Dosimetric effects of small field size, dose grid size, and variable split-arc methods on gamma pass rates in radiation therapy

This study investigates the influence of calculation accuracy in peripheral low-dose regions on the gamma pass rate (GPR), utilizing the Acuros XB (AXB) algorithm and ArcCHECK™ measurement. The effects of varying small field sizes, dose grid sizes, and split-arc techniques on GPR were analyzed. Various small field sizes were employed. Thirty-two single-arc plans with dose grid sizes of 2 mm and 1 mm and prescribed doses of 2, 5, 10, and 20 Gy were calculated using the AXB algorithm. In total, 128 GPR plans were examined. These plans were categorized into three sub-fields (3SF), four sub-fields (4SF), and six sub-fields (6SF). The GPR results deteriorated with smaller target sizes and a 2 mm dose grid size in a single arc. A similar degradation in GPR was observed with smaller target sizes and a 1 mm dose grid size. However, the 1 mm dose grid size generally resulted in better GPR compared with the 2 mm dose grid size for the same target sizes. The GPR improved with finer split angles and a 2 mm dose grid size in the split-arc method. However, no statistically significant improvement was observed with finer split angles and a 1 mm dose grid size. This study demonstrates that coarser dose grid sizes result in lower GPRs in peripheral low-dose regions as calculated by AXB with ArcCHECK™ measurement. To enhance GPR, employing split-arc methods and finer dose grid sizes could be beneficial.