Automated conversion of Millennium-120 VMAT plans to HDMLC geometry: Software development and treatment of first patients

Purpose To provide plan backup resiliency for patients treated on a solitary high definition multileaf collimator (HDMLC) linac by developing a fully integrated Eclipse script, which converts patient plans initially optimized on Millennium-120 (M120) MLC to dosimetrically equivalent leaf motions for delivery on HDMLC. In the event of HDMLC machine downtime, affected patients can be transferred to Millennium-120 units, and their backup plan delivered without delay. Methods Write-enabled Eclipse scripting is leveraged to generate HDMLC treatment fields with control points parameterized to mimic apertures of an existing Millennium-120 VMAT plan. Non-parity between intermediate control point gantry angles of script generated arcs relative to VMAT is reconciled through an interpolation subroutine to correct for the apertures and monitor units that would have existed at intermediate angles. Differences in dosimetric leaf gap are corrected by displacing the subset of leaves undergoing dynamic motion. A nominal change to plan normalization corrects for remaining discrepancies between beam models. Results Over 220 non-SABR VMAT patients were treated on a solitary HDMLC linac with plans converted using the developed script. All have undergone streamlined RO review and physics quality assurance (QA), where the converted plan replicates the original leaf patterns, representing a minor dosimetric perturbation. Analyzing a subset of converted plans delivered at four anatomical sites, on average 99.3% of points pass the 1%/1 mm gamma criterion. Dose-volume histograms between the original and converted plans are in excellent agreement. ArcCheck measurements comparing delivery of the converted HDMLC plan to the calculated M120 dose distribution averaged a gamma pass rate of 99.4% (95.2%) at a 3%/3 mm (2%/2 mm) criterion. The conversion process takes 30 s to run, avoids errors in exporting/re-importing, and generates leaf motions deliverable within machine limits. Conclusion The methodology developed for automated plan conversion helped maximize the utilization of a solitary HDMLC linac, while preserving backup interoperability with minimal overhead.