SU-E-T-282: Remove Field-Size Limitation Using the Combination of Collimator Rotation and Jaw Tracking with MLC Aperture

Purpose: this study is to investigate the use of variable-collimators and/or collimator-rotation to overcome the field-size limitation on TrueBeamSTX. Methods: The maximum static field-size is 22- × 40-cm for TrueBeamSTX and 40- × 40-cm for Trilogy. Maximum displacement between adjacent leaf ends at a single carriage position is 15-cm for TBSTX and 14-cm for Trilogy. Our current practice for IMRT treatment at Trilogy is as follows, if MLC leaves travel more than 13.5 cm in the MLC traveling direction, the treatment fields will be split at isocenter to two groups of IMRT fields to cover the large tumors. However, TrueBeamSTX is not limited in this way because the jaws can track each segments of the MLC aperture. Radiation treatment plans for ten patients (different tumor sites) treated at Trilogy with one dimension of the field is greater than 22 cm and the other dimension is less than or equal to 22 cm. All the plans will be converted with jaws tracking each segment's MLC aperture. If necessary, the collimator rotation will also be applied for the planning. Comparison of the converted plans with the original clinical plans will be evaluated and based on the following criterion: (1) tumor coverage; (2) dose sparing to the critical structures; and (3) treatment time. Results: The tumor coverage is compatible between two plans. The dose of critical structures was evaluated in the cumulative DVH for spinal cord, parotids, and brainstem at V20 and V5. In all patients, the maximum reduction in V20 was never more than 5% and was typically less than 1%. In V5, the maximum reduction was 10% and 3% respectively. The significant difference can be found in using the variable collimator to shorten the treatment time. Conclusion: We conclude that we will use the variable-collimator for all IMRT cases on TrueBeamSTX and as a potential backup machine for Trilogy