Dose linearity and uniformity of a linear accelerator designed for implementation of multileaf collimation system-based intensity modulated radiation therapy

The dose linearity and uniformity of a linear accelerator designed for multileaf collimation system-(MLC) based IMRT was studied as a part of commissioning and also in response to recently published data. The linear accelerator is equipped with a PRIMEVIEW, a graphical interface and a SIMTEC IM-MAXX, which is an enhanced autofield sequencer. The SIMTEC IM-MAXX sequencer permits the radiation beam to be "ON" continuously while delivering intensity modulated radiation therapy subfields at a defined gantry angle. The dose delivery is inhibited when the electron beam in the linear accelerator is forced out of phase with the microwave power while the MLC configures the field shape of a subfield. This beam switching mechanism reduces the overhead time and hence shortens the patient treatment time. The dose linearity, reproducibility, and uniformity were assessed for this type of dose delivery mechanism. The subfields with monitor units ranged from 1 MU to 100 MU were delivered using 6 MV and 23 MV photon beams. The doses were computed and converted to dose per monitor unit. The dose linearity was found to vary within 2% for both 6 MV and 23 MV photon beam using high dose rate setting (300 MU/min) except below 2 MU. The dose uniformity was assessed by delivering 4 subfields to a Kodak X-OMAT TL film using identical low monitor units. The optical density was converted to dose and found to show small variation within 3%. Our results indicate that this linear accelerator with SIMTEC IM-MAXX sequencer has better dose linearity, reproducibility, and uniformity than had been reported.