Monitor unit verification for Varian TrueBeam VMAT plans using Monte Carlo calculations and phase space data

To use the open-source Monte Carlo (MC) software calculations for TPS monitor unit verification of VMAT plans, delivered with the Varian TrueBeam linear accelerator, and compare the results with a commercial software product, following the guidelines set in AAPM Task Group 219. The TrueBeam is modeled in EGSnrc using the Varian-provided phase-space files. Thirteen VMAT TrueBeam treatment plans representing various anatomical regions were evaluated, comprising 37 treatment arcs. VMAT plans simulations were performed on a computing cluster, using 10⁷ -10⁹ particle histories per arc. Point dose differences at five reference points per arc were compared between Eclipse, MC, and the commercial software, MUCheck. MC simulation with 5 × 10⁷ histories per arc offered good agreement with Eclipse and a reasonable average calculation time of 9-18 min per full plan. The average absolute difference was 3.0%, with only 22% of all points exceeding the 5% action limit. In contrast, the MUCheck average absolute difference was 8.4%, with 60% of points exceeding the 5% dose difference. Lung plans were particularly problematic for MUCheck, with an average absolute difference of approximately 16%. Our EGSnrc-based MC framework can be used for the MU verification of VMAT plans calculated for the Varian TrueBeam; furthermore, our phase space approach can be adapted to other treatment devices by using appropriate phase space files. The use of 5 × 10⁷ histories consistently satisfied the 5% action limit across all plan types for the majority of points, performing significantly better than a commercial MU verification system, MUCheck. As faster processors and cloud computing facilities become even more widely available, this approach can be readily implemented in clinical settings.