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The RUBY head phantom in combination with the System QA insert MultiMet can be used for simultaneous point dose measurements at an isocentric and two off-axis positions. This study investigates the suitability of the system for systematic integral end-to-end testing of single-isocenter multiple target stereotactic treatments. Several volumetric modulated arc therapy plans were optimized on a planning CT of the phantom positioned in a stereotactic mask on the stereotactic treatment board. The plans were created for three artificial spherical target volumes centred around the measurement positions in the MultiMet insert. Target diameters between 5 and 40 mm were investigated. Coplanar and non-coplanar plans were optimized using the collapsed cone algorithm of the Oncentra Masterplan treatment planning system and recalculated with the Monte Carlo algorithm of the Monaco treatment planning system. Measurements were performed at an Elekta Synergy linear accelerator. The head phantom was positioned according to clinical workflow comprising immobilization and CBCT imaging. Simultaneous point dose measurements at all target positions were performed with three PinPoint 3D chambers (type 31022) as well as three microDiamond detectors (type 60019) and compared to the treatment planning system calculations. Furthermore, the angular dependence of the detector response was investigated to estimate the associated impact on the measured point dose values. Considering all investigated plans, PTV diameters and positions, the point doses calculated with the Monaco treatment planning system and the microDiamond measurements differed within 3.5%, whereas the PinPoint 3D showed differences of up to 6.9%. Point dose differences determined in comparison to the Oncentra Masterplan dose calculations were larger. The RUBY system was shown to be suitable for end-to-end testing of complex treatment scenarios such as single-isocenter multiple target plans., (Creative Commons Attribution license.)

Purpose: This study evaluates the clinical use of the RUBY modular QA phantom for linac QA to validate the integrity of IGRT workflows including the congruence of machine isocenter, imaging isocenter, and room lasers. The results have been benchmarked against those obtained with widely used systems. Additionally, the RUBY phantom has been implemented to perform system QA (End-to-End testing) from imaging to radiation for IGRT-based VMAT and stereotactic radiations at an Elekta Synergy linac., Material and Methods: The daily check of IGRT workflow was performed using the RUBY phantom, the Penta-Guide, and the STEEV phantom. Furthermore, Winston-Lutz tests was carried out with the RUBY phantom and a ball-bearing phantom to determine the offsets and the diameters of the isospheres of gantry, collimator, and couch rotations, with respect to the room lasers and kV-imaging isocenter. System QA was performed with the RUBY phantom and STEEV phantom for eight VMAT treatment plans. Additionally, the visibility of the embedded objects within these phantoms in the images and the results of CT and MR image fusions were evaluated., Results: All systems used for daily QA of IGRT workflows show comparable results. Calculated shifts based on CBCT imaging agree within 1 mm to the expected values. The results of the Winston-Lutz test based on kV imaging (2D planar and CBCT) or room lasers are consistent regardless of the system tested. The point dose values in the RUBY phantom agree to the expected values calculated using algorithms in Masterplan and Monte Carlo engine in Monaco within 3% of the clinical acceptance criteria., Conclusion: All the systems evaluated in this study yielded comparable results in terms of linac QA and system QA procedures. A system QA protocol has been derived using the RUBY phantom to check the IGRT-based VMAT and stereotactic radiations workflow at an Elekta Synergy linac., (© 2020 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.)

Purpose: High precision radiosurgery demands comprehensive delivery-quality-assurance techniques. The use of a liquid-filled ion-chamber-array for robotic-radiosurgery delivery-quality-assurance was investigated and validated using several test scenarios and routine patient plans., Methods and Material: Preliminary evaluation consisted of beam profile validation and analysis of source-detector-distance and beam-incidence-angle response dependence. The delivery-quality-assurance analysis is performed in four steps: (1) Array-to-plan registration, (2) Evaluation with standard Gamma-Index criteria (local-dose-difference⩽2%, distance-to-agreement⩽2mm, pass-rate⩾90%), (3) Dose profile alignment and dose distribution shift until maximum pass-rate is found, and (4) Final evaluation with 1mm distance-to-agreement criterion. Test scenarios consisted of intended phantom misalignments, dose miscalibrations, and undelivered Monitor Units. Preliminary method validation was performed on 55 clinical plans in five institutions., Results: The 1000SRS profile measurements showed sufficient agreement compared with a microDiamond detector for all collimator sizes. The relative response changes can be up to 2.2% per 10cm source-detector-distance change, but remains within 1% for the clinically relevant source-detector-distance range. Planned and measured dose under different beam-incidence-angles showed deviations below 1% for angles between 0° and 80°. Small-intended errors were detected by 1mm distance-to-agreement criterion while 2mm criteria failed to reveal some of these deviations. All analyzed delivery-quality-assurance clinical patient plans were within our tight tolerance criteria., Conclusion: We demonstrated that a high-resolution liquid-filled ion-chamber-array can be suitable for robotic radiosurgery delivery-quality-assurance and that small errors can be detected with tight distance-to-agreement criterion. Further improvement may come from beam specific correction for incidence angle and source-detector-distance response., (Copyright © 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.)

Purpose: Robotic radiosurgery demands comprehensive delivery quality assurance (DQA), but guidelines for commissioning of the DQA method is missing. We investigated the stability and sensitivity of our film-based DQA method with various test scenarios and routine patient plans. We also investigated the applicability of tight distance-to-agreement (DTA) Gamma-Index criteria., Methods and Material: We used radiochromic films with multichannel film dosimetry and re-calibration and our analysis was performed in four steps: 1) Film-to-plan registration, 2) Standard Gamma-Index criteria evaluation (local-pixel-dose-difference ≤2%, distance-to-agreement ≤2 mm, pass-rate ≥90%), 3) Dose distribution shift until maximum pass-rate (Maxγ) was found (shift acceptance <1 mm), and 4) Final evaluation with tight DTA criteria (≤1 mm). Test scenarios consisted of purposefully introduced phantom misalignments, dose miscalibrations, and undelivered MU. Initial method evaluation was done on 30 clinical plans., Results: Our method showed similar sensitivity compared to the standard End-2-End-Test and incorporated an estimate of global system offsets in the analysis. The simulated errors (phantom shifts, global robot misalignment, undelivered MU) were detected by our method while standard Gamma-Index criteria often did not reveal these deviations. Dose miscalibration was not detected by film alone, hence simultaneous ion-chamber measurement for film calibration is strongly recommended. 83% of the clinical patient plans were within our tight DTA tolerances., Conclusion: Our presented methods provide additional measurements and quality references for film-based DQA enabling more sensitive error detection. We provided various test scenarios for commissioning of robotic radiosurgery DQA and demonstrated the necessity to use tight DTA criteria., (Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.)