skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: SU-F-T-556: A Potential Real Time AQA for Cyberknife Cones and MLC Based Treatments

Abstract

Purpose: To investigate the potential use of the Raven™ (LAP of America Laser Applications) for real time AQA of Cyberknife™ with InCise2 MLC (Accuray™ Medical). Methods: At setup, the Raven was rotated 45° on which an Accuray™ AQA cube was positioned. Three different AQA plans for fixed cone, InCise2MLC, and a modified MLC plan were delivered repeatedly ten times. The additional shapes in modified AQA plan enable additional reproducibility checks for all the MLC pairs. During the test, the cube was aligned by imbedded fiducials and irradiated. The two angled radiation beams aimed center tungsten ball of the cube and projected 45° to phosphor screen and registered by a CCD camera of the Raven device. The centricity of the metal ball in the irradiated field was then analyzed using Matlab codes. Results: For AP images, the average offsets of X, Y, and radial directions are 0.24 ± 0.04 mm, 0.25 ± 0.02 mm and 0.35 ±± 0.03 mm respectively for the cone; 0.34 ± 0.02 mm, 0.49 ± 0.04 mm and 0.60 ± 0.04 mm respectively for the MLC. For lateral images, they are 0.63 ± 0.05 mm, 0.11 ± 0.02 mm and 0.64 ± 0.04 mm respectively for themore » cone, 0.79 ± 0.08 mm, −0.23 ± 0.06 mm and 0.82 ± 0.09 mm respectively for the MLC. No inconsistent MLC shapes were found in the modified AQA group. Conclusion: The results are consistent with clinically acceptable values (≤1mm from baseline). The results suggest the potential of replacement of the standard AQA test with the novel real-time Raven device for Cyberknife daily QA. The modified MLC based AQA provides a more comprehensive MLC daily QA capability. Further improvements in its resolution and automatic analyzing capability are warranted.« less

Authors:
 [1]; ;  [2]; ;  [3];  [4]
  1. Boca Raton Regional Hospital, Boca Raton, FL (United States)
  2. Florida Atlantic University, Boca Raton, FL (United States)
  3. Lynn Cancer Institute, Boca Raton, FL (United States)
  4. Florida Atlantic University, Boca Raton, Florida (United States)
Publication Date:
OSTI Identifier:
22649131
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 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; 61 RADIATION PROTECTION AND DOSIMETRY; CHARGE-COUPLED DEVICES; CONES; POTENTIALS; RADIATION DOSES; RADIOTHERAPY

Citation Formats

Shang, C, Gibbard, G, Khanal, S, Cole, J, Schramm, A, and Leventouri, T. SU-F-T-556: A Potential Real Time AQA for Cyberknife Cones and MLC Based Treatments. United States: N. p., 2016. Web. doi:10.1118/1.4956741.
Shang, C, Gibbard, G, Khanal, S, Cole, J, Schramm, A, & Leventouri, T. SU-F-T-556: A Potential Real Time AQA for Cyberknife Cones and MLC Based Treatments. United States. doi:10.1118/1.4956741.
Shang, C, Gibbard, G, Khanal, S, Cole, J, Schramm, A, and Leventouri, T. Wed . "SU-F-T-556: A Potential Real Time AQA for Cyberknife Cones and MLC Based Treatments". United States. doi:10.1118/1.4956741.
@article{osti_22649131,
title = {SU-F-T-556: A Potential Real Time AQA for Cyberknife Cones and MLC Based Treatments},
author = {Shang, C and Gibbard, G and Khanal, S and Cole, J and Schramm, A and Leventouri, T},
abstractNote = {Purpose: To investigate the potential use of the Raven™ (LAP of America Laser Applications) for real time AQA of Cyberknife™ with InCise2 MLC (Accuray™ Medical). Methods: At setup, the Raven was rotated 45° on which an Accuray™ AQA cube was positioned. Three different AQA plans for fixed cone, InCise2MLC, and a modified MLC plan were delivered repeatedly ten times. The additional shapes in modified AQA plan enable additional reproducibility checks for all the MLC pairs. During the test, the cube was aligned by imbedded fiducials and irradiated. The two angled radiation beams aimed center tungsten ball of the cube and projected 45° to phosphor screen and registered by a CCD camera of the Raven device. The centricity of the metal ball in the irradiated field was then analyzed using Matlab codes. Results: For AP images, the average offsets of X, Y, and radial directions are 0.24 ± 0.04 mm, 0.25 ± 0.02 mm and 0.35 ±± 0.03 mm respectively for the cone; 0.34 ± 0.02 mm, 0.49 ± 0.04 mm and 0.60 ± 0.04 mm respectively for the MLC. For lateral images, they are 0.63 ± 0.05 mm, 0.11 ± 0.02 mm and 0.64 ± 0.04 mm respectively for the cone, 0.79 ± 0.08 mm, −0.23 ± 0.06 mm and 0.82 ± 0.09 mm respectively for the MLC. No inconsistent MLC shapes were found in the modified AQA group. Conclusion: The results are consistent with clinically acceptable values (≤1mm from baseline). The results suggest the potential of replacement of the standard AQA test with the novel real-time Raven device for Cyberknife daily QA. The modified MLC based AQA provides a more comprehensive MLC daily QA capability. Further improvements in its resolution and automatic analyzing capability are warranted.},
doi = {10.1118/1.4956741},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = {Wed Jun 15 00:00:00 EDT 2016},
month = {Wed Jun 15 00:00:00 EDT 2016}
}
  • Purpose: CyberKnife is a well-documented modality for SRS and SBRT treatments. Typical tumors are small and 1–5 fractions are usually used. We determined the feasibility of using CyberKnife, with an InCise multileaf collimator option, for larger tumors undergoing standard dose and fractionation. The intent was to understand the limitation of using this modality for other external beam radiation treatments. Methods: Five tumors from different anatomical sites with volumes from 127.8 cc to 1,320.5 cc were contoured and planned on a Multiplan V5.1 workstation. The target average diameter ranged from 7 cm to 13 cm. The dose fractionation was 1.8–2.0 Gy/fractionmore » and 25–45 fractions for total doses of 45–81 Gy. The sites planned were: pancreas, head and neck, prostate, anal, and esophagus. The plans were optimized to meet conventional dose constraints based on various RTOG protocols for conventional fractionation. Results: The Multiplan treatment planning system successfully generated clinically acceptable plans for all sites studied. The resulting dose distributions achieved reasonable target coverage, all greater than 95%, and satisfactory normal tissue sparing. Treatment times ranged from 9 minutes to 38 minutes, the longest being a head and neck plan with dual targets receiving different doses and with multiple adjacent critical structures. Conclusion: CyberKnife, with the InCise multileaf collimation option, can achieve acceptable dose distributions in large volume tumors treated with conventional dose and fractionation. Although treatment times are greater than conventional accelerator time; target coverage and dose to critical structures can be kept within a clinically acceptable range. While time limitations exist, when necessary CyberKnife can provide an alternative to traditional treatment modalities for large volume tumors.« less
  • Purpose: Performing pre-treatment quality assurance (QA) with the Delta4 system (ScandiDos Inc., Madison, WI) is well established for linac-based radiotherapy. This is not true when using a Cyberknife (Accuray Inc., Sunnyvale, CA) where, typically film-based QA is applied. The goal of this work was to test the feasibility to use the Delta4 system for pre-treatment QA for stereotactic body radiation therapy (SBRT) using a Cyberknife-M6 equipped with the InCise2 multileaf collimator (MLC). Methods: In order to perform measurements without accelerator pulse signal, the Tomotherapy option within the Delta4 software was used. Absolute calibration of the Delta4 phantom was performed usingmore » a 10×10 cm{sup 2} field shaped by the InCise2 MLC of the Cyberknife-M6. Five fiducials were attached to the Delta4 phantom in order to be able to track the phantom before and during measurements. For eight SBRT treatment plans (two liver, two prostate, one lung, three bone metastases) additional verification plans were recalculated on the Delta4 phantom using MultiPlan. Dicom data was exported from MultiPlan and was adapted in order to be compatible with the Delta4 software. The measured and calculated dose distributions were compared using the gamma analysis of the Delta4 system. Results: All eight SBRT plans were successfully measured with the aid of the Delta4 system. In the mean, 98.0±1.9%, 95.8±4.1% and 88.40±11.4% of measured dose points passed the gamma analysis using a global dose deviation criterion of 3% (100% corresponds to the dose maximum) and a distance-to-agreement criterion of 3 mm, 2 mm and 1 mm, respectively, and a threshold of 20%. Conclusion: Pre-treatment QA of SBRT plans using the Delta4 system on a Cyberknife-M6 is feasible. Measured dose distributions of SBRT plans showed clinically acceptable agreement with the corresponding calculated dose distributions.« less
  • Purpose: To provide in vivo measurements of dose to the anterior rectal wall during prostate SBRT boost treatments using MOSFET detectors. Methods: Dual MOSkin detectors were attached to a Rectafix rectal sparing device and inserted into patients during SBRT boost treatments. Patients received two boost fractions, each of 9.5–10 Gy and delivered using 2 VMAT arcs. Measurements were acquired for 12 patients. MOSFET voltages were read out at 1 Hz during delivery and converted to dose. MV images were acquired at known frequency during treatment so that the position of the gantry at each point in time was known. Themore » cumulative dose at the MOSFET location was extracted from the treatment planning system at in 5.2° increments (FF beams) or at 5 points during each delivered arc (FFF beams). The MOSFET dose and planning system dose throughout the entirety of each arc were then compared using root mean square error normalised to the final planned dose for each arc. Results: The average difference between MOSFET measured and planning system doses determined over the entire course of treatment was 9.7% with a standard deviation of 3.6%. MOSFETs measured below the planned dose in 66% of arcs measured. Uncertainty in the position of the MOSFET detector and verification point are major sources of discrepancy, as the detector is placed in a high dose gradient region during treatment. Conclusion: MOSkin detectors were able to provide real time in vivo measurements of anterior rectal wall dose during prostate SBRT boost treatments. This method could be used to verify Rectafix positioning and treatment delivery. Further developments could enable this method to be used during high dose treatments to monitor dose to the rectal wall to ensure it remains at safe levels. Funding has been provided by the University of Newcastle. Kimberley Legge is the recipient of an Australian Postgraduate Award.« less
  • Purpose: To present treatment statistics of a Varian Novalis Tx using more than 90,000 Varian Dynalog files collected over the past 2 years. Methods: Varian Dynalog files are recorded for every patient treated on our Varian Novalis Tx. The files are collected and analyzed daily to check interfraction agreement of treatment deliveries. This is accomplished by creating fluence maps from the data contained in the Dynalog files. From the Dynalog files we have also compiled statistics for treatment delivery times, MLC errors, gantry errors and collimator errors. Results: The mean treatment time for VMAT patients was 153 ± 86 secondsmore » while the mean treatment time for step & shoot was 256 ± 149 seconds. Patient’s treatment times showed a variation of 0.4% over there treatment course for VMAT and 0.5% for step & shoot. The average field sizes were 40 cm2 and 26 cm2 for VMAT and step & shoot respectively. VMAT beams contained and average overall leaf travel of 34.17 meters and step & shoot beams averaged less than half of that at 15.93 meters. When comparing planned and delivered fluence maps generated using the Dynalog files VMAT plans showed an average gamma passing percentage of 99.85 ± 0.47. Step & shoot plans showed an average gamma passing percentage of 97.04 ± 0.04. 5.3% of beams contained an MLC error greater than 1 mm and 2.4% had an error greater than 2mm. The mean gantry speed for VMAT plans was 1.01 degrees/s with a maximum of 6.5 degrees/s. Conclusion: Varian Dynalog files are useful for monitoring machine performance treatment parameters. The Dynalog files have shown that the performance of the Novalis Tx is consistent over the course of a patients treatment with only slight variations in patient treatment times and a low rate of MLC errors.« less
  • Purpose: To study the critical analysis and efficacy of Linac and Cyberknife (CK) treatment plans for acoustic neuroma/schwannoma. Methods: Twelve of acoustic neuroma/schwannoma patients were taken for these study that. Treatment plans were generated in Multiplan treatment planning system (TPS) for CK using 5,7.5 and 10mm diameter collimators. Target volumes were in the range of 0.280 cc to 9.256 cc. Prescription dose (Rx) ranges from 1150cGy to 1950cGy delivered over 1 to 3 Fractions. For same patients stereotactic Volumetric modulated arc plans were generated using Elekta Linac with MLC thickness of 4mm in Monaco TPS. Appropriate calculation algorithms and gridmore » size were used with same Rx and organ at risk (OAR) constrains for both Linac and CK plans. Treatment plans were developed to achieve at least 95% of the target volume to receive the Rx. The dosimetric indices such as conformity index (CI), coverage, OAR dose and volume receiving 50% of Rx (V50%) were used to evaluate the plans. Results: Target volumes ranges from 0.280 cc to 3.5cc shows the CI of 1.16±0.109 and 1.53±0.360 for cyberknife and Linac plans respectively. For small volume targets, the OARs were well spared in CK plans. There are no significant differences in CI and OAR doses were observed between CK and Linac plans that have the target volume >3.5 cc. Perhaps the V50% were lesser in CK plans, and found to be 12.8± 8.4 and 22.8 ± 15.0 for CK and Linac respectively. Conclusion: The analysis shows the importance of collimator size for small volume targets. The target volumes >3.5 cc can be treated in Linac as comparable with CK. For targets <3.5cc CK plans showed superior plan quality with better CI and OAR sparing than the Linac based plans. Further studies may require evaluating the clinical advantage of CK robotic system.« less