Hans Lynggaard Riis

A comprehensive study of the mechanical performance of gantry, EPID and the MLC assembly in Elekta linacs during gantry rotation

OBJECTIVE In radiotherapy treatments, it is crucial to monitor the performance of linear accelerator (linac) components, including gantry, collimation system and electronic portal imaging device (EPID) during arc deliveries. In this study, a simple EPID-based measurement method is suggested in conjunction with an algorithm to investigate the stability of these systems at various gantry angles with the aim of evaluating machine-related errors in treatments. METHODS The EPID sag, gantry sag, changes in source-to-detector distance (SDD), EPID and collimator skewness, EPID tilt and the sag in leaf bank assembly owing to linac rotation were separately investigated by acquisition of 37 EPID images of a simple phantom with 5 ball bearings at various gantry angles. A fast and robust software package was developed for automated analysis of the image data. Nine Elekta AB (Stockholm, Sweden) linacs of different models and number of years in service were investigated. RESULTS The average EPID sag was within 2 mm for all tested linacs. Some machines showed >1-mm gantry sag. Changes in the SDD values were within 1.3 cm. EPID skewness and tilt values were <1° in all machines. The maximum sag in multileaf collimator leaf bank assemblies was around 1 mm. A meaningful correlation was found between the age of the linacs and their mechanical performance. Conclusions and Advances in knowledge: The method and software developed in this study provide a simple tool for effective investigation of the behaviour of Elekta linac components with gantry rotation. Such a comprehensive study has been performed for the first time on Elekta machines.

Plan quality and delivery accuracy of flattening filter free beam for SBRT lung treatments

To the Editor, Stereotactic body radiation therapy (SBRT) or alternatively stereotactic ablative radiotherapy (SABR) is today an important treatment option for a steadily increasing fraction of the...

Elekta Precise Table characteristics of IGRT remote table positioning

Introduction. Cone beam CT is a powerful tool to ensure an optimum patient positioning in radiotherapy. When cone beam CT scan of a patient is acquired, scan data of the patient are compared and evaluated against a reference image set and patient position offset is calculated. Via the linac control system, the patient is moved to correct for position offset and treatment starts. This procedure requires a reliable system for movement of patient. In this work we present a new method to characterize the reproducibility, linearity and accuracy in table positioning. The method applies to all treatment tables used in radiotherapy. Material and methods. The table characteristics are investigated on our two recent Elekta Synergy Platforms equipped with Precise Table installed in a shallow pit concrete cavity. Remote positioning of the table uses the auto set-up (ASU) feature in the linac control system software Desktop Pro R6.1. The ASU is used clinically to correct for patient positioning offset calculated via cone beam CT (XVI)-software. High precision steel rulers and a USB-microscope has been used to detect the relative table position in vertical, lateral and longitudinal direction. The effect of patient is simulated by applying external load on the iBEAM table top. For each table position an image is exposed of the ruler and display values of actual table position in the linac control system is read out. The table is moved in full range in lateral direction (50 cm) and longitudinal direction (100 cm) while in vertical direction a limited range is used (40 cm). Results and discussion. Our results show a linear relation between linac control system read out and measured position. Effects of imperfect calibration are seen. A reproducibility within a standard deviation of 0.22 mm in lateral and longitudinal directions while within 0.43 mm in vertical direction has been observed. The usage of XVI requires knowledge of the characteristics of remote table positioning. It is our opinion that the method presented meets the requirements in high precision IGRT.

Gantry and isocenter displacements of a linear accelerator caused by an add-on micromultileaf collimator.

PURPOSE The delivery of high quality stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) treatments to the patient requires knowledge of the position of the isocenter to submillimeter accuracy. To meet the requirements the deviation between the radiation and mechanical isocenters must be less than 1 mm. The use of add-on micromultileaf collimators (μMLCs) in SRS and SRT is an additional challenge to the anticipated high-level geometric and dosimetric accuracy of the treatment. The aim of this work was to quantify the gantry excursions during rotation with and without an add-on μMLC attached to the gantry head. In addition, the shift in the position of the isocenter and its correlation to the kV beam center of the cone-beam CT system was included in the study. METHODS The quantification of the gantry rotational performance was done using a pointer supported by an in-house made rigid holder attached to the gantry head of the accelerator. The pointer positions were measured using a digital theodolite. To quantify the effect of an μMLC of 50 kg, the measurements were repeated with the μMLC attached to the gantry head. The displacement of the isocenter due to an add-on μMLC of 50 kg was also investigated. In case of the pointer measurement the μMLC was simulated by weights attached to the gantry head. A method of least squares was applied to determine the position and displacement of the mechanical isocenter. Additionally, the displacement of the radiation isocenter was measured using a ball-bearing phantom and the electronic portal image device system. These measurements were based on 8 MV photon beams irradiated onto the ball from the four cardinal angles and two opposed collimator angles. The measurements and analysis of the data were carried out automatically using software delivered by the manufacturer. RESULTS The displacement of the mechanical isocenter caused by a 50 kg heavy μMLC was found to be (-0.01 ± 0.05, -0.10 ± 0.03, -0.26 ± 0.05) mm in lateral, longitudinal, and vertical direction, respectively. Similarly, the displacement of the radiation isocenter was found to be (0.00 ± 0.03, -0.08 ± 0.06, -0.32 ± 0.02) mm. Good agreement was found between the displacement of the two isocenters. A displacement of the kV cone-beam CT beam center due to the attached weight of 50 kg could not be detected. CONCLUSIONS General characteristics of the gantry arm excursions and displacements caused by an add-on μMLC have been reported. A 50 kg heavy add-on μMLC results in a isocenter displacement downward of 0.26-0.32 mm. The authors recommend that the beam center of the kV cone-beam CT image system should be matched to the isocenter related to the weight of the μMLC. Consequently, the imperfections in isocenter localizations are transferred to the conventional radiotherapy where the clinical consequences of uncertainties in the submillimeter regime are negligible.

Investigation of the mechanical performance of Siemens linacs components during arc: Gantry, MLC, and electronic portal imaging device

Background In radiotherapy treatments, it is crucial to monitor the performance of linac components including gantry, collimation system, and electronic portal imaging device (EPID) during arc deliveries. In this study, a simple EPID-based measurement method is suggested in conjunction with an algorithm to investigate the stability of these systems at various gantry angles with the aim of evaluating machine-related errors in treatments. Methods The EPID sag, gantry sag, changes in source-to-detector distance (SDD), EPID and collimator skewness, EPID tilt, and the sag in leaf bank assembly due to linac rotation were separately investigated by acquisition of 37 EPID images of a simple phantom with five ball bearings at various gantry angles. A fast and robust software package was developed for automated analysis of image data. Three Siemens linacs were investigated. Results The average EPID sag was within 1 mm for all tested linacs. Two machines showed >1 mm gantry sag. Changes in the SDD values were within 7.5 mm. EPID skewness and tilt values were <1° in all machines. The maximum sag in leaf bank assembly was <1 mm. Conclusion The method and software developed in this study provide a simple tool for effective investigation of the behavior of Siemens linac components with gantry rotation. Such a comprehensive study has been performed for the first time on Siemens machines.

Gantry and isocenter displacements of a linear accelerator caused by an add-on micromultileaf collimator: Medical Physics

PURPOSE The delivery of high quality stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) treatments to the patient requires knowledge of the position of the isocenter to submillimeter accuracy. To meet the requirements the deviation between the radiation and mechanical isocenters must be less than 1 mm. The use of add-on micromultileaf collimators (μMLCs) in SRS and SRT is an additional challenge to the anticipated high-level geometric and dosimetric accuracy of the treatment. The aim of this work was to quantify the gantry excursions during rotation with and without an add-on μMLC attached to the gantry head. In addition, the shift in the position of the isocenter and its correlation to the kV beam center of the cone-beam CT system was included in the study. METHODS The quantification of the gantry rotational performance was done using a pointer supported by an in-house made rigid holder attached to the gantry head of the accelerator. The pointer positions were measured using a digital theodolite. To quantify the effect of an μMLC of 50 kg, the measurements were repeated with the μMLC attached to the gantry head. The displacement of the isocenter due to an add-on μMLC of 50 kg was also investigated. In case of the pointer measurement the μMLC was simulated by weights attached to the gantry head. A method of least squares was applied to determine the position and displacement of the mechanical isocenter. Additionally, the displacement of the radiation isocenter was measured using a ball-bearing phantom and the electronic portal image device system. These measurements were based on 8 MV photon beams irradiated onto the ball from the four cardinal angles and two opposed collimator angles. The measurements and analysis of the data were carried out automatically using software delivered by the manufacturer. RESULTS The displacement of the mechanical isocenter caused by a 50 kg heavy μMLC was found to be (-0.01 ± 0.05, -0.10 ± 0.03, -0.26 ± 0.05) mm in lateral, longitudinal, and vertical direction, respectively. Similarly, the displacement of the radiation isocenter was found to be (0.00 ± 0.03, -0.08 ± 0.06, -0.32 ± 0.02) mm. Good agreement was found between the displacement of the two isocenters. A displacement of the kV cone-beam CT beam center due to the attached weight of 50 kg could not be detected. CONCLUSIONS General characteristics of the gantry arm excursions and displacements caused by an add-on μMLC have been reported. A 50 kg heavy add-on μMLC results in a isocenter displacement downward of 0.26-0.32 mm. The authors recommend that the beam center of the kV cone-beam CT image system should be matched to the isocenter related to the weight of the μMLC. Consequently, the imperfections in isocenter localizations are transferred to the conventional radiotherapy where the clinical consequences of uncertainties in the submillimeter regime are negligible.

Isocentric rotational performance of the Elekta Precise Table studied using a USB-microscope

The isocentric three-dimensional performance of the Elekta Precise Table was investigated. A pointer was attached to the radiation head of the accelerator and positioned at the geometric rotational axis of the head. A USB-microscope was mounted on the treatment tabletop to measure the table position relative to the pointer tip. The table performance was mapped in terms of USB-microscope images of the pointer tip at different table angles and load configurations. The USB-microscope was used as a detector to measure the pointer tip positions with a resolution down to 0.01 mm. A new elastic model of the treatment table was developed. This model describes the performance of the treatment table quite well except from some deviations due to backlash effects. Geometric and elastic features are described through six parameters. These parameters are calculated using the linear least squares fitting technique. A new method to ensure optimal positioning of the table relative to the accelerator is presented. This method cannot eliminate systematic errors completely. To eliminate systematic errors we suggest that geometric and elastic models of the table and accelerator gantry arm are incorporated in the dose planning system.

EP-1802: Mechanical sag patterns of the cone-beam CT imaging system of Elekta linear accelerators

Figure 1. Bland-Altman Plot of the difference between EPID and CBCT registrations. In a) the EPID images were matched manually in iView and in in b) the match was performed automatically using IGPS. The vertical solid line indicates the mean difference and the vertical dashed lines the limits of agreement. Linear regression was performed to test for trends in the differences. Estimated coefficients for the linear regression and the corresponding p-value for the null hypothesis that the slope = 0 are shown.

Investigation of the accuracy of MV radiation isocentre calculations in the Elekta cone-beam CT software XVI.

Accurate determination of the megavoltage (MV) radiation isocentre of a linear accelerator (linac) is an important task in radiotherapy. The localization of the MV radiation isocentre is crucial for correct calibration of the in-room lasers and the cone-beam CT scanner used for patient positioning prior to treatment. Linac manufacturers offer tools for MV radiation isocentre localization. As a user, there is no access to the documentation for the underlying method and calculation algorithm used in the commercial software. The idea of this work was to evaluate the accuracy of the software tool for MV radiation isocentre calculation as delivered by Elekta using independent software. The image acquisition was based on the scheme designed by the manufacturer. Eight MV images were acquired in each series of a ball-bearing (BB) phantom attached to the treatment couch. The images were recorded at cardinal angles of the gantry using the electronic portal imaging device (EPID). Eight Elekta linacs with three different types of multileaf collimators (MLCs) were included in the test. The influence of MLC orientation, x-ray energy, and phantom modifications were examined. The acquired images were analysed using the Elekta x-ray volume imaging (XVI) software and in-house developed (IHD) MATLAB code. Results from the two different software were compared. A discrepancy in the longitudinal direction of the isocentre localization was found averaging 0.23 mm up to a maximum of 0.75 mm. The MLC orientation or the phantom asymmetry in the longitudinal direction do not appear to cause the discrepancy. The main cause of the differences could not be clearly identified. However, it is our opinion that the commercial software delivered by the linac manufacturer should be improved to reach better stability and precise results in the MV radiation isocentre calculations.

An experimental study of the vertical travel accuracy of the treatment table used in radiotherapy

The idea of the present work was to investigate general features of the vertical travel of the treatment table in different configurations and the limitations of an optimised alignment. The investigations were carried out on two tables for different load cases, lateral positions and turntable angles. A wire was held vertically nearby the rotational axis of the table. The wire was used as reference in the investigations. A digital USB-microscope was attached to the tabletop. An orthogonal set of images of the wire was acquired at different vertical table positions. By analysing the images the vertical travel accuracy of the table was extracted. The two tables were found to travel linearly with the same characteristics over the full range of 110 cm with deviations less than 0.5 mm relative to a straight line. A divergence from a vertical travel above 0.5 mm was found to originate from misalignment. An alignment procedure to attain the optimal vertical performance with a minimum of inclination was presented. This procedure must be relayed on objective measured data of the travel with uncertainties far beyond 0.5 mm. Our suggested experimental method was found to have the potential to obtain the required data.