Commissioning measurements for photon beam data on three TrueBeam linear accelerators, and comparison with Trilogy and Clinac 2100 linear accelerators

This study presents the beam data measurement results from the commissioning of three TrueBeam linear accelerators. An additional evaluation of the measured beam data within the TrueBeam linear accelerators contrasted with two other linear accelerators from the same manufacturer (i.e., Clinac and Trilogy) was performed to identify and evaluate any differences in the beam characteristics between the machines and to evaluate the possibility of beam matching for standard photon energies. We performed a comparison of commissioned photon beam data for two standard photon energies (6 MV and 15 MV) and one flattening filter-free ("FFF") photon energy (10 FFF) between three different TrueBeam linear accelerators. An analysis of the beam data was then performed to evaluate the reproducibility of the results and the possibility of "beam matching" between the TrueBeam linear accelerators. Additionally, the data from the TrueBeam linear accelerator was compared with comparable data obtained from one Clinac and one Trilogy linear accelerator models produced by the same manufacturer to evaluate the possibility of "beam matching" between the TrueBeam linear accelerators and the previous models. The energies evaluated between the linear accelerator models are the 6 MV for low energy and the 15 MV for high energy. PDD and output factor data showed less than 1% variation and profile data showed variations within 1% or 2 mm between the three TrueBeam linear accelerators. PDD and profile data between the TrueBeam, the Clinac, and Trilogy linear accelerators were almost identical (less than 1% variation). Small variations were observed in the shape of the profile for 15 MV at shallow depths (< 5 cm) probably due to the differences in the flattening filter design. A difference in the penumbra shape was observed between the TrueBeam and the other linear accelerators; the TrueBeam data resulted in a slightly greater penumbra width. The diagonal scans demonstrated significant differences in the profile shapes at a distance greater than 20 cm from the central axis, and this was more notable for the 15 MV energy. Output factor differences were found primarily at the ends of the field size spectrum, with observed differences of less than 2% as compared to the other linear accelerators. The TrueBeam's output factor varied less as a function of field size than the output factors for the previous models; this was especially true for the 6 MV. Photon beam data were found to be reproducible between different TrueBeam linear accelerators well within the accepted clinical tolerance of +/- 2%. The results indicate reproducibility in the TrueBeam machine head construction and a potential for beam matching between these types of linear accelerators. Photon beam data (6 MV and 15 MV) from the Trilogy and Clinac 2100 showed several similarities and some small variations when compared to the same data measured on the TrueBeam linear accelerator. The differences found could affect small field data and also very large field sizes in beam matching considerations between the TrueBeam and previous linear accelerator models from the same manufacturer, but should be within the accepted clinical tolerance for standard field sizes and standard treatments.