Commissioning and quality assurance for VMAT delivery systems: An efficient time-resolved system using real-time EPID imaging. 2017

Benjamin J Zwan, and Michael P Barnes, and Jonathan Hindmarsh, and Seng B Lim, and Dale M Lovelock, and Todsaporn Fuangrod, and Daryl J O'Connor, and Paul J Keall, and Peter B Greer
Central Coast Cancer Centre, Gosford Hospital, Gosford, NSW, 2250, Australia.

OBJECTIVE An ideal commissioning and quality assurance (QA) program for Volumetric Modulated Arc Therapy (VMAT) delivery systems should assess the performance of each individual dynamic component as a function of gantry angle. Procedures within such a program should also be time-efficient, independent of the delivery system and be sensitive to all types of errors. The purpose of this work is to develop a system for automated time-resolved commissioning and QA of VMAT control systems which meets these criteria. METHODS The procedures developed within this work rely solely on images obtained, using an electronic portal imaging device (EPID) without the presence of a phantom. During the delivery of specially designed VMAT test plans, EPID frames were acquired at 9.5 Hz, using a frame grabber. The set of test plans was developed to individually assess the performance of the dose delivery and multileaf collimator (MLC) control systems under varying levels of delivery complexities. An in-house software tool was developed to automatically extract features from the EPID images and evaluate the following characteristics as a function of gantry angle: dose delivery accuracy, dose rate constancy, beam profile constancy, gantry speed constancy, dynamic MLC positioning accuracy, MLC speed and acceleration constancy, and synchronization between gantry angle, MLC positioning and dose rate. Machine log files were also acquired during each delivery and subsequently compared to information extracted from EPID image frames. RESULTS The largest difference between measured and planned dose at any gantry angle was 0.8% which correlated with rapid changes in dose rate and gantry speed. For all other test plans, the dose delivered was within 0.25% of the planned dose for all gantry angles. Profile constancy was not found to vary with gantry angle for tests where gantry speed and dose rate were constant, however, for tests with varying dose rate and gantry speed, segments with lower dose rate and higher gantry speed exhibited less profile stability. MLC positional accuracy was not observed to be dependent on the degree of interdigitation. MLC speed was measured for each individual leaf and slower leaf speeds were shown to be compensated for by lower dose rates. The test procedures were found to be sensitive to 1 mm systematic MLC errors, 1 mm random MLC errors, 0.4 mm MLC gap errors and synchronization errors between the MLC, dose rate and gantry angle controls systems of 1°. In general, parameters measured by both EPID and log files agreed with the plan, however, a greater average departure from the plan was evidenced by the EPID measurements. CONCLUSIONS QA test plans and analysis methods have been developed to assess the performance of each dynamic component of VMAT deliveries individually and as a function of gantry angle. This methodology relies solely on time-resolved EPID imaging without the presence of a phantom and has been shown to be sensitive to a range of delivery errors. The procedures developed in this work are both comprehensive and time-efficient and can be used for streamlined commissioning and QA of VMAT delivery systems.

UI MeSH Term Description Entries
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012984 Software Sequential operating programs and data which instruct the functioning of a digital computer. Computer Programs,Computer Software,Open Source Software,Software Engineering,Software Tools,Computer Applications Software,Computer Programs and Programming,Computer Software Applications,Application, Computer Software,Applications Software, Computer,Applications Softwares, Computer,Applications, Computer Software,Computer Applications Softwares,Computer Program,Computer Software Application,Engineering, Software,Open Source Softwares,Program, Computer,Programs, Computer,Software Application, Computer,Software Applications, Computer,Software Tool,Software, Computer,Software, Computer Applications,Software, Open Source,Softwares, Computer Applications,Softwares, Open Source,Source Software, Open,Source Softwares, Open,Tool, Software,Tools, Software
D050397 Radiotherapy, Intensity-Modulated CONFORMAL RADIOTHERAPY that combines several intensity-modulated beams to provide improved dose homogeneity and highly conformal dose distributions. Helical Tomotherapy,Intensity-Modulated Arc Therapy,Volumetric-Modulated Arc Therapy,Arc Therapies, Intensity-Modulated,Arc Therapies, Volumetric-Modulated,Arc Therapy, Intensity-Modulated,Arc Therapy, Volumetric-Modulated,Helical Tomotherapies,Intensity Modulated Arc Therapy,Intensity-Modulated Arc Therapies,Intensity-Modulated Radiotherapies,Intensity-Modulated Radiotherapy,Radiotherapies, Intensity-Modulated,Radiotherapy, Intensity Modulated,Therapies, Intensity-Modulated Arc,Therapies, Volumetric-Modulated Arc,Therapy, Intensity-Modulated Arc,Therapy, Volumetric-Modulated Arc,Tomotherapies, Helical,Tomotherapy, Helical,Volumetric Modulated Arc Therapy,Volumetric-Modulated Arc Therapies
D055615 Electrical Equipment and Supplies Apparatus and instruments that generate and operate with ELECTRICITY, and their electrical components. Electronic Equipment and Supplies
D056888 Patient Positioning Moving a patient into a specific position or POSTURE to facilitate examination, surgery, or for therapeutic purposes. Patient Positionings,Positioning, Patient,Positionings, Patient
D019047 Phantoms, Imaging Devices or objects in various imaging techniques used to visualize or enhance visualization by simulating conditions encountered in the procedure. Phantoms are used very often in procedures employing or measuring x-irradiation or radioactive material to evaluate performance. Phantoms often have properties similar to human tissue. Water demonstrates absorbing properties similar to normal tissue, hence water-filled phantoms are used to map radiation levels. Phantoms are used also as teaching aids to simulate real conditions with x-ray or ultrasonic machines. (From Iturralde, Dictionary and Handbook of Nuclear Medicine and Clinical Imaging, 1990) Phantoms, Radiographic,Phantoms, Radiologic,Radiographic Phantoms,Radiologic Phantoms,Phantom, Radiographic,Phantom, Radiologic,Radiographic Phantom,Radiologic Phantom,Imaging Phantom,Imaging Phantoms,Phantom, Imaging

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