Quality Assurance of Volumetric Modulated Arc Therapy for Elekta Synergy / 의학물리

For applying the quality assurance (QA) of volumetric modulated arc therapy (VMAT) introduced in Eulji Hospital, we classify it into three different QA steps, treatment planning QA, pretreatment delivering QA, and treatment verifying QA. These steps are based on the existing intensity modulated radiation therapy (IMRT) QA that is currently used in our hospital. In each QA step, the evaluated items that are from QA program are configured and documented. In this study, QA program is not only applied to actual patient treatment, but also evaluated to establish a reference of clinical acceptance in pretreatment delivering QA. As a result, the confidence limits (CLs) in the measurements for the high-dose and low-dose regions are similar to the conventional IMRT level, and the clinical acceptance references in our hospital are determined to be 3 to 5% for the high-dose and the low-dose regions, respectively. Due to the characteristics of VMAT, evaluation of the intensity map was carried out using an ArcCheck device that was able to measure the intensity map in all directions, 360degrees. With a couple of dosimetric devices, the gamma index was evaluated and analyzed. The results were similar to the result of individual intensity maps in IMRT. Mapcheck, which is a 2-dimensional (2D) array device, was used to display the isodose distributions and gave very excellent local CL results. Thus, in our hospital, the acceptance references used in practical clinical application for the intensity maps of 360degrees directions and the coronal isodose distributions were determined to be 93% and 95%, respectively. To reduce arbitrary uncertainties and system errors, we had to evaluate the local CLs by using a phantom and to cooperate with multiple organizations to participate in this evaluation. In addition, we had to evaluate the local CLs by dividing them into different sections about the patient treatment points in practical clinics.

A Pilot Research for Real-Time Specific Patient Quality Assurance Using the Hybrid Optimized Vmat Phantom (Hovp) in Volume Modulated Arc Therapy / 의학물리

The purpose of this was to investigate the measurement of fluence dose map for the specific patient quality assurance. The measurement of fluence map was performed using 2D matrixx detector. The absorbed dose was measured by a glass detector, Gafchromic film and ion chamber in Hybrid Optimized VMAT Phantom (HOVP). For 2D Matrixx, the results of comparison were average passing rate 85.22%+/-1.7 (RT_Target), 89.96%+/-2.15 (LT_Target) and 95.14%+/-1.18 (G4). The dose difference was 11.72%+/-0.531, -11.47%+/-0.991, 7.81%+/-0.857, -4.14%+/-0.761 at the G1, G2, G3, G4. In HOVP, the results of comparison for film were average passing rate (3%, 3 mm) 93.64%+/-3.87, 90.82%+/-0.99. We were measured an absolute dose in steep gradient area G1, G2, G3, G4 using the glass detector. The difference between the measurement and calculation are 8.3% (G1), -5.4% (G2), 6.1% (G3), 7.2% (G4). The using an Ion-chamber were an average relative dose error -1.02%+/-0.222 (Rt_target), 0.96%+/-0.294 (Lt_target). Though we need a more study using a transmission detector. However, a measurement of real-time fluence map will be predicting a dose for real-time specific patient quality assurance in volume modulated arc therapy.

Evaluation of Real-time Measurement Liver Tumor's Movement and Synchrony(TM) System's Accuracy of Radiosurgery using a Robot CyberKnife / 대한방사선종양학회지

PURPOSE: This study aimed to quantitatively measure the movement of tumors in real-time and evaluate the treatment accuracy, during the treatment of a liver tumor patient, who underwent radiosurgery with a Synchrony Respiratory motion tracking system of a robot CyberKnife. MATERIALS AND METHODS: The study subjects included 24 liver tumor patients who underwent CyberKnife treatment, which included 64 times of treatment with the Synchrony Respiratory motion tracking system (Synchrony(TM)). The treatment involved inserting 4 to 6 acupuncture needles into the vicinity of the liver tumor in all the patients using ultrasonography as a guide. A treatment plan was set up using the CT images for treatment planning uses. The position of the acupuncture needle was identified for every treatment time by Digitally Reconstructed Radiography (DRR) prepared at the time of treatment planning and X-ray images photographed in real-time. Subsequent results were stored through a Motion Tracking System (MTS) using the Mtsmain.log treatment file. In this way, movement of the tumor was measured. Besides, the accuracy of radiosurgery using CyberKnife was evaluated by the correlation errors between the real-time positions of the acupuncture needles and the predicted coordinates. RESULTS: The maximum and the average translational movement of the liver tumor were measured 23.5 mm and 13.9+/-5.5 mm, respectively from the superior to the inferior direction, 3.9 mm and 1.9+/-0.9 mm, respectively from left to right, and 8.3 mm and 4.9+/-1.9 mm, respectively from the anterior to the posterior direction. The maximum and the average rotational movement of the liver tumor were measured to be 3.3degrees and 2.6+/-1.3degrees, respectively for X (Left-Right) axis rotation, 4.8degrees and 2.3+/-1.0degrees, respectively for Y (Cranio-Caudal) axis rotation, 3.9degrees and 2.8+/-1.1degrees, respectively for Z (Anterior-Posterior) axis rotation. In addition, the average correlation error, which represents the treatment's accuracy was 1.1+/-0.7 mm. CONCLUSION: In this study real-time movement of a liver tumor during the radiosurgery could be verified quantitatively and the accuracy of the radiosurgery with the Synchrony Respiratory motion tracking system of robot could be evaluated. On this basis, the decision of treatment volume in radiosurgery or conventional radiotherapy and useful information on the movement of liver tumor are supposed to be provided.

The Effect of the CT Number for Each CT on Dose Calculation / 의학물리

The CT number corresponds to electron density and its influence on dose calculation was studied. Five kinds of CT scanners were used to obtain images of electron density calibration phantom (Gammex RMI 467). Then the differences between CT numbers for each scanners were +/-2% in homogeneous medium and 9.5% in high density medium. In order to investigate the influence of CT number to dose calculation, patients' thoracic CT images were analyzed. The maximum dose difference was 0.48% for each organ. It acquired the phantom images inserted high density material in the water phantom. Comparing the doses calculated with CT images from each CT scanner, the maximum dose difference was 2.1% in 20 cm in depth. The exact density to CT number conversion according to CT scanner is required to minimize the uncertainty of dose depends on CT number. Especially the each hospital with various CT scanners has to discriminate CT numbers for each CT scanner. Moreover a periodic quality assurance is required for reproducibility of CT number.

A CT Simulator Phantom for Geometrical Test / 대한방사선종양학회지

PURPOSE: To design and test the CT simulator phantom for geometrical test. MATERIAL AND METHODS: The PMMA phantom was designed as a cylinder which is 20 cm in diameter and 24 cm in length, along with a 25x25x31 cm3 rectangular parallelepiped. Radio-opaque wires of which diameter is 0.8 mm are attached on the other surface of the phantom as a spiral. The rectangular phantom was made of four 24x24x0.5 cm3 square plates and each plate had a 24x24 cm2, 12x12 cm2, 6x6 cm2 square line. The squares were placed to face the cylinder at angles 0degrees, 15degrees, 30degrees, respectively. The rectangular phantom made it possible to measure the field size, couch angle, the collimator angle, the isocenter shift and the SSD, the measurements of the gantry angle from the cylindrical part. A virtual simulation software, AcQSimTM, offered various conditions to perform virtual simulations and these results were used to perform the geometrical quality assurance of CT simulator. RESULTS: A 0.3~0.5 mm difference was found on the 24 cm field size which was created with the DRR measurements obtained by scanning of the rectangular phantom. The isocenter shift, the collimator rotation, the couch rotation, and the gantry rotation test showed 0.5~1 mm, 0.5~1degrees0.5~1degrees, and 0.5~ 1degreesdifferences, respectively. We could not find any significant differences between the results from the two scanning methods. CONCLUSION: The geometrical test phantom developed in the study showed less than 1 mm (or 1degrees) differences. The phantom could be used as a routine geometrical QC/QA tools, since the differences are within clinically acceptable ranges.