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Oshika R, Tachibana H, Seki K, Tachibana R, Moriya S, Sakae T. Technical Notes: Robustness of three-dimensional treatment and imaging isocenter testing using a new gel dosimeter and kilovoltage CBCT. J Appl Clin Med Phys 2024:e14439. [PMID: 39031633 DOI: 10.1002/acm2.14439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/16/2024] [Accepted: 05/19/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND Coincidence of the treatment and imaging isocenter coordinates is required to safely perform small-margin treatments, such as stereotactic radiosurgery of multiple brain metastases. A comprehensive and direct methodology for verifying concordance of kilovoltage cone-beam computed tomography (kV-CBCT) and treatment coordinates using an x-ray CT-based polymer gel dosimeter (dGEL) and onboard kV-CBCT was previously reported. Using this methodology, we tested the ability of a new commercially available x-ray CT-based polymer dGEL with a rapid response to provide efficient quality assurance (QA). PURPOSE The aim of this study was to evaluate the robustness of the three-dimensional geometric QA methodology using dGEL. METHODS The dGEL were commercially manufactured. The prescribed dose for each field was determined by visually identifying the 5, 10, and 20 Gy isodose lines. A linear accelerator was used to irradiate the gels with seven non-coplanar beams. An in-house analysis program was used to identify the beam axes and treatment isocenter in kV-CBCT coordinates by processing the pre- and post-irradiation CBCT images. The impact of the radiation dose on the test reproducibility was examined, and the detectability of an intentional geometric error was assessed. RESULTS The treatment isocenter was within 0.4 mm of the imaging isocenter for all radiation doses. The residual error of the test with the intentional error was within 0.2 mm. The analysis and image quality variations for a single dGEL introduced displacement errors less than 0.3 mm. CONCLUSIONS The test assessed the coincidence of treatment and kV-CBCT isocenter coordinates and detected errors with high robustness. Even for a 10 Gy dose, the test yielded results comparable with those obtained using higher radiation doses owing to the rapid response of the dGEL dosimeter.
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Affiliation(s)
- Riki Oshika
- Degree Programs in Comprehensive Human Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
- Radiation Safety and Quality Assurance division, National Cancer Center Hospital East, Chiba, Japan
| | - Hidenobu Tachibana
- Radiation Safety and Quality Assurance division, National Cancer Center Hospital East, Chiba, Japan
| | - Kazuya Seki
- Radiation Safety and Quality Assurance division, National Cancer Center Hospital East, Chiba, Japan
| | | | | | - Takeji Sakae
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Retif P, Djibo Sidikou A, Waltener A, Letellier R, Al Salah A, Pfletschinger E, Taesch F, Verrecchia-Ramos E, Michel X. Integrating cine EPID, dynamic delivery, and the off-axis Winston-Lutz test to enhance quality control in multiple brain metastasis stereotactic radiotherapy. Phys Med 2024; 120:103343. [PMID: 38547546 DOI: 10.1016/j.ejmp.2024.103343] [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: 10/23/2023] [Revised: 03/08/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE Stereotactic radiotherapy (SRT) has transformed cancer treatment, especially for brain metastases. Ensuring accurate SRT delivery is crucial, with the Winston-Lutz test being an important quality control tool. Off-axis Winston-Lutz (OAWL) tests are designed for accuracy assessment, but most are limited to fixed angles and hampered by local-field shifts caused by suboptimal Multi-Leaf Collimator (MLC) positioning. This study introduces a new OAWL approach for quality control in multi-brain-metastasis SRT. Utilizing cine Electronic Portal Imaging Device (EPID) images, it can be used with dynamic conformal arc (DCA) therapy. However, dynamic OAWL (DOAWL) is prone to more local-field shifts due to dynamic MLC movements. A two-step DOAWL is proposed: step 1 calculates local-field shifts using dynamic MLC movements in the beam-eye view data from the Treatment Planning System (TPS), while step 2 processes cine EPID images with an OAWL algorithm to isolate true deviations. METHODS Validation involved an anthropomorphic head phantom with metallic ball-bearings, Varian TrueBeam STx accelerator delivering six coplanar/non-coplanar DCA beams, cine EPID, and ImageJ's OAWL analysis algorithm. RESULTS Inherent local-field shifts ranged from 0.11 to 0.49 mm; corrected mean/max EPID-measured displacement was 0.34/1.03 mm. Few points exceeded 0.75/1.0-mm thresholds. CONCLUSIONS This two-step DOAWL test merges cine-EPID acquisitions, DCA, OAWL, and advanced analysis and offers effective quality control for multi-brain-metastasis SRT. Its routine implementation may also improve physicist knowledge of the treatment precision of their machines.
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Affiliation(s)
- Paul Retif
- Medical Physics Unit, CHR Metz-Thionville, Metz, France; Université de Lorraine, CNRS, CRAN, F-54000 Nancy, France.
| | | | | | | | | | | | - Fabian Taesch
- Medical Physics Unit, CHR Metz-Thionville, Metz, France
| | | | - Xavier Michel
- Radiation Therapy Department, CHR Metz-Thionville, Metz, France
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Li F, Mail N, Stefania diMayorca M, McCaw TJ, Ozhasoglu C, Lalonde R, Chang J, Huq MS. Single isocenter HyperArc treatment of multiple intracranial metastases: Targeting accuracy. J Appl Clin Med Phys 2024; 25:e14234. [PMID: 38059673 PMCID: PMC10795440 DOI: 10.1002/acm2.14234] [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: 05/01/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 12/08/2023] Open
Abstract
PURPOSE/OBJECTIVES (A) To examine the alignment accuracy of CBCT guidance for brain metastases with off centered isocenters, (B) to test dose delivery and targeting accuracy for single isocenter treatments with multiple brain metastases. We report the results of the end-to-end test for Truebeam stereotactic radiosurgery (SRS). MATERIALS/METHODS An anthropomorphic CT head phantom was drilled with five MOSFET inserts and two PTW Pinpoint chamber inserts. The phantom was simulated, planned, and delivered. For the purpose of comparing the accuracy of alignment, CBCTs were acquired with the isocenter centered and offset superiorly 8 cm, inferiorly 8 cm, anteriorly 7 cm, posteriorly 7 cm, and right 5 cm. There were six degrees of freedom corrections applied to the plans, as well as intentional rotational and translational errors for dose comparisons. Dose accuracy checks were performed with MOSFET and PTW Pinpoint chamber, and targeting accuracy was assessed with GafChromic films. RESULT (A) Compared to centered CBCT, off-centered CBCT scan showed some alignment errors, with a maximum difference of 0.6-degree pitch and 0.9 mm translation when the phantom was placed 8 cm inferior off center. (B) For the single isocenter plan, measured doses of the five MOSFET were 95%-100% of the planned dose, whereas the multiple isocenter plans were 96%-100%. With intentional setup errors of 1-degree pitch, doses were 97.1%-100.4% compared to the perfect setup. The same was found for the two pinpoint chamber readings with 1-degree rotation and 1 mm translation. (C) Targeting accuracy for targets at the isocenter is 0.67 mm, within the machine specification of 0.75 mm. Targeting accuracy for isocenters 6-12 cm away from the target is in the range 0.67-1.18 mm. CONCLUSION (A) Single isocenter HyperArc treatments for multiple brain metastases are feasible and targeting accuracy is clinically acceptable. (B) The vertex in a cranial scan is very important for proper alignment.
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Affiliation(s)
- Fang Li
- Radiation OncologyUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Noor Mail
- Radiation OncologyUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | | | - Travis J. McCaw
- Radiation OncologyUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Cihat Ozhasoglu
- Radiation OncologyUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Ronald Lalonde
- Radiation OncologyUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Jina Chang
- Radiation OncologyUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Mohammed Saiful Huq
- Radiation OncologyUniversity of Pittsburgh School of Medicine and UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
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Mangesius J, Seppi T, Ibrahim R, Fleischmann K, Ginestet A, Vorbach S, Hart T, Pointner M, Mangesius S, Ganswindt U. Dynamic intrafractional position monitoring with implanted fiducial markers for enhanced accuracy in radiotherapy of prostate cancer. Phys Eng Sci Med 2023; 46:1365-1374. [PMID: 37523057 PMCID: PMC10703977 DOI: 10.1007/s13246-023-01304-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION Recent advances in the radiation therapy of prostate cancer have brought a shift toward moderate- and ultra-hypofractionated treatment schedules. Reducing safety margins can broaden the therapeutic window in stereotactic treatments and alleviate concerns for toxicity in high dose-per-fraction treatment schedules. Management of intrafractional motion is a necessity for stereotactic body radiation therapy (SBRT). It can be achieved by performing intrafractional image guidance and position corrections. We evaluate the suitability of such a novel prostate motion management system and its potential benefit for treatment accuracy. METHODS Intrafractional IGRT was performed for 22 patients during 149 treatment sessions using repeated orthogonal kV-XR imaging of implanted fiducial markers with the ExacTrac Dynamic (EXTD) system. Position measurements were taken four times during each arc of the applied volumetric modulated arc therapy (VMAT). Position correction was performed if translational deviation exceeded 2 mm in any direction. RESULTS Of 677 single EXTD measurements, 20.6% exceeded the predefined threshold of 2 mm 3D deviation. Without intrafractional corrections, 39.4% of all individual measurements would exceed the threshold. The 3D accuracy could thus significantly be improved, reducing mean 3D shifts from 1.97 (± 1.44) mm to 1.39 (± 1.01) mm by performing intrafractional IGRT. In total, 34% of all treatment sessions required correction of intrafractional position shifts. CONCLUSION Monitoring of prostate motion using repeated intrafractional orthogonal kV-X-ray-based position measurements of implanted fiducial markers proved to be a reliable method to improve precision of stereotactic irradiations of the prostate. It can prevent unacceptable translation deviations in one third of all sessions.
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Affiliation(s)
- Julian Mangesius
- Department of Radiation Oncology, Medical University of Innsbruck, Univ.-Klinik für Strahlentherapie-Radioonkologie, Anichstrasse 35, Innsbruck, 6020, Austria.
| | - Thomas Seppi
- Department of Radiation Oncology, Medical University of Innsbruck, Univ.-Klinik für Strahlentherapie-Radioonkologie, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Ramine Ibrahim
- Department of Radiation Oncology, Medical University of Innsbruck, Univ.-Klinik für Strahlentherapie-Radioonkologie, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Katrin Fleischmann
- Department of Radiation Oncology, Medical University of Innsbruck, Univ.-Klinik für Strahlentherapie-Radioonkologie, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Angela Ginestet
- Department of Radiation Oncology, Medical University of Innsbruck, Univ.-Klinik für Strahlentherapie-Radioonkologie, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Samuel Vorbach
- Department of Radiation Oncology, Medical University of Innsbruck, Univ.-Klinik für Strahlentherapie-Radioonkologie, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Tilmann Hart
- Department of Radiation Oncology, Medical University of Innsbruck, Univ.-Klinik für Strahlentherapie-Radioonkologie, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Martin Pointner
- Department of Radiation Oncology, Medical University of Innsbruck, Univ.-Klinik für Strahlentherapie-Radioonkologie, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ute Ganswindt
- Department of Radiation Oncology, Medical University of Innsbruck, Univ.-Klinik für Strahlentherapie-Radioonkologie, Anichstrasse 35, Innsbruck, 6020, Austria
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Bolten JH, Dunst J, Siebert FA. Geometric accuracy in patient positioning for stereotactic radiotherapy of intracranial tumors. Phys Imaging Radiat Oncol 2023; 27:100461. [PMID: 37720460 PMCID: PMC10500024 DOI: 10.1016/j.phro.2023.100461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 09/19/2023] Open
Abstract
Background/Purpose This study determines and compares the geometric setup errors between stereoscopic x-ray and kilo-voltage cone beam CT (CBCT) in phantom tests on a linear accelerator (linac) for image-guided (IG) stereotactic radiotherapy of intracranial tumors. Additionally, dose-volume metrics in the target volumes of the setup errors of CBCT were evaluated. Materials/Methods A Winston-Lutz- and an anthropomorphic phantom were used. The mean deviation and root mean square error (RMSE) of CBCT and stereoscopic x-ray were compared. Dose-volume metrics of the planning target volume (PTV) and gross target volume (GTV) for CBCT were calculated. Results The RMSEs in the tests with the Winston-Lutz-Phantom were 0.3 mm, 1.1 mm and 0.3 mm for CBCT and 0.1 mm, 0,1 mm and <0.1 mm for stereoscopic x-ray in the translational dimensions (right-left, anterior-posterior and superior-inferior). The RMSEs in the tests with the anthropomorphic phantom were 0.3 mm, 0.2 mm and 0.1 mm for CBCT and 0.1 mm, 0,1 mm and <0.1 mm for stereoscopic x-ray. The effects on dose-volume metrics of the setup errors of CBCT on the GTV were within 1 % for all considered dose values. The effects on the PTV were within 5 % for all considered dose values. Conclusion Both IG systems provide high accuracy patient positioning within a submillimeter range. The phantom tests exposed a slightly higher accuracy of stereoscopic x-ray than CBCT. The comparison with other studies with a similar purpose emphasizes the importance of individual IG installation quality assurance.
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Affiliation(s)
- Jan-Hendrik Bolten
- Clinic of Radiotherapy (Radiooncology), University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Dunst
- Clinic of Radiotherapy (Radiooncology), University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Frank-André Siebert
- Clinic of Radiotherapy (Radiooncology), University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Lai J, Liu S, Liu J, Li X, Chen J, Jia Y, Lei K, Zhou L. Clinical Feasibility of Using Single-isocentre Non-coplanar Volumetric Modulated Arc Therapy Combined with Non-coplanar Cone Beam Computed Tomography in Hypofractionated Stereotactic Radiotherapy for Five or Fewer Multiple Intracranial Metastases. Clin Oncol (R Coll Radiol) 2023; 35:408-416. [PMID: 37002009 DOI: 10.1016/j.clon.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 01/08/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
AIMS To evaluate the clinical feasibility of single-isocentre non-coplanar volumetric modulated arc therapy (NC-VMAT) with non-coplanar cone beam computed tomography (NC-CBCT) in hypofractionated stereotactic radiotherapy (HSRT) for five or fewer multiple brain metastases. MATERIALS AND METHODS Ten patients with multiple brain metastases who underwent single-isocentre NC-VMAT HSRT with limited couch rotations (within ±45°) and NC-CBCT with a limited scanning range (150-200°) were included in the current analysis. Conventional single-isocentre coplanar VMAT (C-VMAT) plans were generated and compared with NC-VMAT plans. The intracranial response and toxicities of single-isocentre NC-VMAT HSRT were also evaluated. RESULTS Compared with C-VMAT, NC-VMAT generated better target conformity (P < 0.05), a lower gradient index (P < 0.05) and better normal brain tissue sparing, especially for volume ≥12 Gy, with a median reduction of 12.65 cm3. For 45° couch rotation, NC-CBCT produced sufficient image quality to differentiate bony anatomy, even with a 150° scanning range, which could be successfully used for patient set-up correction. After NC-CBCT, 57.1% of the measured non-coplanar set-up errors exceeded the threshold value. The median gamma passing rate of NC-VMAT was higher than that of C-VMAT plans (P < 0.05). The non-coplanar beam of NC-VMAT with NC-CBCT corrections exhibited superior gamma passing rate to that without NC-CBCT corrections. The intracranial objective response rate and disease control rate for all patients were 80% (8/10) and 100% (10/10), respectively, and the most common toxicities were headache (20%) and dizziness (20%). CONCLUSION NC-VMAT with limited couch rotation (within ±45°) combined with NC-CBCT with a limited scanning range (150-200°) markedly improves the plan quality and set-up accuracy in single-isocentre multiple-target HSRT.
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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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Perrett B, Ukath J, Horgan E, Noble C, Ramachandran P. A Framework for ExacTrac Dynamic Commissioning for Stereotactic Radiosurgery and Stereotactic Ablative Radiotherapy. J Med Phys 2022; 47:398-408. [PMID: 36908493 PMCID: PMC9997535 DOI: 10.4103/jmp.jmp_67_22] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 01/11/2023] Open
Abstract
This paper aims to provide guidance and a framework for commissioning tests and tolerances for the ExacTrac Dynamic image-guided and surface-guided radiotherapy (SGRT) system. ExacTrac Dynamic includes a stereoscopic X-ray system, a structured light projector, stereoscopic cameras, thermal camera for SGRT, and has the capability to track breath holds and internal markers. The system provides fast and accurate image guidance and intrafraction guidance for stereotactic radiosurgery and stereotactic ablative radiotherapy. ExacTrac Dynamic was commissioned on a recently installed Elekta Versa HD. Commissioning tests are described including safety, isocenter calibration, dosimetry, image quality, data transfer, SGRT stability, SGRT localization, gating, fusion, implanted markers, breath hold, and end-to-end testing. Custom phantom designs have been implemented for assessment of the deep inspiration breath-hold workflow, the implanted markers workflow, and for gating tests where remote-controlled movement of a phantom is required. Commissioning tests were all found to be in tolerance, with maximum translational and rotational deviations in SGRT of 0.3 mm and 0.4°, respectively, and X-ray image fusion reproducibility standard deviation of 0.08 mm. Tolerances were based on published documents and upon the performance characteristics of the system as specified by the vendor. The unique configuration of ExacTrac Dynamic requires the end user to design commissioning tests that validate the system for use in the clinical implementation adopted in the department. As there are multiple customizable workflows available, tests should be designed around these workflows, and can be ongoing as workflows are progressively introduced into departmental procedures.
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Affiliation(s)
- Ben Perrett
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Jaysree Ukath
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Emma Horgan
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Chris Noble
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Prabhakar Ramachandran
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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Da Silva Mendes V, Reiner M, Huang L, Reitz D, Straub K, Corradini S, Niyazi M, Belka C, Kurz C, Landry G, Freislederer P. ExacTrac Dynamic workflow evaluation: Combined surface optical/thermal imaging and X-ray positioning. J Appl Clin Med Phys 2022; 23:e13754. [PMID: 36001389 DOI: 10.1002/acm2.13754] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 07/07/2022] [Accepted: 07/19/2022] [Indexed: 11/09/2022] Open
Abstract
In modern radiotherapy (RT), especially for stereotactic radiotherapy or stereotactic radiosurgery treatments, image guidance is essential. Recently, the ExacTrac Dynamic (EXTD) system, a new combined surface-guided RT and image-guided RT (IGRT) system for patient positioning, monitoring, and tumor targeting, was introduced in clinical practice. The purpose of this study was to provide more information about the geometric accuracy of EXTD and its workflow in a clinical environment. The surface optical/thermal- and the stereoscopic X-ray imaging positioning systems of EXTD was evaluated and compared to cone-beam computed tomography (CBCT). Additionally, the congruence with the radiation isocenter was tested. A Winston Lutz test was executed several times over 1 year, and repeated end-to-end positioning tests were performed. The magnitude of the displacements between all systems, CBCT, stereoscopic X-ray, optical-surface imaging, and MV portal imaging was within the submillimeter range, suggesting that the image guidance provided by EXTD is accurate at any couch angle. Additionally, results from the evaluation of 14 patients with intracranial tumors treated with open-face masks are reported, and limited differences with a maximum of 0.02 mm between optical/thermal- and stereoscopic X-ray imaging were found. As the optical/thermal positioning system showed a comparable accuracy to other IGRT systems, and due to its constant monitoring capability, it can be an efficient tool for detecting intra-fractional motion and for real-time tracking of the surface position during RT.
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Affiliation(s)
| | - Michael Reiner
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Lili Huang
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Reitz
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Katrin Straub
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Philipp Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
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Tsuruta Y, Nakamura M, Nakata M, Hirashima H, Zhou D, Uto M, Takehana K, Fujimoto T, Mizowaki T. Evaluation of correlation between intrafractional residual setup errors and accumulation of delivered dose distributions in single isocenter volumetric modulated arc therapy for multiple brain metastases. Phys Med 2022; 98:45-52. [DOI: 10.1016/j.ejmp.2022.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/30/2022] [Accepted: 04/22/2022] [Indexed: 11/25/2022] Open
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