Influence of aperture shape controller settings on dose distribution and treatment efficiency in lung stereotactic body radiation therapy with a 10 MV flattening filter-free beam

Abstract

We evaluated the effects of different aperture shape controller (ASC) settings on the dose distribution and delivery efficiency of lung stereotactic body radiotherapy (SBRT) using volumetric modulated arc therapy (VMAT) with a 10 MV flattening filter-free (FFF) beam. Ten lung SBRT cases with breath-holding were retrospectively analyzed by comparing plans with no-ASC and those with 5 ASC settings (very low, low, moderate, high, and very high). The gross tumor volume (GTV) coverage: D_98% (minimum dose to 98% of the volume), target conformity index (CI), gradient index (GI), D_2cm (dose maximum at 2cm from the planning target volume), lung dose, monitor unit (MU), modulated complexity score for VMAT (MCSv), and delivery time were evaluated. Compared with the no-ASC setting, there were no significant differences in GTV coverage, GI, or D_2cm in the different ASC settings. A very high ASC setting resulted in a slight increase in the mean lung dose metrics. On average, MU and delivery times were significantly reduced by approximately 200 MU and 5.0 s with very high ASC settings compared to the no-ASC setting. Plan complexity decreased as the ASC increased, with the very high ASC setting showing the highest MCSv values. This study suggests that the very high ASC setting may improve the delivery efficiency for lung SBRT using VMAT with the 10 MV FFF beam under breath-holding while maintaining comparable dose distributions and target coverage.