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Title: SU-E-T-54: A New Method for Optimizing Radiation Isocenter for Linac-Based SRS

Abstract

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 axis 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 totalmore » 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

Authors:
 [1]; ;  [2]
  1. Southeast Missouri Hospital, Cape Girardeau, MO (United States)
  2. University Of Iowa, Iowa City, IA (United States)
Publication Date:
OSTI Identifier:
22545184
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:
46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND TECHNOLOGY; 60 APPLIED LIFE SCIENCES; BALL BEARINGS; BEAM POSITION; BEAMS; CALIBRATION; COMPLIANCE; IMAGES; LINEAR ACCELERATORS; MINIMIZATION; RADIOTHERAPY; TOLERANCE

Citation Formats

Hancock, S, Hyer, D, and Nixon, E. SU-E-T-54: A New Method for Optimizing Radiation Isocenter for Linac-Based SRS. United States: N. p., 2015. Web. doi:10.1118/1.4924415.
Hancock, S, Hyer, D, & Nixon, E. SU-E-T-54: A New Method for Optimizing Radiation Isocenter for Linac-Based SRS. United States. doi:10.1118/1.4924415.
Hancock, S, Hyer, D, and Nixon, E. Mon . "SU-E-T-54: A New Method for Optimizing Radiation Isocenter for Linac-Based SRS". United States. doi:10.1118/1.4924415.
@article{osti_22545184,
title = {SU-E-T-54: A New Method for Optimizing Radiation Isocenter for Linac-Based SRS},
author = {Hancock, S and Hyer, D and Nixon, E},
abstractNote = {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 axis 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.},
doi = {10.1118/1.4924415},
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 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 andmore » 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.« 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 combine and integrate quality assurance (QA) of target localization and radiation isocenter End to End (E2E) test of BrainLAB ExacTrac system, a new QA approach was devised using anthropomorphic head and neck phantom. This test insures the target localization as well as radiation isocenter congruence which is one step ahead the current ExacTrac QA procedures. Methods: The head and neck phantom typically used for CyberKnife E2E test was irradiated to the sphere target that was visible in CT-sim images. The CT-sim was performed using 1 mm thickness slice with helical scanning technique. The size of the sphere wasmore » 3-cm diameter and contoured as a target volume using iPlan V.4.5.2. A conformal arc plan was generated using MLC-based with 7 fields, and five of them were include couch rotations. The prescription dose was 5 Gy and 95% coverage to the target volume. For the irradiation, two Gafchromic films were perpendicularly inserted into the cube that hold sphere inside. The linac used for the irradiation was TrueBeam STx equipped with HD120 MLC. In order to use ExacTrac, infra-red head–array was used to correlate orthogonal X-ray images. Results: Using orthogonal X-rays of ExacTrac the phantom was positioned. For each field, phantom was check again with X-rays and re-positioned if necessary. After each setup using ExacTrac, the target was irradiated. The films were analyzed to determine the deviation of the radiation isocenter in all three dimensions: superior-inferior, left-right and anterior-posterior. The total combining error was found to be 0.76 mm ± 0.05 mm which was within sub-millimeter accuracy. Conclusion: Until now, E2E test for ExacTrac was separately implemented to test image localization and radiation isocenter. This new method can be used for periodic QA procedures.« less
  • Purpose: Single-isocenter Stereotactic Radiotherapy of multiple brain metastases with Varian 21 IX LINAC, using Aktina Pinpoint system for patient setup. Methods: In 2014, five single-isocenter RapidArc SRT plans were delivered to five patients with 2 to 8 brain metastases using Varian 21 IX. Aktina Pinpoint system was used for setup and 2mm PTV margin were used. CBCT was acquired before and after the beam delivery. The prescription is 2100 cGy in 3 fractions. Eclipse planning system was used for treatment planning. Depending on the number of metastases and their locations, 1 to 5 coplanar or non coplanar arcs were used.more » Typically, 2 or 3 arcs are used. IMRT QAs were performed by comparing an A1SL ion chamber point dose measurement in solid water phantom to point dose of the plan; also, based on EPID measurement, 3D spatial dose was calculated using DosimetryCheck software package from MathResolutions Inc. The EPID system has an active area of 40cm by 30cm with 1024 by 768 photodiodes, which corresponds to a resolution of 0.4mm by 0.4mm pixel dimension. Results: for all the plans, at least 95% PTV coverage was achieved for full prescription dose, with plan normalization > 75%. RTOG conformity indices are less than 1.1 and Paddick gradient indices are less than 4.5. The distance from prescription IDL to 50% IDL increases as the number of metastases increases, and it ranges from 0.6mm to 0.8mm. Treatment time varies from 10mins to 30mins, depending on the number of arcs and if the arcs are coplanar. IMRT QA shows that the ion chamber measurement agree with the eclipse calculation within 3%, and 95% of the points passed Gamma, using 3% dose difference and 3mm DTA Conclusion: High quality single isocenter RapidArc SRT plan can be optimized and accurately delivered using Eclipse and Varian 21IX.« less
  • Purpose: To investigate the doses received by the hippocampus and normal brain tissue during a course of stereotactic radiotherapy utilizing a single isocenter (SI) versus multiple isocenter (MI) in patients with multiple intracranial metastases. Methods: Seven patients imaged with MRI including SPGR sequence and diagnosed with 2–3 brain metastases were included in this retrospective study. Two sets of stereotactic IMRT treatment plans, (MI vs SI), were generated. The hippocampus was contoured on SPGR sequences and doses received by the hippocampus and whole brain were calculated. The prescribed dose was 25Gy in 5 fractions. The two groups were compared using t-testmore » analysis. Results: There were 17 lesions in 7 patients. The median tumor, right hippocampus, left hippocampus and brain volumes were: 3.37cc, 2.56cc, 3.28cc, and 1417cc respectively. In comparing the two treatment plans, there was no difference in the PTV coverage except in the tail of the DVH curve. All tumors had V95 > 99.5%. The only statistically significant parameter was the V100 (72% vs 45%, p=0.002, favoring MI). All other evaluated parameters including the V95 and V98 did not reveal any statistically significant differences. None of the evaluated dosimetric parameters for the hippocampus (V100, V80, V60, V40, V20, V10, D100, D90, D70, D50, D30, D10) revealed any statistically significant differences (all p-values > 0.31) between MI and SI plans. The total brain dose was slightly higher in the SI plans, especially in the lower dose regions, although this difference was not statistically significant. Utilizing brain-sub-PTV volumes did not change these results. Conclusion: The use of SI treatment planning for patients with up to 3 brain metastases produces similar PTV coverage and similar normal tissue doses to the hippocampus and the brain compared to MI plans. SI treatment planning should be considered in patients with multiple brain metastases undergoing stereotactic treatment.« less