The objective of this study is to develop a quality assurance program to implement for the new Rotating Gamma System (RGS) in stereotactic surgery. Our experience supports the reliability of the operation of the hardware and software pertaining to RGS to deliver precise treatment to patients. This rotating gamma system with thirty Cobalt-60 sources with an initial total activity of 7465.5 Ci is in operation as the second unit in the USA. The source body and collimator body are synchronously rotating during the treatment procedure with a precise alignment. The radiation exposure is controlled by ON/OFF switches, which are automatically regulated by the computerized control system along with the precision table movement. Machine parameters such as output constancy, radiation isocentricity, alignment of collimator and source bodies, the accuracy of table positioning coordinate system, operation of the ON/OFF switches are independently verified as a part of pre-treatment quality assurance procedure using Ion chambers and Gaf-chromic film. Consistency of the Full Width at Half Maximum (FWHM), Penumbra 80-20% (P80-20%) are monitored periodically. Point dose to an acrylic phantom is calculated in Infini Superplan 4.2.118, and the dose is compared to the measured value. Periodic end-to-end testing is performed to verify the geometrical positioning of the shots and evaluating the MRI fiducials. End-to-End tests and other complicated patient plans are monitored using MAX-HD Head SRS dosimetric Phantom analysis. The interlock tests are performed before the commencement of the treatment as a part of a quality assurance procedure. Mechanical and radiation geometrical iso-center for all collimators (Diameter: 18mm, 14mm, 8mm, and 4mm) with all gamma angles (70, 90, and 100) are less than 0.16mm. Error in output factors(OF) and alignment of collimator and source body ratio(ACSR) is within 0.511±0.393% and 1.527±1.168% on average, respectively. FWHM and P80-20% for each collimator are within an acceptable range in comparison to the acceptance and commissioning data. The verification of the delivered point dose is found to be less than 4.7%. Patient treatment on this unit started on April 22, 2019 and up to date, 125 patients have been treated successfully. Fifty or more cases with multiple metastasis have been treated, and patients with a single metastasis, Trigeminal neuralgia, Meningioma, schwannoma, Acoustic Neuroma have completed treatment. The downtime of the system is minimal. With sub-millimeter accuracy, this new rotating gamma system is accurate, reliable, and shows safe delivery of the radiation dose for cranial stereotactic radiosurgery. A periodic Quality assurance procedure is important to assure the proper monitoring of this dynamic system.
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