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Xu Q, Vinogradskiy Y, Grimm J, Nie W, Dupre P, Chawla AK, Bajaj G, Yang H, LaCouture T, Fan J. Evaluation of a novel patient-specific quality assurance phantom for robotic single-isocentre, multiple-target stereotactic radiosurgery, and stereotactic radiotherapy. Br J Radiol 2024; 97:660-667. [PMID: 38401536 PMCID: PMC11027335 DOI: 10.1093/bjr/tqae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/26/2023] [Accepted: 01/11/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVES To evaluate patient-specific quality assurance (PSQA) of 3 targets in a single delivery using a novel film-based phantom. METHODS The phantom was designed to rotate freely as a sphere and could measure 3 targets with film in a single delivery. After identifying the coordinates of 3 targets in the skull, the rotation angles about the equator and meridian were computed for optimal phantom setup, ensuring the film plane intersected the 3 targets. The plans were delivered on the CyberKnife system using fiducial tracking. The irradiated films were scanned and processed. All films were analysed using 3 gamma criteria. RESULTS Fifteen CyberKnife test plans with 3 different modalities were delivered on the phantom. Both automatic and marker-based registration methods were applied when registering the irradiated film and dose plane. Gamma analysis was performed using a 3%/1 mm, 2%/1 mm, and 1%/1 mm criteria with a 10% threshold. For the automatic registration method, the passing rates were 98.2% ± 1.9%, 94.2% ± 3.7%, and 80.9% ± 6.3%, respectively. For the marker-based registration approach, the passing rates were 96.4% ± 2.7%, 91.7% ± 4.3%, and 78.4% ± 6.2%, respectively. CONCLUSIONS A novel spherical phantom was evaluated for the CyberKnife system and achieved acceptable PSQA passing rates using TG218 recommendations. The phantom can measure true-composite dose and offers high-resolution results for PSQA, making it a valuable device for robotic radiosurgery. ADVANCES IN KNOWLEDGE This is the first study on PSQA of 3 targets concurrently on the CyberKnife system.
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Affiliation(s)
- Qianyi Xu
- Department of Advanced Radiation Oncology and Proton Therapy, Inova Schar Cancer Institute, Fairfax, VA 22031, United States
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Yevgeniy Vinogradskiy
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Jimm Grimm
- Department of Radiation Oncology, Wellstar Health System, Marietta, GA 30060, United States
| | - Wei Nie
- Department of Advanced Radiation Oncology and Proton Therapy, Inova Schar Cancer Institute, Fairfax, VA 22031, United States
| | - Pamela Dupre
- Department of Advanced Radiation Oncology and Proton Therapy, Inova Schar Cancer Institute, Fairfax, VA 22031, United States
| | - Ashish K Chawla
- Department of Advanced Radiation Oncology and Proton Therapy, Inova Schar Cancer Institute, Fairfax, VA 22031, United States
| | - Gopal Bajaj
- Department of Advanced Radiation Oncology and Proton Therapy, Inova Schar Cancer Institute, Fairfax, VA 22031, United States
| | - Haihua Yang
- Department of Radiation Oncology, Taizhou Hospital, Zhejiang 317000, China
| | - Tamara LaCouture
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Jiajin Fan
- Department of Advanced Radiation Oncology and Proton Therapy, Inova Schar Cancer Institute, Fairfax, VA 22031, United States
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Kido T, Ono T, Nakamura M, Ishihara Y, Itoh H, Matsugi K, Yoshimoto A, Kishigami Y, Mizowaki T. Development and multi-institutional evaluation of a new phantom for verifying beam-positioning errors at off-isocenter positions. Phys Med 2023; 112:102645. [PMID: 37478576 DOI: 10.1016/j.ejmp.2023.102645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/10/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023] Open
Abstract
PURPOSE Single-isocenter stereotactic radiotherapy for multiple brain metastases requires highly accurate treatment delivery at off-isocenter positions (off-iso). This study aimed to verify the beam-positioning errors at off-iso using a newly developed phantom tested at multiple institutions. METHODS The off-iso phantom comprised five stainless-steel balls with a 3-mm diameter placed at the center and at four peripheral positions on a diagonal line. Each ball was placed 3.5 cm apart along each of the three axes. Two patterns of the phantom setup were defined as 0° and 90° phantom rotations to evaluate the beam-positioning error, which is the distance between the center of the ball and the irradiated field on the electronic portal imaging device. Furthermore, the reproducibility of the beam-positioning errors was verified by evaluating their standard deviation (SD) at a single institution, which included five measurements for two treatment machines. The errors were evaluated at multiple institutions using eight treatment machines. RESULTS The measurement time from setup to image acquisition was approximately 20 min for two patterns. The SD of the beam-positioning errors in the reproducibility tests was 0.41 mm. In the multi-institutional evaluation, the beam-positioning error at the isocenter position was within 1.00 mm of the AAPM-RSS tolerance, with the exception of two linacs. The largest beam-positioning error (1.36 mm) was observed 7.5 cm away from the isocenter in three directions at a gantry angle of 180°. CONCLUSIONS The developed phantom can be applied as a new tool for establishing beam-positioning errors in single-isocenter stereotactic radiotherapy at off-isocenter positions.
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Affiliation(s)
- Takahisa Kido
- Department of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohiro Ono
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University, Kyoto, Japan
| | - Mitsuhiro Nakamura
- Department of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Yoshitomo Ishihara
- Department of Radiation Oncology, Division of Medical Physics, Japanese Red Cross Wakayama Medical Center, Japan
| | - Hiroyuki Itoh
- Department of Technology, Division of Medical Technology, Medical Physics Office, Yamatotakada Municipal Hospital, Japan
| | | | | | - Yukako Kishigami
- Department of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University, Kyoto, Japan
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Baltz GC, Manigold R, Seier R, Kirsner SM. A hybrid method to improve efficiency of patient specific SRS and SBRT QA using 3D secondary dose verification. J Appl Clin Med Phys 2023; 24:e13858. [PMID: 36583305 PMCID: PMC10018667 DOI: 10.1002/acm2.13858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/25/2022] [Accepted: 11/20/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Patient Specific QA (PSQA) by direct phantom measurement for all intensity modulated radiation therapy (IMRT) cases is labor intensive and an inefficient use of the Medical Physicist's time. The purpose of this work was to develop a hybrid quality assurance (QA) technique utilizing 3D dose verification as a screening tool to determine if a measurement is necessary. METHODS This study utilized Sun Nuclear DoseCHECK (DC), a 3D secondary verification software, and Fraction 0, a trajectory log IMRT QA software. Twenty-two Lung stereotactic body radiation therapy (SBRT) and thirty single isocentre multi-lesion SRS (MLSRS) plans were retrospectively analysed in DC. Agreement of DC and the TPS dose for selected dosimetric criteria was recorded. Calculated 95% confidence limits (CL) were used to establish action limits. All cases were delivered and measured using the Sun Nuclear stereotactic radiosurgery (SRS) MapCheck. Trajectory logs of the delivery were used to calculate Fraction 0 results for the same criteria calculated by DC. Correlation of DC and Fraction 0 results were calculated. Phantom measured QA was compared to Fraction 0 QA results for the cases which had DC criteria action limits exceeded. RESULTS Correlation of DC and Fraction 0 results were excellent, demonstrating the same action limits could be used for both and DC can predict Fraction 0 results. Based on the calculated action limits, zero lung SBRT cases and six MLSRS cases were identified as requiring a measurement. All plans that passed the DC screening had a passing measurement based PSQA and agreed with Fraction 0 results. CONCLUSION Using 95% CL action limits of dosimetric criteria, a 3D secondary dose verification can be used to determine if a measurement is required for PSQA. This method is efficient for it is part of the normal clinical workflow when verifying any clinical treatment. In addition, it can drastically reduce the number of measurements needed for PSQA.
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Affiliation(s)
- Garrett C Baltz
- Scripps MD Anderson Cancer Center, San Diego, California, USA
| | - Remy Manigold
- Scripps MD Anderson Cancer Center, San Diego, California, USA
| | - Richard Seier
- Scripps MD Anderson Cancer Center, San Diego, California, USA
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Small-field dosimetry with detector-specific output correction factor for single-isocenter stereotactic radiotherapy of single and multiple brain metastases. Radiol Phys Technol 2023; 16:10-19. [PMID: 36272022 DOI: 10.1007/s12194-022-00684-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 10/24/2022]
Abstract
Recently, the International Atomic Energy Agency and the American Association of Physicists in Medicine reported correction factors (CFs) for detector-response variation considering the uncertainty in detector readings in small-field dosimetry. In this study, the effect of CFs on small-field dosimetry measurements was evaluated for single-isocenter stereotactic radiotherapy for brain metastases. The output factors (OPFs) were measured with and without CFs in a water-equivalent sphere phantom using TrueBeam with a flattening-filter-free energy of 10 MV. Five detectors were used in a perpendicular orientation: CC01, 3D pinpoint ionization chambers, unshielded SFD detector, shielded EDGE detector, and microDiamond detector. First, the square-field sizes were set to 5-100 mm using a multi-leaf collimator (MLC) field. The OPFs were evaluated in the presence and absence of CFs. Second, single-isocenter stereotactic irradiation was performed on 22 brain metastases in 15 patients following dynamic conformal arc (DCA) treatment. The equivalent field size was calculated using the MLC aperture for each planning target volume. For the OPFs, the mean deviations from the median of the doses measured with detectors other than the CC01 for square-field sizes larger than 10 mm were within ± 4.3% of the median without CFs, and ± 3.3% with CFs. For DCA plans, the deviations without and with CFs were - 2.3 ± 1.9% and - 4.8 ± 2.4% for CC01, - 1.1 ± 3.0% and 1.0 ± 1.6% for 3D pinpoint, 8.8 ± 3.0% and 2.9 ± 2.8% for SFD, - 3.1 ± 3.0% and - 13.5 ± 4.0% for EDGE, and 8.9 ± 2.1% and 0.8 ± 1.9% for microDiamond. This feasibility study confirmed that the deviation of the detectors can be reduced using an appropriate detector with CFs.
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Hayashi N, Kurata S, Saito Y, Ogawa S, Yasui K. Simple quality assurance based on filtered back projection for geometrical/irradiation accuracy in single-isocenter multiple-target stereotactic radiotherapy. Radiol Phys Technol 2022; 15:409-416. [PMID: 36261754 DOI: 10.1007/s12194-022-00683-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 10/24/2022]
Abstract
In single-isocenter multiple-target stereotactic radiotherapy (SIMT-SRT), it is difficult to evaluate both the geometrical accuracy and absorbed dose measurement when irradiating off-isocenter targets. This study aimed to develop a simple quality assurance (QA) method to evaluate off-isocenter irradiation position accuracy in SIMT-SRT and compare its feasibility with that of a commercial device. First, we created two types of inserts and metallic balls with a diameter of 5 mm to be inserted into a commercially available phantom (SIMT phantom). Second, we developed a dedicated analysis software using Python for the Winston-Lutz test (WLT). Third, an image processing software, including the filtered back-projection algorithm, was developed to analyze the images obtained using an electronic portal imaging device (EPID). Fourth, the feasibility of our method was evaluated by comparing it with the results of WLT using two commercially available phantoms: WL-QA and MultiMet-WL cubes. Notably, 92% of the results in one-dimensional deviations were within 0.26 mm (EPID pixel width). The correlation coefficients were 0.52, 0.92, and 0.96 in the left-right, superior-inferior, and anterior-posterior directions, respectively. In the WLT, a maximum two-dimensional deviation of 0.70 mm was detected in our method, while the deviation in the other method was within 0.5 mm. The advantage of our method is that it can evaluate the geometrical accuracy at any gantry angle during dynamic rotation irradiation using a filtered back-projection algorithm, even if the target is located off the isocenter. Our method can perform WLT at arbitrary positions and is suitable for the QA of dynamic rotation irradiation using an EPID.
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Affiliation(s)
- Naoki Hayashi
- School of Medical Sciences, Fujita Health University, Toyoake, Aichi, Japan.
| | - Shun Kurata
- School of Medical Sciences, Fujita Health University, Toyoake, Aichi, Japan.,Department of Radiology, Kindai University Hospital, Osakasayama, Osaka, Japan
| | - Yasunori Saito
- School of Medical Sciences, Fujita Health University, Toyoake, Aichi, Japan.,Department of Radiology, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Shuta Ogawa
- Department of Radiology, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Keisuke Yasui
- School of Medical Sciences, Fujita Health University, Toyoake, Aichi, Japan
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Development of an x-ray-opaque-marker system for quantitative phantom positioning in patient-specific quality assurance. Phys Med 2021; 91:121-130. [PMID: 34785490 DOI: 10.1016/j.ejmp.2021.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/10/2021] [Accepted: 10/30/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE We developed an x-ray-opaque-marker (XOM) system with inserted fiducial markers for patient-specific quality assurance (QA) in CyberKnife (Accuray) and a general-purpose linear accelerator (linac). The XOM system can be easily inserted or removed from the existing patient-specific QA phantom. Our study aimed to assess the utility of the XOM system by evaluating the recognition accuracy of the phantom position error and estimating the dose perturbation around a marker. METHODS The recognition accuracy of the phantom position error was evaluated by comparing the known error values of the phantom position with the values measured by matching the images with target locating system (TLS; Accuray) and on-board imager (OBI; Varian). The dose perturbation was evaluated for 6 and 10 MV single-photon beams through experimental measurements and Monte Carlo simulations. RESULTS The root mean squares (RMSs) of the residual position errors for the recognition accuracy evaluation in translations were 0.07 mm with TLS and 0.30 mm with OBI, and those in rotations were 0.13° with TLS and 0.15° with OBI. The dose perturbation was observed within 1.5 mm for 6 MV and 2.0 mm for 10 MV from the marker. CONCLUSIONS Sufficient recognition accuracy of the phantom position error was achieved using our system. It is unnecessary to consider the dose perturbation in actual patient-specific QA. We concluded that the XOM system can be utilized to ensure quantitative and accurate phantom positioning in patient-specific QA with CyberKnife and a general-purpose linac.
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