An extensive log-file analysis of step-and-shoot intensity modulated radiation therapy segment delivery errors

We present a study to evaluate the monitor unit (MU), dosimetric, and leaf-motion errors found in the delivery of 91 step-and-shoot IMRT treatment plans performed at three nominal dose rates using a dual modality high energy Linac (Varian 2100 C/D, Varian Medical Systems Inc., Palo Alto, CA) equipped with a 120-leaf multileaf collimator (MLC). The analysis was performed by studying log files generated by the MLC controller system. Recent studies by our group have validated that the automatically generated MLC log files accurately record the actual system delivery. A total of 635 beams were delivered at three nominal dose rates: 100, 300, and 600 MU/min. The log files were manually retrieved and analysis software was developed to extract the recorded MU delivery and leaf positions for each segment. Our analysis revealed that the magnitude of segment MU errors were independent of the planned segment MUs. Segment MU errors were found to increase with dose rate having maximum errors per segment of ±1.8 MU at 600 MU/min, ±0.8 MU at 300 MU/min, and ±0.5 MU at 100 MU/min. The total absolute MU error in each plan was observed to increase with the number of plan segments, with the trend increasing more rapidly for higher dose rates. Three dimensional dose distributions were recomputed based on the observed segment MU errors for three plans with large cumulative absolute MU errors. Comparison with the original treatment plans indicated no clinically significant consequences due to these errors. In addition, approximately 80% of the total segment deliveries reported at least one collimator leaf moving at least 1 mm (projected at isocenter) during segment delivery. Such errors occur near the end of segment delivery and have been previously observed by our group using a fast video-based electronic portal imaging device. At 600 MU/min, between 5% and 23% of the plan MUs were delivered during leaf motion that had exceeded a 1 mm position tolerance. These leaf motion errors were not included in the treatment plan recalculations performed in this study.