improved with increasing modulation factor and an increasing number of iterations. The compromise between an improved dose distribution and smaller s ¯ e q was shown. Conclusion In this work, a method was presented to determine the average subfield size for helical TomoTherapy plans. The response of the Delta4 did not show any dependence on field size in the range of the field sizes covered by the studied plans. The influence of the subfield sizes on other dosimetry systems remains to be investigated.