Application of a new dosimetry formalism to volumetric modulated arc therapy (VMAT).

Volumetric modulated arc therapy (VMAT) offers a challenge to classical dosimetry protocols as the beams are dynamic in orientation and aperture shape and may include small apertures. The aim of this paper is to apply a formalism to VMAT beams that has recently been published by the International Atomic Energy Agency (IAEA) working party to improve the dosimetry for small and non-standard fields. We investigated three possible fields and assessed their suitability as plan class specific reference (pcsr) fields. The factors in the new dosimetry formalism were investigated: the conversion of dose to water from the conventional reference field to the pcsr and then from the pcsr to a treatment plan, using a PTW semiflex chamber, two Farmer chambers and an electron diode. Finally, the dose was compared for Alanine, the new formalism and calculated using Pinnacle(3) (Philips Radiation Oncology Systems) for two typical clinical VMAT beams. Correction factors between the reference field and the pcsr determined with Alanine range from 0.1% to 2.3% for the three pcsr fields. Dose to water measured using the calibrated ionization chambers is less than 2% different to the dose calculated by Pinnacle(3). VMAT planning and delivery procedures have been successfully implemented and a new dosimetry protocol has been investigated for this new technique. Calibration factors for pcsr fields are found to be up to 2.3% different when using the new formalism, compared to using a standard dosimetry protocol. Using the calibration factors determined in the pcsr fields, the ionization chambers and electron diode agree to within 1% with Alanine dosimetry for two clinical VMAT plans. Good agreements between calculations and measurements are found for these two plans when the new formalism is used.