Intensity modulated radiation therapy (IMRT) is a highly accurate technique that is usually implemented in either dy-namic or step-and-shoot fashion with many segments each having low monitor units (MUs). The present study evalu-ated the effects of beam startup characteristics on the dose delivery accuracy for each segment at low MUs for step-and-shoot IMRT with an Elekta Precise accelerator at the highest dose rates. We used a two-dimensional semi-conductor detector for the dose measurements. The field size of each segment was assumed to be 20 × 20 cm2 and each segment was set to deliver 1- 10 MUs. Our results show a variation in dose delivery accuracy between segments for the same IMRT beam, which can be attributed to the beam startup characteristics. This variability is attributed to the changes in the transient changes in the temperatures of the electron gun filament and the magnetron. That is, the tran-sient increase in the temperature of the filament leads to increasing doses with time and that of the magnetron leads to decreasing doses with time during the first few MUs
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