Académique Documents
Professionnel Documents
Culture Documents
C we putt th
Can
the dose
d
where
h
we wantt it?
Other sources:
MRI Distortion
Image Fusion
Relocatable frames
Dosimetric
Frames & CT
Isocentric Accuracy
Isocentric Accuracy:
The Winston-Lutz
Test
After
Before
Assess e
everything
er thing yourself
o rself
Structure
C li d
Cylinder
Cube
Cone
Sphere
AP
00
0.0
20.0
-35.0
25.0
Phantom Specifications
LAT
VERT
00
0.0
30 0
30.0
-17.0
40.0
-20.0
40.0
20.0
32.7
Verification of MLC
shapes and isocenter
System Accuracy
Simulate the entire
procedures: Scan,
target, plan, deliver
Phantom with
fil holder
film
h ld
Pin denotes
isocenter
Offset from
intended target
0.8
0.6
0.4
02
0.2
0
-1
-0.5
0.5
Off Ax is Distance (m m )
RPC Phantom
Hidden Target
g Test
scan,, p
plan,,
localize, assess
Lucy Phantom
Courtesy Sam Hancock, PhD, Southeast Missouri Hospital
Imaging Uncertainties
Use CT for geometric accuracy
Use MR for target delineation
Other References
TS Sumanaweera,
S
JR Adler,
Adl
S Napel,
N
l ett al.,
l Characterization
Ch
t i ti
off
spatial distortion in magnet resonance imaging and its implications
for stereotactic surgery, Neurosurgery 35: 696-704, 1994.
Fusion Verification
Standard Diode
PTW Detectors
PinPoint
0.015 cc
Cylindrical or Spherical
MicroLion
0.002 cc
Liquid-filled
i id fill d
800 V
Diode
1 mm x 2.5 m
Diamond
1-6 mm x 0.3 mm
100 V
A14
0.016 cc
A16
0.007 cc
A14SL
0.016 cc
Exradin Detectors
Wellhofer Detectors
CC04
0.04 cc
CC01
0.01 cc
Diode Warnings!!!
1) Di
Diode
d response will
ill d
drift
ift over ti
time
Re-measure reference between each chance in
field size
2) Diodes exhibit enough energy dependence that
ratios
ti
between
b t
large
l
and
d small
ll field
fi ld measurements
t
are inaccurate at the level required for radiosurgery
Use an intermediate reference field appropriate for
both diodes and ion chambers
Output
Factor
NO!
YES!
Reading (FS)diode
Reading (Ref)diode
Reading (Ref)IC
Reading (Ref)IC
Reading (6 mm)diode
Reading (100 mm)diode
Reading (6 mm)diode
di d
Reading (24
mm)diode
Relative Outpu
ut Factor
0.9
0.8
0.7
0.6
01
0.1
0
0
10
12
14
16
Institution 2
Institution 1
Institution 2
Institution 3
Institution 3
HD-120
Institution 1
Institution 2
Institution 1
Institution 2
Cones
MMLC
Penumb
bra, 80%-2
20% (mm)
2.5
1.5
0.5
0
0
20
40
60
80
100
Outp
put Fac
ctor
~45%
Institution
Cone size
(mm)
Original Output
Factor
4.0
7.5
10.0
12.5
15.0
17.5
20.0
25.0
30.0
0.312
0.610
0.741
0.823
0.862
0.888
0.903
0.920
0.928
Re-measured
Output Factor
0.699
0.797
0.835
0.871
0.890
0.904
0.913
0.930
0.940
Institution A
Institution B
0.8
0.6
0.4
0.2
0
0
50
100
150
Depth (mm)
200
250
300
Institution A
Institution B
Perce
ent Depth Dos
se
80
6.0 %
70
10.3 %
60
50
40
30
20
10
0
0
50
100
150
200
250
Depth (mm)
300
350
400
450
Phantom Plans
End-to-end testing
Dosimetric uncertainty
Calculation
Calculation
arc-step
= 10o
arc-step = 2o
Relative Dosimetry
1 isocenter
4 field box
D
Dynamic
i Conformal
C f
l Arcs
A
2 isocenters off axis
2 isocenters on axis
IMRT
End-to-end testing
Dosimetric
Do
i et i
uncertainty
Absolute Dosimetry
Independent MU
Calculations
End-to-end dosimetric
evaluation
Absolute Dosimetry
Lucy Phantom
Relative Dosimetry
Lucy Phantom
Relative Dosimetry
y Phantom
Lucy
Contours defined on MR
Stereophotogrammetry in Radiotherapy
Optical
Photogrammetry
0.2 mm
Stereophotogrammetry in Radiotherapy
X-ray
Identify target & plan
DRR
Set up
p in treatment room
Irradiate
Evaluate
(
(mm)
)
L t
Lat.
L
Long.
V t
Vert.
3D vector
t
Average
-0.06
-0.01
0.05
1.11
Standard
Deviation
0.56
0.32
0.82
0.42
Superior / Inferior
1
0.8
06
0.6
0.4
1.01 0.54 mm
2.36 1.32 mm
0.2
0
-8.0
-6.0
-4.0
-2.0
0.0
2.0
4.0
6.0
8.0
End-to-end evaluation:
Extracranial
Localization using
implanted fiducials
Courtesy Sam Hancock, PhD, Southeast Missouri Hospital
Radiosurgery Guidelines
ACR / ASTRO Practice Guidelines
What
h d
do they
h
cover?
?
Personnel Qualifications / Responsibilities
Procedure Specifications
Quality Control / Verification / Validation
Follow-up
p
Radiosurgery Guidelines
Task Group Reports
AAPM Report #54 Stereotactic Radiosurgery
AAPM Report #91 The Management of Motion in Radiation Oncology
(TG 76)
TG 68 Intracranial Stereotactic Positioning Systems
TG 101 Stereotactic Body Radiotherapy
TG 104 kV Localization in Therapy
TG 117 Use of MRI in Treatment Planning and Stereotactic Procedures
TG 132 Use
U
off I
Image Registration
R i t ti
and
dD
Data
t F
Fusion
i
Algorithms
Al
ith
and
d
Techniques in Radiotherapy Treatment Planning
TG 135 QA for Robotic Radiosurgery
TG 147 QA for Non-Radiographic Radiotherapy Localization and
Positioning Systems
TG 155 Small Fields and Non-Equilibrium Condition Photon Beam
Dosimetry
TG 176 Task Group on Dosimetric Effects of Immobilization Devices
TG 178 Gamma Stereotactic Radiosurgery Dosimetry and QA
TG 179 QA for Image-Guided Radiation Therapy Utilizing CT-Based
Technologies
Radiosurgery Guidelines
RTOG Protocols
RTOG 9005 Single Dose Radiosurgical Treatment of Recurrent Previously
I
Irradiated
di t d Primary
P i
Brain
B i T
Tumors and
d Brain
B i Metastases
M t t
RTOG 9305 Randomized Prospective Comparison Of Stereotactic
Radiosurgery (SRS) Followed By Conventional Radiotherapy (RT) With
BCNU T
To RT With BCNU Al
Alone F
For S
Selected
l t dP
Patients
ti t With S
Supratentorial
t t i l
Glioblastoma Multiforme (GBM)
RTOG 9508 A Phase III Trial Comparing Whole Brain Irradiation Alone
V
Versus
Whole
Wh l Brain
B i Irradiation
I
di ti
Plus
Pl
Stereotactic
St
t ti Radiosurgery
R di
for
f
Patients with Two or Three Unresected Brain Metastases
RTOG 0236 A phase II trial of SBRT in the treatment of patients with
medically
di ll inoperable
i
bl stage
t
I/II non-small
ll cell
ll lung
l
cancer
RTOG 0618 A phase II trial of SBRT in the treatment of patients with
operable stage I/II non-small cell lung cancer
RTOG 0813 Seamless phase I/II study of SBRT for early stage, centrally
located, non-small cell lung cancer in medically operable patients
Other Documents
ASTRO/AANS Consensus Statement on stereotactic
radiosurgery quality improvement, 1993
RTOG Radiosurgery QA Guidelines, 1993
European Quality Assurance Program on Stereotactic
Radiosurgery, 1995
DIN 6875
6875-1
1 (Germany) Quality Assurance in
Stereotactic Radiosurgery/Radiotherapy, 2004