Validation of MLC-based linac radiosurgery for trigeminal neuralgia.

This study details a validation process for linear accelerator-based treatment of trigeminal neuralgia using HD-MLC field collimation. Nine trigeminal neuralgia treatment plans utilizing HD-MLC were selected for absolute dose measurement at isocenter using a commercial scintillating detector in an anthropomorphic phantom. Four plans were chosen for film dosimetry measurements in each of the three principal planes to assess spatial dose distribution agreement with the treatment planning system. Additionally, trajectory log analysis for each treatment field in the nine cases was performed to assess mechanical positioning accuracy of the MLC system during delivery. Scintillator and film measurements both revealed mean dose agreement at isocenter of better than 3% while FWHM of the 2D dose distribution in each plane showed agreement between plan and measurement within 0.2 mm. Analysis of log files revealed a maximum MLC leaf positioning error of 0.04 mm across 178 treatment fields. In conjunction with a quality-controlled treatment delivery methodology, an appropriately commissioned treatment planning system can be used for accurate and clinically appropriate design of trigeminal neuralgia treatment plans utilizing HD-MLC.