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

Title: SU-G-TeP4-15: The Roucoulette: A Set of Quality Control Tests for Dynamic Trajectory (4Pi) Treatment Delivery Techniques

Abstract

Purpose: To present and validate a set of quality control tests for trajectory treatment delivery using synchronized dynamic couch (translation and rotation), MLC and collimator motion. Methods: The quality control tests are based on the Picket fence test, which consist of 5 narrow band 2mm width spaced at 2.5cm intervals, and adds progressively synchronized dynamic motions. The tests were exposed on GafChromic EBT3 films. The first test is a regular (no motion and MLC static while beam is on) Picket Fence test used as baseline. The second test includes simultaneous collimator and couch rotation, each stripe corresponding to a different rotation speed. Errors in these tests were introduced (0.5 degree and 1 degree error in rotation synchronization) to assess the error sensitivity of this test. The second test is similar to the regular Picket Fence but now including dynamic MLC motion and couch translation (including acceleration during delivery) while the beam is on. Finally in the third test, which is a combination of the first and second test, the Picket Fence pattern is delivered using synchronized collimator and couch rotation and synchronized dynamic MLC and couch translation including acceleration. Films were analyzed with FilmQA Pro. Results: The distance between themore » peaks in the dose profile where measured (18.5cm away from the isocentre in the inplane direction where non synchronized rotation would have the largest effect) and compared to the regular Picket Fence tests. For well synchronized motions distances between peaks where between 24.9–25.4 mm identical to the regular Picket Fence test. This range increased to 24.4–26.4mm and 23.4–26.4mm for 0.5 degree and 1 degree error respectively. The amplitude also decreased up to 15% when errors are introduced. Conclusion: We demonstrated that the Roucoulette tests can be used as a quality control tests for trajectory treatment delivery using synchronized dynamic motion.« less

Authors:
 [1]
  1. BC Cancer Agency, Centre for the Southern Interior, Kelowna, BC (Canada)
Publication Date:
OSTI Identifier:
22649477
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:
61 RADIATION PROTECTION AND DOSIMETRY; 60 APPLIED LIFE SCIENCES; COLLIMATORS; CUSPED GEOMETRIES; ERRORS; QUALITY CONTROL; RADIOTHERAPY; ROTATION; TRAJECTORIES

Citation Formats

Teke, T. SU-G-TeP4-15: The Roucoulette: A Set of Quality Control Tests for Dynamic Trajectory (4Pi) Treatment Delivery Techniques. United States: N. p., 2016. Web. doi:10.1118/1.4957140.
Teke, T. SU-G-TeP4-15: The Roucoulette: A Set of Quality Control Tests for Dynamic Trajectory (4Pi) Treatment Delivery Techniques. United States. doi:10.1118/1.4957140.
Teke, T. 2016. "SU-G-TeP4-15: The Roucoulette: A Set of Quality Control Tests for Dynamic Trajectory (4Pi) Treatment Delivery Techniques". United States. doi:10.1118/1.4957140.
@article{osti_22649477,
title = {SU-G-TeP4-15: The Roucoulette: A Set of Quality Control Tests for Dynamic Trajectory (4Pi) Treatment Delivery Techniques},
author = {Teke, T},
abstractNote = {Purpose: To present and validate a set of quality control tests for trajectory treatment delivery using synchronized dynamic couch (translation and rotation), MLC and collimator motion. Methods: The quality control tests are based on the Picket fence test, which consist of 5 narrow band 2mm width spaced at 2.5cm intervals, and adds progressively synchronized dynamic motions. The tests were exposed on GafChromic EBT3 films. The first test is a regular (no motion and MLC static while beam is on) Picket Fence test used as baseline. The second test includes simultaneous collimator and couch rotation, each stripe corresponding to a different rotation speed. Errors in these tests were introduced (0.5 degree and 1 degree error in rotation synchronization) to assess the error sensitivity of this test. The second test is similar to the regular Picket Fence but now including dynamic MLC motion and couch translation (including acceleration during delivery) while the beam is on. Finally in the third test, which is a combination of the first and second test, the Picket Fence pattern is delivered using synchronized collimator and couch rotation and synchronized dynamic MLC and couch translation including acceleration. Films were analyzed with FilmQA Pro. Results: The distance between the peaks in the dose profile where measured (18.5cm away from the isocentre in the inplane direction where non synchronized rotation would have the largest effect) and compared to the regular Picket Fence tests. For well synchronized motions distances between peaks where between 24.9–25.4 mm identical to the regular Picket Fence test. This range increased to 24.4–26.4mm and 23.4–26.4mm for 0.5 degree and 1 degree error respectively. The amplitude also decreased up to 15% when errors are introduced. Conclusion: We demonstrated that the Roucoulette tests can be used as a quality control tests for trajectory treatment delivery using synchronized dynamic motion.},
doi = {10.1118/1.4957140},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • In this study, the authors introduce and demonstrate quality control procedures for evaluating the geometric and dosimetric fidelity of dynamic treatment delivery techniques involving treatment couch motion synchronous with gantry and multileaf collimator (MLC). Tests were designed to evaluate positional accuracy, velocity constancy and accuracy for dynamic couch motion under a realistic weight load. A test evaluating the geometric accuracy of the system in delivering treatments over complex dynamic trajectories was also devised. Custom XML scripts that control the Varian TrueBeam™ STx (Serial #3) axes in Developer Mode were written to implement the delivery sequences for the tests. Delivered dosemore » patterns were captured with radiographic film or the electronic portal imaging device. The couch translational accuracy in dynamic treatment mode was 0.01 cm. Rotational accuracy was within 0.3°, with 0.04 cm displacement of the rotational axis. Dose intensity profiles capturing the velocity constancy and accuracy for translations and rotation exhibited standard deviation and maximum deviations below 3%. For complex delivery involving MLC and couch motions, the overall translational accuracy for reproducing programmed patterns was within 0.06 cm. The authors conclude that in Developer Mode, TrueBeam™ is capable of delivering dynamic treatment delivery techniques involving couch motion with good geometric and dosimetric fidelity.« less
  • Purpose: There is potentially a wide variation in plan quality for a certain disease site, even for clinics located in the same system of hospitals. We have used a prostate-specific knowledge-based planning (KBP) model as a quality control tool to investigate the variation in prostate treatment planning across a network of affiliated radiation oncology departments. Methods: A previously created KBP model was applied to 10 patients each from 4 community-based clinics (Clinics A, B, C, and D). The KBP model was developed using RapidPlan (Eclipse v13.5, Varian Medical Systems) from 60 prostate/prostate bed IMRT plans that were originally planned usingmore » an in-house treatment planning system at the central institution of the community-based clinics. The dosimetric plan quality (target coverage and normal-tissue sparing) of each model-generated plan was compared to the respective clinically-used plan. Each community-based clinic utilized the same planning goals to develop the clinically-used plans that were used at the main institution. Results: Across all 4 clinics, the model-generated plans decreased the mean dose to the rectum by varying amounts (on average, 12.5, 2.6, 4.5, and 2.7 Gy for Clinics A, B, C, and D, respectively). The mean dose to the bladder also decreased with the model-generated plans (5.4, 2.3, 3.0, and 4.1 Gy, respectively). The KBP model also identified that target coverage (D95%) improvements were possible for for Clinics A, B, and D (0.12, 1.65, and 2.75%) while target coverage decreased by 0.72% for Clinic C, demonstrating potentially different trade-offs made in clinical plans at different institutions. Conclusion: Quality control of dosimetric plan quality across a system of radiation oncology practices is possible with knowledge-based planning. By using a quality KBP model, smaller community-based clinics can potentially identify the areas of their treatment plans that may be improved, whether it be in normal-tissue sparing or improved target coverage. M. Matuszak has research funding for KBP from Varian Medical Systems.« less
  • Purpose: Integration of coordinated robotic table motion with inversely-planned arc delivery has the potential to resolve table-top delivery limitations of large-field treatments such as Total Body Irradiation (TBI), Total Lymphoid Irradiation (TLI), and Cranial-Spinal Irradiation (CSI). We formulate the foundation for Trajectory Modulated Arc Therapy (TMAT), and using Varian Developer Mode capabilities, experimentally investigate its practical implementation for such techniques. Methods: A MATLAB algorithm was developed for inverse planning optimization of the table motion, MLC positions, and gantry motion under extended-SSD geometry. To maximize the effective field size, delivery trajectories for TMAT TBI were formed with the table rotated atmore » 270° IEC and dropped vertically to 152.5cm SSD. Preliminary testing of algorithm parameters was done through retrospective planning analysis. Robotic delivery was programmed using custom XML scripting on the TrueBeam Developer Mode platform. Final dose was calculated using the Eclipse AAA algorithm. Initial verification of delivery accuracy was measured using OSLDs on a solid water phantom of varying thickness. Results: A comparison of DVH curves demonstrated that dynamic couch motion irradiation was sufficiently approximated by static control points spaced in intervals of less than 2cm. Optimized MLC motion decreased the average lung dose to 68.5% of the prescription dose. The programmed irradiation integrating coordinated table motion was deliverable on a TrueBeam STx linac in 6.7 min. With the couch translating under an open 10cmx20cm field angled at 10°, OSLD measurements along the midline of a solid water phantom at depths of 3, 5, and 9cm were within 3% of the TPS AAA algorithm with an average deviation of 1.2%. Conclusion: A treatment planning and delivery system for Trajectory Modulated Arc Therapy of extended volumes has been established and experimentally demonstrated for TBI. Extension to other treatment techniques such as TLI and CSI is readily achievable through the developed platform. Grant Funding by Varian Medical Systems.« less
  • Purpose: The MLC dosimetric leaf gap (DLG) and transmission are measured parameters which impact the dosimetric accuracy of IMRT and VMAT plans. This investigation aims to develop an efficient and accurate routine constancy check of the physical DLG in two dimensions. Methods: The manufacturer’s recommended DLG measurement method was modified by using 5 fields instead of 11 and by utilizing the Electronic Portal Imaging Device (EPID). Validations were accomplished using an ion chamber (IC) in solid water and a 2D IC array. EPID data was collected for 6 months on multiple TrueBeam linacs using both Millennium and HD MLCs atmore » 5 different clinics in an international consortium. Matlab code was written to automatically analyze the images and calculate the 2D results. Sensitivity was investigated by introducing deliberate leaf position errors. MLC calibration and initialization history was recorded to allow quantification of their impact. Results were analyzed using statistical process control (SPC). Results: The EPID method took approximately 5 minutes. Due to detector response, the EPID measured DLG and transmission differed from the IC values but were reproducible and consistent with changes measured using the ICs. For the Millennium MLC, the EPID measured DLG and transmission were both consistently lower than IC results. The EPID method was implemented as leaf offset and transmission constancy tests (LOC and TC). Based on 6 months of measurements, the initial leaf-specific action thresholds for changes from baseline were set to 0.1 mm. Upper and lower control limits for variation were developed for each machine. Conclusion: Leaf offset and transmission constancy tests were implemented on Varian HD and Millennium MLCs using an EPID and found to be efficient and accurate. The test is effective for monitoring MLC performance using dynamic delivery and performing process control on the DLG in 2D, thus enhancing dosimetric accuracy. This work was supported by a grant from Varian Medical Systems.« less
  • Purpose: Statistical process control (SPC) is a quality control method used to ensure that a process is well controlled and operates with little variation. This study determined whether SPC was a viable technique for evaluating the proper operation of a high-dose-rate (HDR) brachytherapy treatment delivery system. Methods and Materials: A surrogate prostate patient was developed using Vyse ordnance gelatin. A total of 10 metal oxide semiconductor field-effect transistors (MOSFETs) were placed from prostate base to apex. Computed tomography guidance was used to accurately position the first detector in each train at the base. The plan consisted of 12 needles withmore » 129 dwell positions delivering a prescribed peripheral dose of 200 cGy. Sixteen accurate treatment trials were delivered as planned. Subsequently, a number of treatments were delivered with errors introduced, including wrong patient, wrong source calibration, wrong connection sequence, single needle displaced inferiorly 5 mm, and entire implant displaced 2 mm and 4 mm inferiorly. Two process behavior charts (PBC), an individual and a moving range chart, were developed for each dosimeter location. Results: There were 4 false positives resulting from 160 measurements from 16 accurately delivered treatments. For the inaccurately delivered treatments, the PBC indicated that measurements made at the periphery and apex (regions of high-dose gradient) were much more sensitive to treatment delivery errors. All errors introduced were correctly identified by either the individual or the moving range PBC in the apex region. Measurements at the urethra and base were less sensitive to errors. Conclusions: SPC is a viable method for assessing the quality of HDR treatment delivery. Further development is necessary to determine the most effective dose sampling, to ensure reproducible evaluation of treatment delivery accuracy.« less