Quantifying the gantry sag on linear accelerators and introducing an MLC-based compensation strategy

Purpose: Gantry sag is one of the well-known sources of mechanical imperfections that compromise the spatial accuracy of radiation dose delivery. The objectives of this study were to quantify the gantry sag on multiple linear accelerators (linacs), to investigate a multileaf collimator (MLC)-based strategy to compensate for gantry sag, and to verify the gantry sag and its compensation with film measurements. Methods: The authors used the Winston-Lutz method to measure gantry sag on three Varian linacs. A ball bearing phantom was imaged with megavolt radiation fields at 10° gantry angle intervals. The images recorded with an electronic portal imaging device were analyzed to derive the radiation isocenter and the gantry sag, that is, the superior-inferior wobble of the radiation field center, as a function of the gantry angle. The authors then attempted to compensate for the gantry sag by applying a gantry angle-specific correction to the MLC leaf positions. The gantry sag and its compensation were independently verified using film measurements. Results: Gantry sag was reproducible over a six-month measurement period. The maximum gantry sag was found to vary from 0.7 to 1.0 mm, depending on the linac and the collimator angle. The radiation field center moved inferiorly (i.e., away from the gantry) when the gantry was rotated from 0° to 180°. After the MLC leaf position compensation was applied at 90° collimator angle, the maximum gantry sag was reduced to <0.2 mm. The film measurements at gantry angles of 0° and 180° verified the inferior shift of the radiation fields and the effectiveness of MLC compensation. Conclusions: The results indicate that gantry sag on a linac can be quantitatively measured using a simple phantom and an electronic portal imaging device. Reduction of gantry sag is feasible by applying a gantry angle-specific correction to MLC leaf positions at 90° collimator angle.