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Title: SU-F-T-643: Feasibility of Performing Patient Specific VMAT QA On Single Linac for Plans Treated in Beam-Matched Elekta Agility Linacs

Abstract

Purpose: The increasing application of VMAT demands a more efficient workflow and QA solution. This study aims to investigate the feasibility of performing VMAT QA measurements on one linac for plans treated on other beam-matched Elekta Agility linacs. Methods: A single model was used to create 24 clinically approved VMAT plans (12 head-and-neck and 12 prostate using 6MV and 10MV respectively) on Pinnacle v9.10 (Philips, Einhoven, Netherlands). All head-and-neck plans were delivered on three beam-matched machines while all prostate cases were delivered on two beam-matched 10MV Agility machines. All plans were delivered onto PTW Octavius 4D phantom with 1500 detector array (PTW, Freiburg, Germany). Reconstructed volume doses were then compared with the Pinnacle reference plans in Verisoft 6.1 under 3%/3mm gamma criteria at local dose. Plans were considered clinically acceptable if >90% of the voxels passing the gamma criteria. Results: All measurements were passed (3D gamma passing rate >90%) and the result shows that the mean difference of 3D gamma of 12 head-and-neck cases is 1.2% with standard deviation of 0.6%. While for prostate cases, the mean difference of 3D gamma is 0.9% with standard deviation of 0.7%. Maximum difference of 3D gamma of all measurements between beam-matched machines ismore » less than 2.5%. The differences of passing rates between different machines were statistically insignificant (p>0.05). Conclusion. The result suggests that ther Conclusion: The result suggests that there exists a 3D gamma threshold, in our case 92.5%, above which the VMAT QA performed in any one of beam-matched machine will also pass in another one. Therefore, VMAT QA efficiency may be increased and phantom set up time can be saved by implementing such method. A constant performance across all beam matched machines must be maintained to make this QA approach feasible.« less

Authors:
; ; ; ; ; ; ;  [1]
  1. Hospital, Hong Kong (Hong Kong)
Publication Date:
OSTI Identifier:
22649201
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; LINEAR ACCELERATORS; NEOPLASMS; PERFORMANCE; PROSTATE; RADIOTHERAPY

Citation Formats

Leung, R, Lee, V, Cheung, S, Lee, K, Law, G, Wong, M, Chan, M, and Mun, Tuen. SU-F-T-643: Feasibility of Performing Patient Specific VMAT QA On Single Linac for Plans Treated in Beam-Matched Elekta Agility Linacs. United States: N. p., 2016. Web. doi:10.1118/1.4956828.
Leung, R, Lee, V, Cheung, S, Lee, K, Law, G, Wong, M, Chan, M, & Mun, Tuen. SU-F-T-643: Feasibility of Performing Patient Specific VMAT QA On Single Linac for Plans Treated in Beam-Matched Elekta Agility Linacs. United States. doi:10.1118/1.4956828.
Leung, R, Lee, V, Cheung, S, Lee, K, Law, G, Wong, M, Chan, M, and Mun, Tuen. 2016. "SU-F-T-643: Feasibility of Performing Patient Specific VMAT QA On Single Linac for Plans Treated in Beam-Matched Elekta Agility Linacs". United States. doi:10.1118/1.4956828.
@article{osti_22649201,
title = {SU-F-T-643: Feasibility of Performing Patient Specific VMAT QA On Single Linac for Plans Treated in Beam-Matched Elekta Agility Linacs},
author = {Leung, R and Lee, V and Cheung, S and Lee, K and Law, G and Wong, M and Chan, M and Mun, Tuen},
abstractNote = {Purpose: The increasing application of VMAT demands a more efficient workflow and QA solution. This study aims to investigate the feasibility of performing VMAT QA measurements on one linac for plans treated on other beam-matched Elekta Agility linacs. Methods: A single model was used to create 24 clinically approved VMAT plans (12 head-and-neck and 12 prostate using 6MV and 10MV respectively) on Pinnacle v9.10 (Philips, Einhoven, Netherlands). All head-and-neck plans were delivered on three beam-matched machines while all prostate cases were delivered on two beam-matched 10MV Agility machines. All plans were delivered onto PTW Octavius 4D phantom with 1500 detector array (PTW, Freiburg, Germany). Reconstructed volume doses were then compared with the Pinnacle reference plans in Verisoft 6.1 under 3%/3mm gamma criteria at local dose. Plans were considered clinically acceptable if >90% of the voxels passing the gamma criteria. Results: All measurements were passed (3D gamma passing rate >90%) and the result shows that the mean difference of 3D gamma of 12 head-and-neck cases is 1.2% with standard deviation of 0.6%. While for prostate cases, the mean difference of 3D gamma is 0.9% with standard deviation of 0.7%. Maximum difference of 3D gamma of all measurements between beam-matched machines is less than 2.5%. The differences of passing rates between different machines were statistically insignificant (p>0.05). Conclusion. The result suggests that ther Conclusion: The result suggests that there exists a 3D gamma threshold, in our case 92.5%, above which the VMAT QA performed in any one of beam-matched machine will also pass in another one. Therefore, VMAT QA efficiency may be increased and phantom set up time can be saved by implementing such method. A constant performance across all beam matched machines must be maintained to make this QA approach feasible.},
doi = {10.1118/1.4956828},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: To evaluate VMAT treatment plans generated with HD120 MLC and Millennium 120 MLC between two matched linacs and to determine if one can back up the other. Methods: The 6x photon beams are matched for our Varian TrueBeam STx and Trilogy linacs, which are equipped with HD120 MLC and Millennium 120 MLC, respectively. Three prostate and three brain VMAT plans were used for the evaluation. Five plans (three prostate and two brain plans) were originally generated with the TrueBeam STx and re-computed with the Trilogy. One brain plan was evaluated the other way around. For each plan, the PTVmore » coverage of V95 was made the same between two linacs. The dosimetric differences associated with the plans were compared using: 1) Percentage mean dose differences to the PTV, 2) Homogeneity index, HI = (Dmax − Dmin)/Dmean for the PTV. For prostate plans, the mean dose differences to the rectum were evaluated. While for brain plans, the percentage max dose differences to the lenses (left and right lens) were evaluated. Results: For three prostate plans, the average of the percentage mean dose differences to the PTV was 0.5 ± 0.1% and the HI was 0.1 ± 0.0%. The average of the percentage mean dose difference to the rectum was 3.5 ± 0.5%. For three brain plans, the average of the percentage mean dose differences to the PTV was 0.2 ± 1.1% and the HI was 0.2 ± 0.1%. The average of the percentage max dose differences to the lenses was 22.9 ± 4.0%. Conclusion: For prostate VMAT plans, changing the treatment from the TrueBeam STx to the Trilogy does not necessarily need re-optimization. But for brain plans, in order to minimize dose to the lenses, it is recommended to re-optimize the plan if changing the treatment between these two linacs.« less
  • Purpose: To implement VMAT in RayStation with the Elekta Synergy linac with the new Agility MLC, and to utilize the same vendor softwares to determine the optimum Elekta VMAT machine parameters in RayStation for accurate modeling and robust delivery. Methods: iCOMCat is utilized to create various beam patterns with user defined dose rate, gantry, MLC and jaw speed for each control point. The accuracy and stability of the output and beam profile are qualified for each isolated functional component of VMAT delivery using ion chamber and Profiler2 with isocentric mounting fixture. Service graphing on linac console is used to verifymore » the mechanical motion accuracy. The determined optimum Elekta VMAT machine parameters were configured in RayStation v4.5.1. To evaluate the system overall performance, TG-119 test cases and nine retrospective VMAT patients were planned on RayStation, and validated using both ArcCHECK (with plug and ion chamber) and MapCHECK2. Results: Machine output and profile varies <0.3% when only variable is dose rate (35MU/min-600MU/min). <0.9% output and <0.3% profile variation are observed with additional gantry motion (0.53deg/s–5.8deg/s both directions). The output and profile variation are still <1% with additional slow leaf motion (<1.5cm/s both direction). However, the profile becomes less symmetric, and >1.5% output and 7% profile deviation is seen with >2.5cm/s leaf motion. All clinical cases achieved comparable plan quality as treated IMRT plans. The gamma passing rate is 99.5±0.5% on ArcCheck (<3% iso center dose deviation) and 99.1±0.8% on MapCheck2 using 3%/3mm gamma (10% lower threshold). Mechanical motion accuracy in all VMAT deliveries is <1°/1mm. Conclusion: Accurate RayStation modeling and robust VMAT delivery is achievable on Elekta Agility for <2.5cm/s leaf motion and full range of dose rate and gantry speed determined by the same vendor softwares. Our TG-119 and patient results have provided us with the confidence to use VMAT clinically.« less
  • Purpose: To report and investigate observed differences in electron beam profiles at various energies/applicators between Elekta MLCi2 and Agility treatment head on Elekta Infinity LINAC Methods: When we upgraded from MLCi2 to Agility on one of our Elekta Infinity LINAC's, electron beam PDDs and profiles were acquired for comparison purpose. All clinical electron energies (6/9/12/15/12/18 MeV) and electron applicators (6/10/14/20/25 square) were included in measurement. PDDs were acquired at 100 SSD in water (PTW MP3 water tank) with a plane-parallel ion chamber (PTW Roos). X and Y Profiles were acquired using IC Profiler (Sun Nuclear Corp.) at 1cm and maximummore » PDD depths (water equivalent). Results: All PDD curves match very well between MLCi2 and Agility treatment head. However, some significant differences on electron profiles were found. On Agility, even after increasing the default auto-tracking offset values for backup diaphragms in Y and MLC in X by 2.8 cm (the maximum allowed change is 3.0 cm), electron profiles still have rounder shoulders comparing to corresponding MLCi2 profiles. This difference is significantly more pronounced at larger applicators (20 and 25 square), for all electron energies. Conclusion: The significant design change between MLCi2 and Agility beam limiting device seems to affect exit electron beam profiles. In IEC1217 X direction, the main change on Agility is the removal of the original MLCi2 X backup diaphragms and replacing it with MLC leaves; In Y direction, the main change is the radius and materials on Y backup diaphragms.« less
  • Purpose: Historically, beam matching of similar Linear Accelerators has been accomplished by sending beam data to the manufacturer to match at their factory. The purpose of this work is to demonstrate that fine beam matching can be carried out on-site as part of the acceptance test, with similar or better results. Methods: Initial scans of a 10 × 10 Percent depth dose (PDD) and a 40 × 40 beam profile at the depth of Dmax, for 6MV and 10 MV were taken to compare with the standard beam data from the Versa. The energy was then adjusted and the beammore » steered to achieve agreement between the depth dose and the horns of the beam profile. This process was repeated until the best agreement between PDD and profiles was achieved. Upon completion, all other clinical data were measured to verify match. This included PDD, beam profiles, output factors and Wedge factors. For electron beams PDD’s were matched and the beam profiles verified for the final beam energy. Confirmatory PDD and beam profiles for clinical field sizes, as well as Output Factors were measured. Results: The average difference in PDD’s for 6MV and 10MV were within 0.4% for both wedged and open fields. Beam profile comparisons over the central 80% of the field, at multiple depths, show agreement of 0.8% or less for both wedged and open fields. Average output factor agreement over all field sizes was 0.4% for 6MV and 0.2 % for 10MV. Wedge factors agreement was less than 0.6% for both photon energies over all field sizes. Electron PDD agreed to 0.5mm. Cone ratios agreed to 1% or less. Conclusion: This work indicates that beam matching can be carried out on-site simply and quickly. The results of this beam matching can achieve similar or better results than factory matching.« less
  • Purpose: To test whether unified vendor specified beam conformance for matched machines implies volumetric modulated arc radiotherapy(VMAT) delivery consistency. Methods: Twenty-two identical patient QA plans, eleven 6MV and eleven 15MV, were delivered to the Delta{sup 4}(Scandidos, Uppsala, Sweden) on two Varian TrueBEAM matched machines. Sixteen patient QA plans, nine 6 MV and seven 10 MV, were delivered to Delta{sup 4} on two Elekta Agility matched machines. The percent dose deviation(%DDev), distance-to-agreement(DTA), and the gamma analysis(γ) were collected for all plans and the differences in measurements were tabulated between matched machines. A paired t-test analysis of the data with an alphamore » of 0.05 determines statistical significance. Power(P) was calculated to detect a difference of 5%; all data except Elekta %DDev sets were strong with above a 0.85 power. Results: The average differences for Varian machines (%DDev, DTA, and γ) are 6.4%, 1.6% and 2.7% for 6MV, respectively, and 8.0%, 0.6%, and 2.5% for 15MV. The average differences for matched Elekta machines (%DDev, DTA, and γ) are 10.2%, 0.6% and 0.9% for 6 MV, respectively, and 7.0%, 1.9%, and 2.8% for 10MV.A paired t-test shows for Varian the %DDev difference is significant for 6MV and 15MV(p-value6MV=0.019, P6MV=0.96; p-value15MV=0.0003, P15MV=0.86). Differences in DTA are insignificant for both 6MV and 15MV(p-value6MV=0.063, P6MV=1; p-value15MV=0.907, P15MV=1). Varian differences in gamma are significant for both energies(p-value6MV=0.025, P6MV=0.99; p-value15MV=0.013, P15MV=1). A paired t-test shows for Elekta the difference in %DDev is significant for 6MV but not 10MV(p-value6MV=0.00065, P6MV=0.68; p-value10MV=0.262, P10MV=0.39). Differences in DTA are statistically insignificant(p-value6MV=0.803, P6MV = 1; p-value10MV=0.269, P10MV=1). Elekta differences in gamma are significant for 10MV only(p-value6MV=0.094, P6MV=1; p-value10MV=0.011, P10MV=1). Conclusion: These results show vendor specified beam conformance across machines does not ensure equivalent patient specific QA pass rates. Gamma differences are statistically significant in three of the four comparisons for two pairs of vendor matched machines.« less