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Title: SU-E-J-48: Imaging Origin-Radiation Isocenter Coincidence for Linac-Based SRS with Novalis Tx

Abstract

Purpose To implement and evaluate an image-based Winston-Lutz (WL) test to measure the displacement between ExacTrac imaging origin and radiation isocenter on a Novalis Tx system using RIT V6.2 software analysis tools. Displacement between imaging and radiation isocenters was tracked over time. The method was applied for cone-based and MLC-based WL tests. Methods The Brainlab Winston-Lutz phantom was aligned to room lasers. The ExacTrac imaging system was then used to detect the Winston- Lutz phantom and obtain the displacement between the center of the phantom and the imaging origin. EPID images of the phantom were obtained at various gantry and couch angles and analyzed with RIT calculating the phantom center to radiation isocenter displacement. The RIT and Exactrac displacements were combined to calculate the displacement between imaging origin and radiation isocenter. Results were tracked over time. Results Mean displacements between ExacTrac origin and radiation isocenter were: VRT: −0.1mm ± 0.3mm, LNG: 0.5mm ± 0.2mm, LAT: 0.2mm ± 0.2mm (vector magnitude of 0.7 ± 0.2mm). Radiation isocenter was characterized by the mean of the standard deviations of the WL phantom displacements: σVRT: 0.2mm, σLNG: 0.4mm, σLAT: 0.6mm. The linac couch base was serviced to reduce couch walkout. This reduced σLAT tomore » 0.2mm. These measurements established a new baseline of radiation isocenter-imaging origin coincidence. Conclusion The image-based WL test has ensured submillimeter localization accuracy using the ExacTrac imaging system. Standard deviations of ExacTrac-radiation isocenter displacements indicate that average agreement within 0.3mm is possible in each axis. This WL test is a departure from the tradiational WL in that imaging origin/radiation isocenter agreement is the end goal not lasers/radiation isocenter.« less

Authors:
; ;  [1]
  1. Anne Arundel Medical Center, Annapolis, MD (United States)
Publication Date:
OSTI Identifier:
22494071
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 42; Journal Issue: 6; Other Information: (c) 2015 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; ACCURACY; BIOMEDICAL RADIOGRAPHY; COMPUTER CODES; IMAGES; LASER RADIATION; LINEAR ACCELERATORS; PARTICLE TRACKS; PHANTOMS

Citation Formats

Geraghty, C, Workie, D, and Hasson, B. SU-E-J-48: Imaging Origin-Radiation Isocenter Coincidence for Linac-Based SRS with Novalis Tx. United States: N. p., 2015. Web. doi:10.1118/1.4924135.
Geraghty, C, Workie, D, & Hasson, B. SU-E-J-48: Imaging Origin-Radiation Isocenter Coincidence for Linac-Based SRS with Novalis Tx. United States. doi:10.1118/1.4924135.
Geraghty, C, Workie, D, and Hasson, B. Mon . "SU-E-J-48: Imaging Origin-Radiation Isocenter Coincidence for Linac-Based SRS with Novalis Tx". United States. doi:10.1118/1.4924135.
@article{osti_22494071,
title = {SU-E-J-48: Imaging Origin-Radiation Isocenter Coincidence for Linac-Based SRS with Novalis Tx},
author = {Geraghty, C and Workie, D and Hasson, B},
abstractNote = {Purpose To implement and evaluate an image-based Winston-Lutz (WL) test to measure the displacement between ExacTrac imaging origin and radiation isocenter on a Novalis Tx system using RIT V6.2 software analysis tools. Displacement between imaging and radiation isocenters was tracked over time. The method was applied for cone-based and MLC-based WL tests. Methods The Brainlab Winston-Lutz phantom was aligned to room lasers. The ExacTrac imaging system was then used to detect the Winston- Lutz phantom and obtain the displacement between the center of the phantom and the imaging origin. EPID images of the phantom were obtained at various gantry and couch angles and analyzed with RIT calculating the phantom center to radiation isocenter displacement. The RIT and Exactrac displacements were combined to calculate the displacement between imaging origin and radiation isocenter. Results were tracked over time. Results Mean displacements between ExacTrac origin and radiation isocenter were: VRT: −0.1mm ± 0.3mm, LNG: 0.5mm ± 0.2mm, LAT: 0.2mm ± 0.2mm (vector magnitude of 0.7 ± 0.2mm). Radiation isocenter was characterized by the mean of the standard deviations of the WL phantom displacements: σVRT: 0.2mm, σLNG: 0.4mm, σLAT: 0.6mm. The linac couch base was serviced to reduce couch walkout. This reduced σLAT to 0.2mm. These measurements established a new baseline of radiation isocenter-imaging origin coincidence. Conclusion The image-based WL test has ensured submillimeter localization accuracy using the ExacTrac imaging system. Standard deviations of ExacTrac-radiation isocenter displacements indicate that average agreement within 0.3mm is possible in each axis. This WL test is a departure from the tradiational WL in that imaging origin/radiation isocenter agreement is the end goal not lasers/radiation isocenter.},
doi = {10.1118/1.4924135},
journal = {Medical Physics},
number = 6,
volume = 42,
place = {United States},
year = {Mon Jun 15 00:00:00 EDT 2015},
month = {Mon Jun 15 00:00:00 EDT 2015}
}
  • Purpose: To develop a new method to minimize deviation of linac x-ray beams from the centroid of the volumetric radiation isocenter for all combinations of gantry and table angle. Methods: A set of ball-bearing (Winston-Lutz) images was used to determine the gantry radiation isocenter as the midrange of deviation values. Deviations in the cross-plane direction were minimized by calibration of MLC leaf position offset, and by adjusting beam position steering for each energy. Special attention was also paid to matching the absolute position of isocenter across all energies by adjusting position steering in the gun-target axis. Displacement of table axismore » from the gantry isocenter, and recommended table axis adjustment for contemporary Elekta linacs, was also determined. Eight images were used to characterize the volumetric isocenter for the full range of gantry and table rotations available. Tabulation of deviation for each beam was used to test compliance with isocenter tolerance. Results: Four contemporary Elekta linacs were evaluated and the radius in the gun-target axis of the radiation isocenter was 0.5 to 0.7 mm. After beam steering adjustment, the radius in the cross-plane direction was typically 0.2 to 0.4 mm. Position matching between energies can be reduced to 0.28 mm. Maximum total deviation was 0.68 to 1.07 mm, depending primarily on the effect of systematic table axis wobble with rotation. Conclusion: This new method effectively facilitates minimization of deviation between beam center and target position. The test, which requires a few minutes to perform, can be easily incorporated into a routine machine QA program. A tighter radiation isocenter for contemporary Elekta linacs would require reducing the effect of gantry arm flex and/or table axis wobble that are the two main components of deviation from the designated isocenter point.« less
  • Purpose: Orthogonal kV image pairs are used for target localization when fiducial markers are implanted. CBCT is used to verify cone SRS setup. Therefore it is necessary to evaluate the isocenter congruence between radiation fields and kV imaging center. This study used a simple method to evaluate the isocenter congruence, and compared the results for MLC and cone fields on two different Linacs. Methods: Varian OBI block was attached on the couch. It has a central 1mm BB with markers on three surfaces to align with laser. KV and MV images were taken at four cardinal angles. A 3x3cm2 MLCmore » field and a 20mm cone field were irradiated respectively. On each kV image, the distance from BB center to the kV graticule center were measured. On the MV image of MLC field, the center of radiation field was determined manually, while for cone field, the Varian AM maintenance software was used to analyze the distance between BB and radiation field. The subtraction of the two distances gives the discrepancy between kV and radiation centers. Each procedure was repeated on five days at Trilogy and TrueBeam respectively. Results: The maximum discrepancy was found in the longitudinal direction at 180° gantry angel. It was 1.5±0.1mm for Trilogy and 0.6±0.1mm for TrueBeam. For Trilogy, although radiation center wobbled only 0.7mm and image center wobbled 0.8mm, they wobbled to the opposite direction. KV Pair using gantry 180° should be avoided in this case. Cone vs. kV isocenter has less discrepancy than MLC for Trilogy. Conclusion: Radiation isocenter of MLC and cone field is different, so is between Trilogy and TrueBeam. The method is simple and reproducible to check kV and radiation isocenter congruence.« less
  • Purpose: To compare the plan quality of linear accelerator (linac)-based stereotactic radiosurgery (SRS) using single-isocenter volumetric arc therapy (SI-VMAT), restricted single-isocenter dynamic-arc (RSI-DARC), and multi-isocenter DARC (MI-DARC) techniques. Methods: Fifteen SRS cases were randomly selected and re-planned using the SI-VMAT (Pinnacle), RSI-DARC (iPlanNet) and MI-DARC (iPlanNet). The number of planning target volumes (PTVs) for each plan ranged from 1 to 6. For SI-VMAT, a single isocenter and 3-4 VMAT beams are used for all PTVs, while for MI-DARC, each PTV has its own isocetner with 3 DARC beams. RSI-DARC uses one isocnter with 3-6 DARC beams to irradiate all PTVsmore » within 2.5-cm radius. Both SI-DARC and RSI-DARC plans were optimized manually. The prescription dose was 20 Gy to each PTV. The maximal dose was 25 Gy for RSI-DARC and MI-DARC, but could not be controlled for SI-VMAT due to the nature of VMAT planning. Plan quality indexes including PTV coverage, mean dose of PTV (PTVmean) and tissue (Tmean), V12Gy, conformity index (CI), and V10Gy/VPTV were calculated and compared. Results: Full PTV coverage was achieved for all three techniques. Using the MI-DARC plans as the gold standard, the PTVmean of the SI-VMAT plans was 12.5%±8.3% (mean±standard deviation) higher, in comparison to 0.7%±1.4% for the RSI-DARC plans. Similar trend was observed for other indexes including V12Gy (39.4%±27.3% vs. 9.3%±7.8%), Tmean (35.0%±26.8% vs. 2.8%±3.4%), and V10Gy/VPTV (42.2%±31.5% vs. 9.9%±8.2%). CI is comparable (6.2%±14.2% vs. 6.3%±7.2%). Assuming the treatment time is proportional to the number of isocenters, the reduction of the treatment time in comparison to MI-DARC was 70% for SI-VMAT and 42% for RSI-DARC. Conclusion: Although the SI-VMAT can save a considerable amount of treatment time, the plan indexes also significantly deviates from the gold standard, MI-DARC. RSI-DARC, on the other hand, provides a good compromise between the treatment time and plan quality.« less
  • Purpose: To develop a practical device having sufficient accuracy for daily QA tests of accelerators used for SRS and SBRT. Methods: The UAB (Universal Alignment Ball) consists of a 6.35 mm (1/4 inch) diameter tungsten sphere located concentrically within a 25.4 mm (1 inch) diameter acrylic plastic (PMMA) sphere. The spheres are embedded in polystyrene foam, which, in turn, is surrounded by a cylindrical PMMA shell. The UAB is placed on the couch and aligned with wall lasers according to marks that have known positions in relation to the center of the spheres. Using planar and cone beam images themore » couch is shifted till the surface of the PMMA sphere matches Eclipse-generated circular contours. Anterior and lateral MV images taken with small MLC openings allow measurement of distance between kV and MV isocenter, laser and MLC alignment. Measurements were taken over a one-month period. Results: Artifacts from the tungsten sphere were confined within the PMMA sphere and did not affect cone beam localization of the sphere boundary, allowing 0.1 mm precise alignment with a computer-generated circle centered at kV isocenter. In tests extending over a one-month period, the distance between kV and MV isocenters along the vertical, longitudinal and lateral directions was 0.125 +/−0.06, 0.19 +/−0.08, and 0.02 +/−0.08 mm, respectively. Laser misalignment along these directions was 0.34 +/- 0.15, 0.74 +/−0.29, and 0.49 +/−0.22 mm. Automated couch shifts moved the spheres to within 0.1 mm of the selected position. The center of a 1cmx1cm MLC-defined field remained within +/−0.2 mm of the tungsten sphere center as the gantry was rotated. Conclusion: The UAB is practical for daily end-to-end QA tests of accelerator alignment. It provides tenths-mm accuracy for measuring agreement of kV and MV isocenters, couch motions, gantry flex and laser alignment.« less
  • Purpose: To commission the Monaco Treatment Planning System for the Novalis Tx machine. Methods: The commissioning of Monte-Carlo (MC), Collapsed Cone (CC) and electron Monte-Carlo (eMC) beam models was performed through a series of measurements and calculations in medium and in water. In medium measurements relied Octavius 4D QA system with the 1000 SRS detector array for field sizes less than 4 cm × 4 cm and the 1500 detector array for larger field sizes. Heterogeneity corrections were validated using a custom built phantom. Prior to clinical implementation, an end to end testing of a Prostate and H&N VMAT plansmore » was performed. Results: Using a 0.5% uncertainty and 2 mm grid sizes, Tables I and II summarize the MC validation at 6 MV and 18 MV in both medium and water. Tables III and IV show similar comparisons for CC. Using the custom heterogeneity phantom setup of Figure 1 and IGRT guidance summarized in Figure 2, Table V lists the percent pass rate for a 2%, 2 mm gamma criteria at 6 and 18 MV for both MC and CC. The relationship between MC calculations settings of uncertainty and grid size and the gamma passing rate for a prostate and H&N case is shown in Table VI. Table VII lists the results of the eMC calculations compared to measured data for clinically available applicators and Table VIII for small field cutouts. Conclusion: MU calculations using MC are highly sensitive to uncertainty and grid size settings. The difference can be of the order of several per cents. MC is superior to CC for small fields and when using heterogeneity corrections, regardless of field size, making it more suitable for SRS, SBRT and VMAT deliveries. eMC showed good agreement with measurements down to 2 cm − 2 cm field size.« less