The effect of beam interruption during FFF-VMAT plans for SBRT.

To investigate the dosimetric effect of intended beam interruption during volumetric modulated arc therapy (VMAT) with flattening filter free (FFF) beam for exploring the possibility of deep inspiration breath hold stereotactic body radiation therapy (SBRT). A total of ten SBRT plans with 6 and 10 MV FFF beams were retrospectively selected. All plans consisted of four partial arcs, except one plan with six partial arcs. We delivered the plans using a Varian Truebeam™ with three different scenarios; without interruption (0int), with one intentional interruption (1int), or with two intentional interruptions (2int), per each partial arc. The treatment log files were exported from the treatment console, and the variations in delivered MU were evaluated at the beam interruption angles. The dose distributions were also measured using a 3D cylindrical diode array detector, ArcCHECK™. The 2D global gamma evaluations were performed, compared to the planned dose distribution, with 3%/3 and 4%/2 mm passing criterion. The dose difference (DD) was also determined between uninterrupted and interrupted data with 3, 2, 1, and 0.5% of global maximum dose. The interruption caused a total increase of 0.14 ± 0.05% and 0.25 ± 0.08% of the total planned MU, ranging from 1746 to 3261 MU, at the interrupted angles in 1int and 2int, respectively. All global gamma passing rates satisfied our clinical threshold of 90%, and the differences of passing rates were less than 0.3% on average with both criterions. All measured 1int and 2int data were within 3% DD from 0int measured data. For 6 MV FFF beams, the average passing rate with 2, 1, and 0.5% DD were 99.9 ± 0.2%, 92.3 ± 12.0%, and 81.9 ± 24.9%, respectively, between 0int and 1int, and 99.8 ± 0.4%, 92.1%12.4%, and 80.7 ± 26.5%, respectively, between 0int and 2int. For 10 MV FFF beams, the average passing rate with 2, 1, and 0.5% DD were 100.0 ± 0.2%, 95.4 ± 9.4% and 87.0 ± 19.8%, respectively, between 0int and 1int, and 99.9 ± 0.3%, 95.4 ± 9.7%, and 87.2 ± 21.3% between 0int and 2int. The dosimetric impact of beam interruption was investigated with small field and high dose rate FFF-VMAT SBRT plans. The delivered dose distributions with up to 12 interruptions per plan were still clinically acceptable. Only minimal changes were observed in Gamma, DD, and log file analysis.