Technical Notes: Robustness of three-dimensional treatment and imaging isocenter testing using a new gel dosimeter and kilovoltage CBCT.

Abstract

Coincidence of the treatment and imaging isocenter coordinates is required to safely perform small-margin treatments, such as stereotactic radiosurgery of multiple brain metastases. A comprehensive and direct methodology for verifying concordance of kilovoltage cone-beam computed tomography (kV-CBCT) and treatment coordinates using an x-ray CT-based polymer gel dosimeter (dGEL) and onboard kV-CBCT was previously reported. Using this methodology, we tested the ability of a new commercially available x-ray CT-based polymer dGEL with a rapid response to provide efficient quality assurance (QA). The aim of this study was to evaluate the robustness of the three-dimensional geometric QA methodology using dGEL. The dGEL were commercially manufactured. The prescribed dose for each field was determined by visually identifying the 5, 10, and 20Gy isodose lines. A linear accelerator was used to irradiate the gels with seven non-coplanar beams. An in-house analysis program was used to identify the beam axes and treatment isocenter in kV-CBCT coordinates by processing the pre- and post-irradiation CBCT images. The impact of the radiation dose on the test reproducibility was examined, and the detectability of an intentional geometric error was assessed. The treatment isocenter was within 0.4mm of the imaging isocenter for all radiation doses. The residual error of the test with the intentional error was within 0.2mm. The analysis and image quality variations for a single dGEL introduced displacement errors less than 0.3mm. The test assessed the coincidence of treatment and kV-CBCT isocenter coordinates and detected errors with high robustness. Even for a 10Gy dose, the test yielded results comparable with those obtained using higher radiation doses owing to the rapid response of the dGEL dosimeter.