Imaging Isocenter Research Articles

Characterization and longitudinal assessment of daily quality assurance for an MR-guided radiotherapy (MRgRT) linac.

PurposeTo describe and characterize daily machine quality assurance (QA) for an MR‐guided radiotherapy (MRgRT) linac system, in addition to reporting a longitudinal assessment of the dosimetric and mechanical stability over a 7‐month period of clinical operation.MethodsQuality assurance procedures were developed to evaluate MR imaging/radiation isocenter, imaging and patient handling system, and linear accelerator stability. A longitudinal assessment was characterized for safety interlocks, laser and imaging isocenter coincidence, imaging and radiation (RT) isocentricity, radiation dose rate and output, couch motion, and MLC positioning. A cylindrical water phantom and an MR‐compatible A1SL detector were utilized. MR and RT isocentricity and MLC positional accuracy was quantified through dose measured with a 0.40 cm2 x 0.83 cm2 field at each cardinal angle. The relationship between detector response to MR/RT isocentricity and MLC positioning was established through introducing known errors in phantom position.ResultsCorrelation was found between detector response and introduced positional error (N = 27) with coefficients of determination of 0.9996 (IEC‐X), 0.9967 (IEC‐Y), 0.9968 (IEC‐Z) in each respective shift direction. The relationship between dose (DoseMR/RT+MLC) and the vector magnitude of MLC and MR/RT positional error (Errormag) was calculated to be a nonlinear response and resembled a quadratic function: DoseMR/RT+MLC[%] = −0.0253 Errormag [mm]2 − 0.0195 Errormag [mm]. For the temporal assessment (N = 7 months), safety interlocks were functional. Laser coincidence to MR was within ±2.0 mm (99.6%) and ±1.0 mm (86.8%) over the 7‐month assessment. IGRT position–reposition shifts were within ±2.0 mm (99.4%) and ±1.0 mm (92.4%). Output was within ±3% (99.4%). Mean MLC and MR/RT isocenter accuracy was 1.6 mm, averaged across cardinal angles for the 7‐month period.ConclusionsThe linac and IGRT accuracy of an MR‐guided radiotherapy system has been validated and monitored over seven months for daily QA. Longitudinal assessment demonstrated a drift in dose rate, but temporal assessment of output, MLC position, and isocentricity has been stable.

Measurement of isocenter alignment accuracy and image distortion of an 0.35 T MR-Linac system

For hybrid devices combining magnetic resonance (MR) imaging and a linac for radiation treatment, the isocenter accuracy as well as image distortions have to be checked. This study presents a new phantom to investigate MR-Linacs in a single measurement in terms of (i) isocentricity of the irradiation and (ii) alignment of the irradiation and imaging isocenter relative to each other using polymer dosimetry gel as well as (iii) 3-dimensional (3D) geometric MR image distortions. The evaluation of the irradiated gel was performed immediately after irradiation with the imaging component of the 0.35 T MR-Linac using a T2-weighted turbo spin-echo sequence. Eight plastic grid sheets within the phantom allow for measurement of geometric distortions in 3D by comparing the positions of the grid intersections (control points) within the MR-image with their nominal position obtained from a CT-scan. The distance of irradiation and imaging isocenter in 3D was found to be (0.8 ± 0.9) mm for measurements with 32 image acquisitions. The mean distortion over the whole phantom was (0.60 ± 0.28) mm and 99.8% of the evaluated control points had distortions below 1.5 mm. These geometrical uncertainties have to be considered by additional safety margins.

Efficient quality assurance method with automated data acquisition of a single phantom setup to determine radiation and imaging isocenter congruence.

We developed a quality assurance (QA) method to determine the isocenter congruence of Optical Surface Monitoring System (OSMS, Varian, CA, USA), kilovoltage (kV), and megavoltage (MV) imaging, and the radiation isocenter using a single setup of the OSMS phantom for frameless Stereotactic Radiosurgery (SRS) treatment. After aligning the phantom to the OSMS isocenter, a cone‐beam computed tomography (CBCT) of the phantom was acquired and registered to a computed tomography (CT) scan of the phantom to determine the CBCT isocenter. Without moving the phantom, MV and kV images were simultaneously acquired at four gantry angles to localize MV and kV isocenters. Then, Winston‐Lutz (W‐L) test images of the central BB in the phantom were acquired to analyze the radiation isocenter. The gantry and couch were automatically controlled using the TrueBeam Developer Mode during MV, kV, and W‐L image acquisition. All the images were acquired weekly for 17 weeks to track the congruence of all the imaging modalities' isocenter in six‐dimensional (6D) translations and rotations, and the radiation isocenter in three‐dimensional (3D) translations. The shifts of isocenters of all imaging modalities and the radiation isocenter from the OSMS isocenter were within 0.2 mm and 0.2° on average over 17 weeks. The maximum discrepancy between OSMS and other imaging modalities or radiation isocenters was 0.8 mm and 0.3°. However, systematic shifts of radiation isocenter anteriorly and laterally relative to the OSMS isocenter were observed. The measured discrepancies were consistent from week‐to‐week except for two weeks when the isocenter discrepancies of 0.8 mm were noted due to drifts of the OSMS isocenter. Once recalibration was performed on OSMS, the discrepancy was reduced to 0.3 mm and 0.2°.By performing the proposed QA on a weekly basis, the isocenter congruencies of multiple imaging systems and radiation isocenter were validated for a linear accelerator.

Polymer gel-based measurements of the isocenter accuracy in an MR-LINAC

As magnetic resonance-guided radiotherapy (MRgRT) is becoming increasingly important in clinical applications, the development of new quality assurance (QA) methods is needed. One important aspect is the alignment of the radiation and imaging isocenter. MR-visible polymer gels offer a way to perform such measurements online and additionally may allow for 3-dimensional (3D) evaluation. We present a star shot measurement irradiated and scanned with a 0.35 T MR-LINAC device evaluating the polyacrylamide gelatin (PAGAT) gel dosimeter immediately and 48 h after irradiation. The gel was additionally scanned at a 3 T MR device 5 h and 52 h after irradiation. The evaluation revealed an isocircle radius of 0.5 mm for both imaging devices and all image resolutions and time points after irradiation. The distance between radiation and imaging isocenter varied between 0.25 mm and 1.30 mm depending on the applied image resolution. This demonstrates that evaluation of a star shot measurement in a 0.35 T MR-LINAC is feasible, even immediately after irradiation.

A 3D printed modular phantom for quality assurance of image-guided small animal irradiators: Design, imaging experiments, and Monte Carlo simulations.

The goal of this work was to develop and test a cylindrical tissue-equivalent quality assurance (QA) phantom for micro computed tomography (microCT) image-guided small animal irradiators that overcomes deficiencies of existing phantoms due to its mouse-like dimensions and composition. The 8.6-cm-long and 2.4-cm-diameter phantom was three-dimensionally (3D) printed out of Somos NeXt plastic on a stereolithography (SLA) printer. The modular phantom consisted of four sections: (a) CT number evaluation section, (b) spatial resolution with slanted edge (for the assessment of longitudinal resolution) and targeting section, (c) spatial resolution with hole pattern (for the assessment of radial direction) section, and (d) uniformity and geometry section. A Python-based graphical user interface (GUI) was developed for automated analysis of microCT images and evaluated CT number consistency, longitudinal and radial modulation transfer function (MTF), image uniformity, noise, and geometric accuracy. The phantom was placed at the imaging isocenter and scanned with the small animal radiation research platform (SARRP) in the pancake geometry (long axis of the phantom perpendicular to the axis of rotation) with a variety of imaging protocols. Tube voltage was set to 60 and 70kV, tube current was set to 0.5 and 1.2mA, voxel size was set to 200 and 275μm, imaging times of 1, 2, and 4min were used, and frame rates of 6 and 12 frames per second (fps) were used. The phantom was also scanned in the standard (long axis of the phantom parallel to the axis of rotation) orientation. The quality of microCT images was analyzed and compared to recommendations presented in our previous work that was derived from a multi-institutional study. Additionally, a targeting accuracy test with a film placed in the phantom was performed. MicroCT imaging of the phantom was also simulated in a modified version of the EGSnrc/DOSXYZnrc code. Images of the resolution section with the hole pattern were acquired experimentally as well as simulated in both the pancake and the standard imaging geometries. The radial spatial resolution of the experimental and simulated images was evaluated and compared to experimental data. For the centered phantom images acquired in the pancake geometry, all imaging protocols passed the spatial resolution criterion in the radial direction (>1.5lp/mm @ 0.2MTF), the geometric accuracy criterion (<200μm), and the noise criterion (<55HU). Only the imaging protocol with 200-μm voxel size passed the criterion for spatial resolution in the longitudinal direction (>1.5lp/mm @ 0.2MTF). The 70-kV tube voltage dataset failed the bone CT number consistency test (<55HU). Due to cupping artifacts, none of the imaging protocols passed the uniformity test of <55HU. When the phantom was scanned in the standard imaging geometry, image uniformity and longitudinal MTF were satisfactory; however, the CT number consistency failed the recommended limit. A targeting accuracy of 282 and 251μm along the x- and z-direction was observed. Monte Carlo simulations confirmed that the radial spatial resolution for images acquired in the pancake geometry was higher than the one acquired in the standard geometry. The new 3D-printed phantom presents a useful tool for microCT image analysis as it closely mimics a mouse. In order to image mouse-sized animals with acceptable image quality, the standard protocol with a 200-μm voxel size should be chosen and cupping artifacts need to be resolved.

Semi-automated IGRT QA using a cone-shaped scintillator screen detector for proton pencil beam scanning treatments

To promote accurate image-guided radiotherapy (IGRT) for a proton pencil beam scanning (PBS) system, a new quality assurance (QA) procedure employing a cone-shaped scintillator detector has been developed for multiple QA tasks in a semi-automatic manner. The cone-shaped scintillator detector (XRV-124, Logos Systems, CA) is sensitive to both x-ray and proton beams. It records scintillation on the cone surface as a 2D image, from which the geometry of the radiation field that enters and exits the cone can be extracted. Utilizing this feature, QA parameters that are essential to PBS IGRT treatment were measured and analyzed. The first applications provided coincidence checks of laser, imaging and radiation isocenters, and dependencies on gantry angle and beam energies. The analysis of the Winston–Lutz test was made available by combining the centricity measurements of the x-ray beam and the pencil beam. The accuracy of the gantry angle was validated against console readings provided by the digital encoder and an agreement of less than 0.2° was found. The accuracy of the position measurement was assessed with a robotic patient positioning system (PPS) and an agreement of less than 0.5 mm was obtained. The centricity of the two onboard x-ray imaging systems agreed well with that from the routinely used Digital Imaging Positioning System (DIPS), up to a consistent small shift of (−0.5 mm, 0.0 mm, −0.3 mm). The pencil beam spot size, in terms of σ of Gaussian fitting, agreed within 0.2 mm for most energies when compared to the conventional measurements by a 2D ion-chamber array (MatriXX-PT, IBA Dosimetry, Belgium). The cone-shaped scintillator system showed advantages in making multi-purpose measurements with a single setup. The in-house algorithms were successfully implemented to measure and analyze key QA parameters in a semi-automatic manner. This study presents an alternative and more efficient approach for IGRT QA for PBS and potentially for linear accelerators.

Development and long-term stability of a comprehensive daily QA program for a modern pencil beam scanning (PBS) proton therapy delivery system.

PurposeThe main purpose of this study is to demonstrate the clinical implementation of a comprehensive pencil beam scanning (PBS) daily quality assurance (QA) program involving a number of novel QA devices including the Sphinx/Lynx/parallel‐plate (PPC05) ion chamber and HexaCheck/multiple imaging modality isocentricity (MIMI) imaging phantoms. Additionally, the study highlights the importance of testing the connectivity among oncology information system (OIS), beam delivery/imaging systems, and patient position system at a proton center with multi‐vendor equipment and software.MethodsFor dosimetry, a daily QA plan with spot map of four different energies (106, 145, 172, and 221 MeV) is delivered on the delivery system through the OIS. The delivery assesses the dose output, field homogeneity, beam coincidence, beam energy, width, distal‐fall‐off (DFO), and spot characteristics — for example, position, size, and skewness. As a part of mechanical and imaging QA, a treatment plan with the MIMI phantom serving as the patient is transferred from OIS to imaging system. The HexaCheck/MIMI phantoms are used to assess daily laser accuracy, imaging isocenter accuracy, image registration accuracy, and six‐dimensional (6D) positional correction accuracy for the kV imaging system and robotic couch.ResultsThe daily QA results presented herein are based on 202 daily sets of measurements over a period of 10 months. Total time to perform daily QA tasks at our center is under 30 min. The relative difference (Δrel) of daily measurements with respect to baseline was within ± 1% for field homogeneity, ±0.5 mm for range, width and DFO, ±1 mm for spots positions, ±10% for in‐air spot sigma, ±0.5 spot skewness, and ±1 mm for beam coincidence (except 1 case: Δrel = 1.3 mm). The average Δrel in dose output was −0.2% (range: −1.1% to 1.5%). For 6D IGRT QA, the average absolute difference (Δabs) was ≤0.6 ± 0.4 mm for translational and ≤0.5° for rotational shifts.ConclusionThe use of novel QA devices such as the Sphinx in conjunction with the Lynx, PPC05 ion chamber, HexaCheck/MIMI phantoms, and myQA software was shown to provide a comprehensive and efficient method for performing daily QA of a number of system parameters for a modern proton PBS‐dedicated treatment delivery unit.

Characterization of a prototype rapid kilovoltage x-ray image guidance system designed for a ring shape radiation therapy unit.

This study aims to characterize the performance of a prototype rapid kilovoltage (kV) x-ray image guidance system onboard the newly released Halcyon 2.0 linear accelerator (Varian Medical Systems, Palo Alto, CA) by use of conventional and innovatively designed testing procedures. Basic imaging system performance tests and radiation dose measurements were performed for all eleven kV-cone beam computed tomography (CBCT) imaging protocols available on a preclinical Halcyon 2.0 LINAC. Both conventional CBCT reconstruction using the Feldkamp-Davis-Kress (FDK) algorithm and a novel, advanced iterative reconstruction (iCBCT) available on this platform were evaluated. Standard image quality metrics, including slice thickness accuracy, high-contrast resolution, low-contrast resolution, regional uniformity and noise, and CT Hounsfield unit (HU) number accuracy and linearity were evaluated using a manufacturer-supplied QUART phantom (GmbH, Zorneding, Germany) and an independent image quality phantom (Catphan 500, The Phantom Laboratory, New York, NY). Due to the simplified design of the QUART phantom, we developed surrogate and clinically feasible strategies for measuring slice thickness and high- and low-contrast resolution. Imaging dose delivered by these eleven protocols was measured using a computed tomography dose index phantom and pencil chamber with commonly accepted methods and procedures. A subset of measurements were repeated on a conventional C-arm LINAC (TrueBeam and Trilogy, Varian Medical System) for comparison. Clinical patient images of pelvic and abdominal regions are also presented for qualitative assessment as part of a feasibility study for clinical implementation. Image acquisition time was 17-42s on the Halcyon system compared with 60s on the C-arm LINAC systems. The kV imager projection offset, imaging and treatment isocenter coincidence and the couch three-dimensional match movement all achieved less than1mm mechanical accuracy. All major image quality metrics were within either the national guideline or vendor-recommended tolerances. The designed surrogate approach with the QUART phantom showed a range of 0.24-0.35cycles/mm for spatial resolution, a contrast-to-noise ratio (CNR) of 2-20 for FDK reconstruction and a tolerance of 0.5mm for slice thickness. Other metrics derived from the Catphan images obtained on the Halcyon and C-arm LINACs showed comparable values for the FDK reconstruction. The iterative reconstruction tended to reduce noise, as evidenced by a higher CNR ratio. The fast scan pelvis protocols for Halcyon resulted in 50% lower dose compared to the standard scans, and the thorax fast protocol similarly delivered 10% lower dose than the standard thoracic scan. Preliminary patient images indicated that rapid kV CBCT with breath-hold is feasible, with improved imaging quality compared to free-breathing scans. Independent and comprehensive characterization of the kV imaging guidance system on the Halcyon 2.0 system demonstrated acceptable image quality for clinical use. The imaging unit onboard the Halcyon meets vendor specifications and satisfies requirements for routine clinical use. The fast kV imaging system enables the potential for volumetric CBCT acquisition during a single breath-hold and the iterative reconstruction tends to reduce the noise therefore has the potential to improve the CNR for normal size patient.

A Method to Determine the Coincidence of MRI-Guided Linac Radiation and Magnetic Isocenters.

To assure accurate treatment delivery on any image-guided radiotherapy system, the relative positions and walkout of the imaging and radiation isocenters must be periodically verified and kept within specified tolerances. In this work, we first validated the multiaxis ion chamber array as a tool for finding the radiation isocenter position of a magnetic resonance–guided linear accelerator. The treatment couch with the array on it was shifted in 0.2-mm increments and the reported beam center position was plotted against that shift and fitted to a straight line, in both X and Y directions. From the goodness-of-fit and intercepts of the regression lines, the accuracy and precision were conservatively estimated at 0.2 and 0.1 mm, respectively. This holds true whether the array is irradiated from the front or from the back, which allows efficient collecting the data from the 4 cardinal gantry angles with just 2 array positions. The average isocenter position agreed to within at most 0.4 mm along any cardinal axis with the linac vendor’s film-based procedure, and the maximum walkout radii were 0.32 mm and 0.53 mm, respectively. The magnetic resonance imaging isocenter walkout as a function of gantry angle was studied with 2 different phantoms, one employing a single fiducial at the center and another extracting the rigid displacement values from the distortion map fit of 523 fiducials dispersed over a large volume. The results were close between the 2 phantoms and demonstrated variation in the magnetic resonance imaging isocenter location as high as 1.3 mm along a single axis in the transverse plane. Verification of the magnetic resonance imaging isocenter location versus the gantry angle should be a part of quality assurance for magnetic resonance-guided linear accelerators.

Toward adaptive proton therapy guided with a mobile helical CT scanner

PurposeTo evaluate the feasibility of image-guided adaptive proton therapy (IGAPT) with a mobile helical-CT without rails. MethodCT images were acquired with a 32-slice mobile CT (mCT) scanning through a 6 degree-of-freedom robotic couch rotated isocentrically 90 degrees from an initial setup position. The relationship between the treatment isocenter and the mCT imaging isocenter was established by a stereotactic reference frame attached to the treatment couch. Imaging quality, geometric integrity and localization accuracy were evaluated according to AAPM TG-66. Accuracy of relative stopping power ratio (RSPR) was evaluated by comparing water equivalent distance (WED) and dose calculations on anthropomorphic phantoms to that of planning CT (pCT). Feasibility of image-guided adaptive proton therapy was demonstrated on fractional images acquired with the mCT scanner. ResultsmCT images showed slightly lower spatial resolution and a higher contrast-to-noise ratio compared to pCT images from the standard helical CT scanner. The geometric accuracy of the mCT was <1 mm. Localization accuracy was <0.4 mm and <0.3° with respect to 2DkV/kV matching. WED differences between mCT and pCT images were negligible, with discrepancies of 0.8 ± 0.6 mm and 1.3 ± 0.9 mm for brain and lung phantoms respectively. 3D gamma analysis (3% and 3 mm) passing rate was >95% on dose computed on mCT, with respect to dose calculation on pCT. ConclusionOur study has demonstrated that the geometric integrity, image quality and RSPR accuracy of the mCT are sufficient for IGAPT.

An end-to-end postal audit test to examine the coincidence between the imaging isocenter and treatment beam isocenter of the IGRT linac system for Japan Clinical Oncology Group (JCOG) clinical trials

PurposeThe aim of this study was to develop an end-to-end postal audit test to examine the coincidence between the imaging isocenter and treatment beam isocenter of the image guided radiotherapy (IGRT) linac system for Japan Clinical Oncology Group (JCOG) trials, as a part of IGRT credentialing of institutions participating in JCOG trials. MethodsWe developed an end-to-end postal audit test to verify radiation positional errors associated with IGRT techniques. This test is intended for simulating a clinical IGRT flow and uses a static cubic phantom measuring 15 × 15 × 15 cm3 and weighing approximately 3.4 kg. The phantom has four gold fiducial markers and a spherical dummy target for setup, with known shift values from the phantom center. Two pairs of Gafchromic RTQA2 films were inserted 5 mm from the phantom’s anterior-posterior and right-left surfaces. Radiation positional errors at the isocenter were determined by analyzing the center of the radiation field on the films and the known shift values of the dummy target. The test was performed on 47 IGRT devices at 35 institutions. ResultsRadiation positional errors were within acceptance levels (1 mm/1°) for 42 IGRT devices (89.4%) in the first check. Median time to complete IGRT credentialing was 11.5 days. This audit method was applicable for any radiotherapy machine with an IGRT device. ConclusionsA postal audit test to verify radiation positional errors for JCOG trials was successfully developed. In the postal audit, all but one institution passed this credentialing item within two trials.

Feasibility of polymer gel-based measurements of radiation isocenter accuracy in magnetic fields

For conventional irradiation devices, the radiation isocenter accuracy is determined by star shot measurements on films. In magnetic resonance (MR)-guided radiotherapy devices, the results of this test may be altered by the magnetic field and the need to align the radiation and imaging isocenter may require a modification of measurement procedures. Polymer dosimetry gels (PG) may offer a way to perform both, the radiation and imaging isocenter test, however, first it has to be shown that PG reveal results comparable to the conventionally applied films. Therefore, star shot measurements were performed at a linear accelerator using PG as well as radiochromic films. PG were evaluated using MR imaging and the isocircle radius and the distance between the isocircle center and the room isocenter were determined. Two different types of experiments were performed: i) a standard star-shot isocenter test and (ii) a star shot, where the detectors were placed between the pole shoes of an experimental electro magnet operated either at 0 T or 1 T. For the standard star shot, PG evaluation was independent of the time delay after irradiation (1 h, 24 h, 48 h and 216 h) and the results were comparable to those of film measurements. Within the electro magnet, the isocircle radius increased from 0.39 ± 0.01 mm to 1.37 ± 0.01 mm for the film and from 0.44 ± 0.02 mm to 0.97 ± 0.02 mm for the PG-measurements, respectively. The isocenter distance was essentially dependent on the alignment of the magnet to the isocenter and was between 0.12 ± 0.02 mm and 0.82 ± 0.02 mm. The study demonstrates that evaluation of the PG directly after irradiation is feasible, if only geometrical parameters are of interest. This allows using PG for star shot measurements to evaluate the radiation isocenter accuracy with comparable accuracy as with radiochromic films.

Normal tissue doses from MV image-guided radiation therapy (IGRT) using orthogonal MV and MV-CBCT.

PurposeThe aim of this study was to measure and compare the mega‐voltage imaging dose from the Halcyon medical linear accelerator (Varian Medical Systems) with measured imaging doses with the dose calculated by Eclipse treatment planning system.MethodsAn anthropomorphic thorax phantom was imaged using all imaging techniques available with the Halcyon linac — MV cone‐beam computed tomography (MV‐CBCT) and orthogonal anterior‐posterior/lateral pairs (MV‐MV), both with high‐quality and low‐dose modes. In total, 54 imaging technique, isocenter position, and field size combinations were evaluated. The imaging doses delivered to 11 points in the phantom (in‐target and extra‐target) were measured using an ion chamber, and compared with the imaging doses calculated using Eclipse.ResultsFor high‐quality MV‐MV mode, the mean extra‐target doses delivered to the heart, left lung, right lung and spine were 1.18, 1.64, 0.80, and 1.11 cGy per fraction, respectively. The corresponding mean in‐target doses were 3.36, 3.72, 2.61, and 2.69 cGy per fraction, respectively. For MV‐MV technique, the extra‐target imaging dose had greater variation and dependency on imaging field size than did the in‐target dose. Compared to MV‐MV technique, the imaging dose from MV‐CBCT was less sensitive to the location of the organ relative to the treatment field. For high‐quality MV‐CBCT mode, the mean imaging doses to the heart, left lung, right lung, and spine were 8.45, 7.16, 7.19, and 6.51 cGy per fraction, respectively. For both MV‐MV and MV‐CBCT techniques, the low‐dose mode resulted in an imaging dose about half of that in high‐quality mode.ConclusionThe in‐target doses due to MV imaging using the Halcyon ranged from 0.59 to 9.75 cGy, depending on the choice of imaging technique. Extra‐target doses from MV‐MV technique ranged from 0 to 2.54 cGy. The MV imaging dose was accurately calculated by Eclipse, with maximum differences less than 0.5% of a typical treatment dose (assuming a 60 Gy prescription). Therefore, the cumulative imaging and treatment plan dose distribution can be expected to accurately reflect the actual dose.

Stability assessment of radiation isocenter with the gimbaled linac system

Purpose: We report the results of our year-long radiation isocenter accuracy verification for daily quality assurance (QA) implementation on a Vero4DRT system. Methods: The radiation isocenter was calculated using a cube phantom with a steel ball of diameter 10 mm fixed to the center of the phantom. A single photon beam was set with a field size of 100 × 100 mm 2 . Coincidence of the centroid of the steel ball at kiloVolt X-ray imaging isocenter and megaVolt beam radiation isocenter at each gantry and ring angle was tested. This procedure was performed for gantry angles of 0°, 90°, 180°, and 270°, and ring angles of 0°, 20°, and 340°. The centroid of the steel ball and the center of the radiation field were calculated to analyze the radiation isocenter error. This analysis was automatically calculated using the Daily Check tool in the Vero4DRT system. This QA was implemented between 24 August 2015 and 23 August 2016. Results: The average and standard deviation for pan and tilt directions were 0.12 ± 0.10 mm and -0.20 ± 0.13 mm, respectively. The maximum radiation isocenter accuracy error was 0.50 mm in both directions. Conclusion: The radiation isocenter alignment for the one year duration of the experiment was performed with high accuracy.

Beam focal spot position: The forgotten linac QA parameter. An EPID-based phantomless method for routine Stereotactic linac QA.

Modern day Stereotactic treatments require high geometric accuracy of the delivered treatment. To achieve the required accuracy the IGRT imaging isocenter needs to closely coincide with the treatment beam isocenter. An influence on this isocenter coincidence and on the spatial positioning of the beam itself is the alignment of the treatment beam focal spot with collimator rotation axis. The positioning of the focal spot is dependent on the linac beam steering and on the stability of the monitor chamber and beam steering servo system. As such, there is the potential for focal spot misalignment and this should be checked on a regular basis. Traditional methods for measuring focal spot position are either indirect, inaccurate, or time consuming and hence impractical for routine use. In this study a novel, phantomless method has been developed using the EPID (Electronic Portal Imaging Device) that utilizes the different heights of the MLC and jaws. The method has been performed on four linear accelerators and benchmarked against an alternate ion chamber‐based method. The method has been found to be reproducible to within ±0.012 mm (1 SD) and in agreement with the ion chamber‐based method to within 0.001 ± 0.015 mm (1 SD). The method could easily be incorporated into a departmental routine linac QA (Quality Assurance) program.

EP-1746: A new method for exact co-calibration of the ExacTrac X-ray system and linac imaging isocenter

EP-1746: A new method for exact co-calibration of the ExacTrac X-ray system and linac imaging isocenter

Quantitative Approach to Failure Mode and Effect Analysis for Linear Accelerator Quality Assurance

To determine clinic-specific linear accelerator quality assurance (QA) TG-142 test frequencies, to maximize physicist time efficiency and patient treatment quality. A novel quantitative approach to failure mode and effect analysis is proposed. Nine linear accelerator-years of QA records provided data on failure occurrence rates. The severity of test failure was modeled by introducing corresponding errors into head and neck intensity modulated radiation therapy treatment plans. The relative risk of daily linear accelerator QA was calculated as a function of frequency of test performance. Although the failure severity was greatest for daily imaging QA (imaging vs treatment isocenter and imaging positioning/repositioning), the failure occurrence rate was greatest for output and laser testing. The composite ranking results suggest thatperforming output and lasers tests daily, imaging versus treatment isocenter and imaging positioning/repositioning tests weekly, and optical distance indicator and jaws versus light field tests biweekly would be acceptable for non-stereotactic radiosurgery/stereotactic body radiation therapy linear accelerators. Failure mode and effect analysis is a useful tool to determine the relative importance of QA tests from TG-142. Because there are practical time limitations on how many QA tests can be performed, this analysis highlights which tests are the mostimportant and suggests the frequency of testing based on each test's risk priority number.

Quantification of local geometric distortion in structural magnetic resonance images: Application to ultra-high fields

Ultra-high field magnetic resonance imaging (MRI) provides superior visualization of brain structures compared to lower fields, but images may be prone to severe geometric inhomogeneity. We propose to quantify local geometric distortion at ultra-high fields in in vivo datasets of human subjects scanned at both ultra-high field and lower fields. By using the displacement field derived from nonlinear image registration between images of the same subject, focal areas of spatial uncertainty are quantified. Through group and subject-specific analysis, we were able to identify regions systematically affected by geometric distortion at air-tissue interfaces prone to magnetic susceptibility, where the gradient coil non-linearity occurs in the occipital and suboccipital regions, as well as with distance from image isocenter. The derived displacement maps, quantified in millimeters, can be used to prospectively evaluate subject-specific local spatial uncertainty that should be taken into account in neuroimaging studies, and also for clinical applications like stereotactic neurosurgery where accuracy is critical. Validation with manual fiducial displacement demonstrated excellent correlation and agreement. Our results point to the need for site-specific calibration of geometric inhomogeneity. Our methodology provides a framework to permit prospective evaluation of the effect of MRI sequences, distortion correction techniques, and scanner hardware/software upgrades on geometric distortion.

SU-G-JeP2-12: Quantification of 3D Geometric Distortion for 1.5T and 3T MRI Scanners Used for Radiation Therapy

Purpose: To quantify the magnitude of geometric distortion for MRI scanners and provide recommendations for MRI imaging for radiation therapy Methods: A novel phantom, QUASAR MRID3D [Modus Medical Devices Inc.], was scanned to evaluate the level of 3D geometric distortion present in five MRI scanners used for radiation therapy in our department. The phantom was scanned using the body coil with 1mm image slice thickness to acquire 3D images of the phantom body. The phantom was aligned to its geometric center for each scan, and the field of view was set to visualize the entire phantom. The dependence of distortion magnitude with distance from imaging isocenter and with magnetic field strength (1.5T and 3T) was investigated. Additionally, the characteristics of distortion for Siemens and GE machines were compared. The image distortion for each scanner was quantified in terms of mean, standard deviation (STD), maximum distortion, and skewness. Results: The 3T and 1.5T scans show a similar absolute distortion with a mean of 1.38mm (0.33mm STD) for 3T and 1.39mm (0.34mm STD) for 1.5T for a 100mm radius distance from isocenter. Some machines can have a distortion larger than 10mm at a distance of 200mm from the isocenter. The distortions are presented with plots of the x, y, and z directional components. Conclusion: The results indicate that quantification of MRI image distortion is crucial in radiation oncology for target and organ delineation and treatment planning. The magnitude of geometric distortion determines the margin needed for target contouring which is usually neglected in treatment planning process, especially for SRS/SBRT treatments. Understanding the 3D distribution of the MRI image distortion will improve the accuracy of target delineation and, hence, treatment efficacy. MRI imaging with proper patient alignment to the isocenter is vital to reducing the effects of MRI distortion in treatment planning.

SU‐F‐T‐160: Commissioning of a Single‐Room Double‐Scattering Proton Therapy System

Purpose:To report the detailed commissioning experience for a compact double‐scattering Mevion S250 proton therapy system at a University Cancer Center site.Methods:The commissioning of the proton therapy system mainly consisted of ensuring integrity of mechanical and imaging system, beam data collection, and commissioning of a treatment planning system (TPS). First, mechanical alignment and imaging were tested including safety, interlocks, positional accuracy of couch and gantry, image quality, mechanical and imaging isocenter and so on. Second, extensive beam data (outputs, PDDs, and profiles) were collected and analyzed through effective sampling of range (R) and modulation width (M) from 24 beam options. Three different output (cGy/MU) prediction models were also commissioned as primary and secondary MU calculation tool. Third, the Varian Eclipse TPS was commissioned through five sets of data collections (in‐water Bragg peak scans, in‐air longitudinal fluence scans, in‐air lateral profiles, in‐air half‐beam profiles, and an HU‐to‐stopping‐power conversion curve) and accuracy of TPS calculation was tested using in‐water scans and dose measurements with a 2D array detector with block and range compensator. Finally, an anthropomorphic phantom was scanned and heterogeneity effects were tested by inserting radiochromic films in the phantom and PET activation scans for range verification in conjunction with end‐to‐end test.Results:Beam characteristics agreed well with the vendor specifications; however, minor mismatches in R and M were found in some measurements during the beam data collection. These were reflected into the TPS commissioning such that the TPS could accurately predict the R and M within tolerance levels. The output models had a good agreement with measured outputs (&lt;3% error). The end‐to‐end test using the film and PET showed reasonably the TPS predicted dose, R and M in heterogeneous medium.Conclusion:The proton therapy system was successfully commissioned and was released for clinical use.