QA

ArcCHECK

3DVHIMRT-QA


ArcCHECK3DVH

RapidArc

IMRT-QA

0.5%
3%/3mm97%! !

IMRT-QA

MapCHECK

B. E. Nelms, et al. Per-beam, planar IMRT QA passing rates do not predict clinically relevant patient dose error,
Med. Phys. 38, 1037-1044 (2011)

IMRT-QA

(false negative)

QA

(false positive)

QA

B. E. Nelms, et al. Per-beam, planar IMRT QA passing rates do not predict clinically relevant patient dose error,
Med. Phys. 38, 1037-1044 (2011)

IMRT-QA

EPID Fluence

Transmission
Detector

2D Ion Chamber
Array

Phantom DVH

gantry

Sun Nuclear

0.8 0.8 mm2n10 mm

1386

ArcCHECK
()

()

()

()

ArcCHECK ()

ArcCHECK
QA()

Multi Plug

IMRT-QA (3DVH)

ArcCHECK
DVH
IMRT-QA

DVH
Perfect Plan
Eclipse: AAA

Gantry error; 2
Eclipse: AAA

(
)

DVH Difference
Dose Difference

3DVH
MGRT, measurement-guided dose reconstruction

ACPDPPhantom

Plan on ArcCHECK

3D dose difference

Plan on Patient

Measurment
(2D dose difference)

ACPDPPatient

PDP: planned dose perturbation

3DVH
SYNC Function

control point (CPs) 2

gantry angle ()
leaf position
MU

ArcCHECK

Gantry angle (deg)

DICOM RT Plan (TPS)

Time (sec)

virtual inclinometer, VI
gantry angle
50 ms
time
dose

Gantry angle

DICOM RT Plan

Leaf position

3DVH
AC_CONV and MORPH_NORM
Plan datasub-beam

(CPs2)
Dose

ACPDP

morphing
leaf
position

sub beam
fluence

DICOM RT Plan

(2mm voxel grid)

ACPDPPhantom

Distance

3DVH
Fast Fourie Transform (FFT)
TERMA+ parameters (PMMA)

MLC
MLC
jaw

3D dose kernels (PMMA)

DICOM RT Plan
(FFT)

ACPDP
(FFT)

3DVH
Diff_MORPH Function

TPS
morphing
ACPDP
AC
(, , )
, , =
TPS
AC
(, , )

ACPDPTPS

ACPDP
TPS
Pat
, , = (, , ) Pat
(, , )

B. E. Nelms, et al. Dosimetric verification of the anisotropic analytical algorithm in lung equivalent
heterogeneities with and waithout bone equivalent heterogeneities, Med. Phys. 37, 4457-4463 (2010)

3DVH(ACPDPPhantom)
sagittal

axial

virtual gel
coronal

3DVH(ACPDPPhantom)

sagittal

axial

coronal

3DVH(ACPDPPatient)
sagittal

axial

coronal

VCF

3DVH(ACPDPPatient)
DVH

V65

65 Gy

3DVH

ArcCHECK

MLC


ArcCHECK3DVH


()
Electron beam

Novalis Tx (BrainLAB/Varian)
Target
Primary collimator
Vacuum window

Flattening filter
lon Chamber

MCNPX

Mirror

(Monte Carlo N-Particle Transport Cord System

Version X, Los Alamos)

Y Jaw
X Jaw

PDD

ArcCHECK

6.25 MeV

FWHM 3%

FWHM 1.3mm

0.01 MeV (P), 0.512 MeV (E)

2.0 108

Yes!!!
6 MV-X, 10 x 10

Percentage depth dose [%]

120

AAA
iPlan MC
MCNP X

100

80

exit
%

60

40

20

PMMA

Air

PMMA

0
0

10

15

Depth [cm]

20

25


6 MV-X, 10 x 10

PMMA
ArcCHECK

PDDTPS
(ArcCHECKCT)
CT150 HU

ArcCHECKPDD ()
6 MV-X, 120
10 x 10
Plan
MC

100

IC

PDD [%]

80

60
40
20
0
0

10

15

Depth [cm]

20

25

PMMA

1
1H

12
16
C
6
8O

PMMA11.2%8%
()
(10.3% 3.4%)

(160 kV vs. 6 MV)

Z

Z/A

Water

PMMA

0.992

11.19

8.05

0.500

0.500

88.81

31.96

(g/cm3)

1.000

1.190

Z/A

0.555

0.539

59.98

J. Seco, et al. Assessing the effect of electron density in photon dose calculations, Med. Phys. 33, 540-552 (2006)

 ()
scaled,med = med med water

equivalent pathlength
(eEPL)

scaled, PMMA = med 3.248 1023 /g

3.343 1023 /g

= 1.1836 0.9716
= 1.15 [1.147 1.153] g/cm3

CT

CT
3

Relative Electron Density

2.5
2
bone

1.5

1.147
muscl

water

lung

0.5

279 HU

air

0
-1000

1000

2000

CT Number (HU)

3000

ArcCHECKPDD ()
CT279HU (1.147)
12010 x 10
6 MV-X,

2
Plan (eEPL)
MC
IC
Plan/IC

100

PDD [%]

60

1
0.5
0

Plan / IC [%]

80

1.5

0.5%
-0.5

40

-1
20

-1.5

0
0

10

15

Depth [cm]

20

-2
25

6 MV-X, 4 x 4

6 MV-X, 16 x 16
2

2
Plan
IC
Plan/IC

60

Plan
IC

1.5

100

Plan/IC

-0.5

0.5

80

60

-0.5
40

40

-1

-1
20

-1.5

20

-1.5

0.5%
0
0

10

15

Depth [cm]

20

-2
25

0
0

10

15

Depth [cm]

20

-2
25

Plan / IC [%]

0.5

80

Plan / IC [%]

PDD [%]

100

120
1.5

PDD [%]

120

 ()
water = PMMA water,PMMA

water,PMMA = en /

water
PMMA

water (ref )
=
PMMA (eq )

PMMA
water

ESC

AAPM TG-21 A protocol for the determination of absorbed dose from high-energy photons and electrons,
Med. Phys. 10, 741 (1983)
C-M Ma, et al. A quality assurance phantom for IMRT dose verification, Phys. Med. Biol. 48, 561-572 (2003)

ArcCHECK
6 MV-X, 10 x 10, 200MU, 300MU/min

SSD=86.7 cm

2.85 x 1.15 = 3.28 cm ()

2.85 cm
SSD=86.27 cm

ArcCHECK

PMMA = water /water,PMMA

or

= 239.16/0.992
= 241.1 cGy (. : )

ACPDPPDD
6 MV-X, 10 x 10

PlanACPDPPDD

PlanACPDP

ACPDPPDD
ACPDPPhantom ()
6 MV-X,
12010 x 10
Plan
MC
ACPDP

PDD [%]

100
80

IC

60

ACPDP

40
20
0
0

10

15

Depth [cm]

20

25

ACPDP
(Test Plan)
Simple Plan
3 x 3 cm2
3 x 3 cm2 MLC (jaw: 10 x 10)
5 x 5 cm2
5 x 5 cm2 MLC (jaw: 10 x 10)
10 x 10 cm2
5 cm MLC 1arc

10 cm MLC 1arc
Clinical Plan (AAPM TG119)
Mock Prostate
Mock Head and Neck
Cshape (easier)

Simple Plan(ACPDP)

3 x 3 cm2
3 x 3 cm2 MLC (jaw: 10 x 10)
5 x 5 cm2
5 x 5 cm2 MLC (jaw: 10 x 10)
10 x 10 cm2
5 cm MLC 1arc
10 cm MLC 1arc

EBT3 (coronal)

ACPDPPhantom

CC13 ()

(EBT3)
MapCHECK2 software
Film (EDR3)

DICOM RT Plan
DICOM RT ACPDP

ACPDP

Simple Plan
Phantom ACPDP ()

Difference from Ion Chamber [%]

1
Plan/IC
ACPDP/IC
0.5

-0.5

ACPDP
-1
3cm

3cmMLC

5cm

5cmMLC

10cm

5cmArc 10cmArc

Simple Plan
Phantom ACPDP ()

Passing Rate [%]

100

Plan/Film
ACPDP/Film

95

3%/3mm
90

85

3cm 3cmMLC 5cm 5cmMLC 10cm

5cmArc 10cmArc
ACPDP

Passing Rate [%]

100

95

2%/2mm
90

85
3cm 3cmMLC 5cm 5cmMLC 10cm 5cmArc 10cmArc


ArcCHECK3DVH

Clinical Plan (TG119)

Mock Prostate

Mock Head and Neck

Cshape (easier)

G. A. Ezzell, et al. IMRT commissioning: Multiple institution planning and dosimetry comparisons, a report from
AAPM Task Group 119, Med. Phys. 36, 5359-5373 (2009)

TG119
(mock prostate)

D1010%
10%

Gy
G. A. Ezzell, et al. IMRT commissioning: Multiple institution planning and dosimetry comparisons, a report from
AAPM Task Group 119, Med. Phys. 36, 5359-5373 (2009)

Clinical Plan (TG119)

EBT3 (coronal)

EBT3 (sagittal)

ACPDPPhantom

Mock Prostate
Mock Head and Neck
Cshape (easier)

Pinpoint (PTV)

 (TG119)
6 MV-X, 10 x 10
200 MU x 2fields

Farmer
(0.13cc, 0.03cc, etc)
Correction factor

[]
=
[]

Plan dose (mean)

 (TG119)
(TG119)

(24)
10 x 10

Clinical Plan
Phantom ACPDP ()

Difference from Ion Chamber [%]

2
Plan/IC
ACPDP/IC

1.5
1
0.5
0
-0.5
-1

ACPDP

-1.5
-2
Prostate

Neck

C-shape

Clinical Plan
Phantom ACPDP ()
3%/3mm

2%/2mm

Plan/Film
ACPDP/Film

100

Plan/Film
ACPDP/Film

100

Passing Rate [%]

Passing Rate [%]

ACPDP

95

90

85

95

90

85
Prostate

Neck

C-shape

Prostate

Neck

C-shape

ArcCHECK3DVH
Phantom ACPDP ()
3%/3mm

ArcCHECK
3DVH

100

Passing Rate [%]

100

Passing Rate [%]

2%/2mm

ArcCHECK
3DVH

95

90

85

95 Global max normalization

3DVH

90

85
Prostate

Neck

C-shape

Prostate

Neck

C-shape


()

CUBIC

OVAL

Pinpoint (PTV)

EBT3
(coronal/sagittal)
ImRT Phantom (IBA Dosimetry)

EBT3

ACPDPPatient

AAPM TG-119 Plan

(CUBIC and OVAL)
Mock Prostate
CUBIC

OVAL

Mock Head and Neck

Cshape (easier)

Clinical Plan
Patient ACPDP ()

CUBIC

OVAL
2
Plan/IC
ACPDP/IC

1.5
1
0.5
0
-0.5
-1
-1.5
-2

Difference from Ion Chamber [%]

Difference from Ion Chamber [%]

Plan/IC
ACPDP/IC

1.5
1
0.5
0
-0.5
-1
-1.5

ACPDP

-2
Prostate

Neck

C-shape

Prostate

Neck

C-shape

 (prostate)
Film (EDR3)

ACPDP

ACPDP

Clinical Plan
Patient ACPDP ()
CUBIC
Plan/Film
ACPDP/Film

95
90
85
Prostate

Neck

C-shape

Passing Rate [%]

2%/2mm

Passing Rate [%]

100
95
90
85

Plan/Film
ACPDP/Film

100

Passing Rate [%]

Passing Rate [%]

100

3%/3mm

OVAL

95
90
85
Prostate
Neck
C-shape
ACPDP
100
95
90
85

Prostate

Neck

C-shape

Prostate

Neck

C-shape

3DVHAAPM-TG119
()

Prostate

Neck

3%/3mm
2%/2mm

3%/3mm
2%/2mm

95

90

85

100

95

95

90
)

90

85
Prostate Rectum Bladder

3%/3mm
2%/2mm

Passing Rate [%]

100

Passing Rate [%]

100

Passing Rate [%]

Cshape

85
PTV

Cord

Parotid ,R Rarotid, L

PTV

Core

DVH (mock prostate)

PTV

Rectum

ACPDP

Bladder

Plan

3DVHAAPM-TG119
(Mock Prostate)

Plan goal
(cGy)

Plan
mean
(cGy)

3DVH
mean
(cGy)

3DVH
/Plan
(%)

D95

>7560

7609

7711

1.3

D5

<8300

8178

8188

0.1

D30

<7000

4976

5033

1.1

D10

<7500

7303

7505

2.8

D30

<7000

3819

3786

-0.9

D10

<7500

5331

5269

-1.2

Planning parameter

Prostate

Rectum

Bladder

3DVHAAPM-TG119
(Mock Head and Neck)

Plan goal
(cGy)

Plan
mean
(cGy)

3DVH
mean
(cGy)

3DVH
/Plan
(%)

D90

5000

5004

4962

-0.8

D99

>4650

4721

4700

-0.4

D20

<5500

5399

5413

0.3

Cord

Dmax

<4000

3729

3794

1.7

Parotid, R

D50

<2000

1807

1747

-3.3

Parotid, L

D50

<2000

1846

1823

-1.2

Planning parameter

PTV

3DVHAAPM-TG119
(Cshape easier)
DVH

Plan goal
(cGy)

Plan
mean
(cGy)

3DVH
mean
(cGy)

3DVH
/Plan
(%)

D95

5000

5018

5016

0.0

D10

>5500

5466

5454

-0.2

D10

<2500

2344

2288

-2.4

Planning parameter

PTV

Core


ArcCHECK3DVH

TPS
3D Cubic (Eclipse)

TPS()
2.5 mm MLCslit plan

TPS

ArcCHECK
IMRT
MLC

()
plan

Pass Rate : 30.8% (3%/3mm)

diode

ArcCHECK1cm


IMRT Plan (Eclipse)
DLG, dosimetric leaf gap ()TPS

DLG = 0 mm (none)
DLG = 0.78mm (default)
DLG = 1.56 mm (high)
dosimetric leaf gap
(DLG )

0.4 mm

Clinical Plan (TG119)


(0.4 mm)

Prostate
Prostate, D95/D5
Rectum, D30/D10
Bladder, D30/D10

6
4
2
0
-2

6
4
2
0
-2

-4
Default

High

PTV, D95/D10
Core, D10

8
6
4
2
0
-2

-4
None

10

PTV, D90/D99/D20
Cord, Dmax
Parotid, D50

Difference from Plan [%]

Difference from Plan [%]

10

C-shape

Difference from Plan [%]

10

Neck

-4
None

Default

High

None

Default

key word; (IMRT)

High


ArcCHECK3DVH

 ()

Wood Insert

Quasar Insert

Quasar Phantom
Modus Medical Devices inc.

Simple Plan ()
6 MV-X, 4 x 4, 10 x 10

PDD (MCNPX)

EBT3 (coronal)

PDD
6 MV-X, 4 x 4

6 MV-X, 10 x 10

120

120
Plan
MC

100

ACPDP

80

PDD [%]

PDD [%]

100

Plan

60

40

ACPDP
MC
TPS
ACPDP

80

60

40
wood

MC

wood

20

MC

20
0

10

15

Depth [cm]

20

25

10

15

20

25

Depth [cm]

build-up kernel correction

K. Ono, et al. Dosimetric verification of the anisotropic analytical algorithm in lung equivalent heterogeneities
with and without bone equivalent heterogeneities, Med. Phys. 37, 4457-4463 (2010)

Plan/Film
ACPDP/Film

2%/2mm

100

100

98

98

Passing Ratio [%]

Passing Ratio [%]

3%/3mm

96

6 MV-X, 10 x 10
Plan/Film
ACPDP/Film

ACPDP vs. Film

96

ACPDP
94
94

(TPS
)
92

92

90

90
4cm Lung

10cm_lung

4cm Lung

10cm_lung

Clinical Plan ()
Arc_Lung

1 arc RA

Tumor

Wood

Quas_Lung

EBT3
1 arc RA

Bone

Wood

Tumor

pinpoint

3DVH (ACPDP)
Quas_Lung
sagittal

axial

ACPDP

coronal

ACPDP
Plan


ACPDP

SI-direction

Film

Film
Plan

ACPDP


Plan/Film
ACPDP/Film

2%/2mm

100

100

95

95

Passing Rate [%]

Passing Rate [%]

3%/3mm

90

85

85

80

75

75
Quas_Lung

ACPDP

90

80

Arc_Lung

Plan/Film
ACPDP/Film

Arc_Lung

Quas_Lung

Difference from Ion Chamber [%]

1
Plan/IC
ACPDP/IC

0.5

-0.5

ACPDP

-1

-1.5
Arc_Lung

Quas_Lung

ArcCHECKPTV
()

ArcCHECK
3DVH (PTV)

2%/2mm

100

100

90

90

Passing Rate [%]

Passing Rate [%]

3%/3mm

80

70

60

ArcCHECK
3DVH (PTV)

ArcCHECK3%/3mm
PTV
()

80

70

60

50

50
Arc_Lung

Quas_Lung

Arc_Lung

Quas_Lung


ArcCHECK3DVH

RapidArc3DVH
78
N
(CA19-9: 1529)
SMAborder line resectable
IMRT
64.8 Gy (54 Gy)RapidArc

3DVH ()
sagittal

axial

RapidArc
coronal

RapidArc ()
PTV

20 deg

45 deg

minimum leaf gap

minimum leaf gap = 0.5 mm

PTV1, 2

Planning
parameter
Duodenum

D1cc

Plan
(Gy)

ACPDP
(Gy)

ACPDP
/Plan
(%)

47.9

49.3

2.9

Duodenum
1cc

RapidArc3DVH
64
2007.6
()
2010.8

KO
2010.9

2010.10 IMRT
2arcs RA, 50 Gy/ 25fx

 (3DVH)
sagittal

axial

coronal

DVH (3DVH)

Plan (Gy)

ACPDP
(Gy)

ACPDP
/Plan(%)

D1cc

39.6

41.5

4.7

D2%

45.1

47.7

5.7

Planning parameter
Cord

PTV

Cord
2%

10

KO()

3DVH(ArcCHECK)

()

()

()
DVH
()


3DVHIMRT-QA
!!!