Search

Purpose: Mask-immobilized stereotactic radiosurgery (SRS) using a gating window is an emerging technology. However, the amount of intracranial tumor motion that can be tolerated during treatment while satisfying clinical dosimetric goals is unknown. The purpose of this study was to quantify the sensitivity of target dose to tumor motion., Methods and Materials: In clinical SRS plans, where a nose marker was tracked as surrogate for target motion, translational and rotational target movements were simulated using nose-marker displacements of ±0.5 mm, ±1.0 mm, or ±1.5 mm. The effect on minimum dose to 99% of the target (D 99 ) and percent target coverage by prescription dose was quantified using mixed-effect modeling with variables: displacement, target volume, and location., Results: The effect on dose metrics is statistically larger for translational displacements compared with rotational displacements, and the effect of pitch rotations is statistically larger compared with yaw rotations. The mixed-effect model for translations showed that displacement and target volume are statistically significant variables, for rotation the variable target distance to rotation axis is additionally significant. For mean target volume (12.6 cc) and translational nose-marker displacements of 0.5 mm, 1.0 mm, and 1.5 mm, D 99 decreased by 2.2%, 7.1%, and 13.0%, and coverage by 0.4%, 1.8%, and 4.4%, respectively. For mean target volume, mean distance midpoint-target to pitch axis (7.6cm), and rotational nose-marker displacement of 0.5 mm, 1.0 mm, and 1.5 mm, D 99 decreased by 1.0%, 3.6%, and 6.9%, and coverage by 0.2%, 0.8%, and 1.9%, respectively. For rotational yaw axis displacement, mean distance midpoint-target axis (4.2cm), D 99 decreased by 0.3%, 1.2%, and 2.5%, and coverage by 0.1%, 0.2%, and 0.5%, respectively., Conclusions: Simulated target displacements showed that sensitivity of tumor dose to motion depends on both target volume and target location. Suggesting that patient- and target-specific thresholds may be implemented for optimizing the balance between dosimetric plan accuracy and treatment prolongation caused by out-of-tolerance motion., (Copyright © 2021 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)

Purpose: Despite their availability and simplicity of use, Electronic Portal Imaging Devices (EPIDs) have not yet replaced detector arrays for patient specific QA in 3D. The purpose of this study is to perform a large scale dosimetric evaluation of transit and non-transit EPID dosimetry against absolute dose measurements in 3D., Methods: After evaluating basic dosimetric characteristics of the EPID and two detector arrays (Octavius 1500 and Octavius 1000 SRS ), 3D dose distributions for 68 VMAT arcs, and 10 IMRT plans were reconstructed within the same phantom geometry using transit EPID dosimetry, non-transit EPID dosimetry, and the Octavius 4D system. The reconstructed 3D dose distributions were directly compared by γ-analysis (2L2 = 2% local/2 mm and 3G2 = 3% global/2 mm, 50% isodose) and by the percentage difference in median dose to the high dose volume (%∆HDV D 50 )., Results: Regarding dose rate dependency, dose linearity, and field size dependence, the agreement between EPID dosimetry and the two detector arrays was found to be within 1.0%. In the 2L2 γ-comparison with Octavius 4D dose distributions, the average γ-pass rate value was 92.2 ± 5.2%(1SD) and 94.1 ± 4.3%(1SD) for transit and non-transit EPID dosimetry, respectively. 3G2 γ-pass rate values were higher than 95% in 150/156 cases. %∆HDV D 50 values were within 2% in 134/156 cases and within 3% in 155/156 cases. With regard to the clinical classification of alerts, 97.5% of the treatments were equally classified by EPID dosimetry and Octavius 4D., Conclusion: Transit and non-transit EPID dosimetry are equivalent in dosimetric terms to conventional detector arrays for patient specific QA. Non-transit 3D EPID dosimetry can be readily used for pre-treatment patient specific QA of IMRT and VMAT, eliminating the need of phantom positioning., (© 2019 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.)

Purpose: To systematically evaluate machine specific quality assurance (QA) for volumetric modulated arc therapy (VMAT) based on log files by applying a dynamic benchmark plan., Methods and Materials: A VMAT benchmark plan was created and tested on 18 Elekta linacs (13 MLCi or MLCi2, 5 Agility) at 4 different institutions. Linac log files were analyzed and a delivery robustness index was introduced. For dosimetric measurements an ionization chamber array was used. Relative dose deviations were assessed by mean gamma for each control point and compared to the log file evaluation., Results: Fourteen linacs delivered the VMAT benchmark plan, while 4 linacs failed by consistently terminating the delivery. The mean leaf error (±1SD) was 0.3±0.2 mm for all linacs. Large MLC maximum errors up to 6.5 mm were observed at reversal positions. Delivery robustness index accounting for MLC position correction (0.8-1.0) correlated with delivery time (80-128 s) and depended on dose rate performance. Dosimetric evaluation indicated in general accurate plan reproducibility with γ(mean)(±1 SD)=0.4±0.2 for 1 mm/1%. However single control point analysis revealed larger deviations and attributed well to log file analysis., Conclusion: The designed benchmark plan helped identify linac related malfunctions in dynamic mode for VMAT. Log files serve as an important additional QA measure to understand and visualize dynamic linac parameters., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To compare the dosimetric and geometric properties of a commercial x-ray based image-guided small animal irradiation system, installed at three institutions and to establish a complete and broadly accessible commissioning procedure., Methods: The system consists of a 225 kVp x-ray tube with fixed field size collimators ranging from 1 to 44 mm equivalent diameter. The x-ray tube is mounted opposite a flat-panel imaging detector, on a C-arm gantry with 360° coplanar rotation. Each institution performed a full commissioning of their system, including half-value layer, absolute dosimetry, relative dosimetry (profiles, percent depth dose, and relative output factors), and characterization of the system geometry and mechanical flex of the x-ray tube and detector. Dosimetric measurements were made using Farmer-type ionization chambers, small volume air and liquid ionization chambers, and radiochromic film. The results between the three institutions were compared., Results: At 225 kVp, with 0.3 mm Cu added filtration, the first half value layer ranged from 0.9 to 1.0 mm Cu. The dose-rate in-air for a 40 × 40 mm(2) field size, at a source-to-axis distance of 30 cm, ranged from 3.5 to 3.9 Gy/min between the three institutions. For field sizes between 2.5 mm diameter and 40 × 40 mm(2), the differences between percent depth dose curves up to depths of 3.5 cm were between 1% and 4% on average, with the maximum difference being 7%. The profiles agreed very well for fields >5 mm diameter. The relative output factors differed by up to 6% for fields larger than 10 mm diameter, but differed by up to 49% for fields ≤5 mm diameter. The mechanical characteristics of the system (source-to-axis and source-to-detector distances) were consistent between all three institutions. There were substantial differences in the flex of each system., Conclusions: With the exception of the half-value layer, and mechanical properties, there were significant differences between the dosimetric and geometric properties of the three systems. This underscores the need for careful commissioning of each individual system for use in radiobiological experiments.