The impact of corrected field output factors based on IAEA/AAPM code of practice on small‐field dosimetry to the calculated monitor unit in eclipse™ treatment planning system

The objective of this study was to investigate the effect of field output factors (FOFs) according to the current protocol for small‐field dosimetry in conjunction to treatment planning system (TPS) commissioning. The calculated monitor unit (MU) for intensity‐modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans in Eclipse™ TPS were observed. Micro ion chamber (0.01 CC) (CC01), photon field diode (shielded diode) (PFD), and electron field diode (unshielded diode) (EFD) were used to measure percentage depth doses, beam profiles, and FOFs from 1 × 1 cm(2) to 10 × 10 cm(2) field sizes of 6 MV photon beams. CC01 illustrated the highest percentage depth doses at 10 cm depth while EFD exhibited the lowest with the difference of 1.6% at 1 × 1 cm(2). CC01 also produced slightly broader penumbra, the difference with other detectors was within 1 mm. For uncorrected FOF of three detectors, the maximum percent standard deviation (%SD) was 5.4% at 1 × 1 cm(2) field size. When the correction factors were applied, this value dropped to 2.7%. For the calculated MU in symmetric field sizes, beam commissioning group from uncorrected FOF demonstrated maximum %SD of 6.0% at 1 × 1 cm(2) field size. This value decreased to 2.2% when the corrected FOF was integrated. For the calculated MU in IMRT‐SRS plans, the impact of corrected FOF reduced the maximum %SD from 6.0% to 2.5% in planning target volume (PTV) less than 0.5 cm(3). Beam commissioning using corrected FOF also decreased %SD for VMAT‐SRS plans, although it was less pronounced in comparison to other treatment planning techniques, since the %SD remained less than 2%. The use of FOFs based on IAEA/AAPM TRS 483 has been proven in this research to reduce the discrepancy of calculated MU among three beam commissioning datasets in Eclipse™ TPS. The dose measurement of both symmetric field and clinical cases comparing to the calculation illustrated the dependence of the types of detector commissioning and the algorithm of the treatment planning for small field size.