Quality assurance of Cyberknife robotic stereotactic radiosurgery using an angularly independent silicon detector.

PURPOSE: The aim of this work was to evaluate the use of an angularly independent silicon detector (edgeless diodes) developed for dosimetry in megavoltage radiotherapy for Cyberknife in a phantom and for patient quality assurance (QA). METHOD: The characterization of the edgeless diodes has been performed on Cyberknife with fixed and IRIS collimators. The edgeless diode probes were tested in terms of basic QA parameters such as measurements of tissue-phantom ratio (TPR), output factor and off-axis ratio. The measurements were performed in both water and water-equivalent phantoms. In addition, three patient-specific plans have been delivered to a lung phantom with and without motion and dose measurements have been performed to verify the ability of the diodes to work as patient-specific QA devices. The data obtained by the edgeless diodes have been compared to PTW 60016, SN edge, PinPoint ionization chamber, Gafchromic EBT3 film, and treatment planning system (TPS). RESULTS: The TPR measurement performed by the edgeless diodes show agreement within 2.2% with data obtained with PTW 60016 diode for all the field sizes. Output factor agrees within 2.6% with that measured by SN EDGE diodes corrected for their field size dependence. The beam profiles' measurements of edgeless diodes match SN EDGE diodes with a measured full width half maximum (FWHM) within 2.3% and penumbra widths within 0.148 mm. Patient-specific QA measurements demonstrate an agreement within 4.72% in comparison with TPS. CONCLUSION: The edgeless diodes have been proved to be an excellent candidate for machine and patient QA for Cyberknife reproducing commercial dosimetry device measurements without need of angular dependence corrections. However, further investigation is required to evaluate the effect of their dose rate dependence on complex brain cancer dose verification.

CyberKnife® fixed cone and Iris™ defined small radiation fields: Assessment with a high-resolution solid-state detector array.

PURPOSE: The challenges of accurate dosimetry for stereotactic radiotherapy (SRT) with small unflattened radiation fields have been widely reported in the literature. In this case, suitable dosimeters would have to offer a submillimeter spatial resolution. The CyberKnife® (Accuray Inc., Sunnyvale, CA, USA) is an SRT-dedicated linear accelerator (linac), which can deliver treatments with submillimeter positional accuracy using circular fields. Beams are delivered with the desired field size using fixed cones, the InCise™ multileaf collimator or a dynamic variable-aperture Iris™ collimator. The latter, allowing for field sizes to be varied during treatment delivery, has the potential to decrease treatment time, but its reproducibility in terms of output factors (OFs) and dose profiles (DPs) needs to be verified. METHODS: A 2D monolithic silicon array detector, the "Octa", was evaluated for dosimetric quality assurance (QA) for a CyberKnife system. OFs, DPs, percentage depth-dose (PDD) and tissue maximum ratio (TMR) were investigated, and results were benchmarked against the PTW SRS diode. Cross-plane, in-plane and 2 diagonal dose profiles were measured simultaneously with high spatial resolution (0.3 mm). Monte Carlo (MC) simulations with a GEANT4 (GEometry ANd Tracking 4) tool-kit were added to the study to support the experimental characterization of the detector response. RESULTS: For fixed cones and the Iris, for all field sizes investigated in the range between 5 and 60 mm diameter, OFs, PDDs, TMRs, and DPs in terms of FWHM measured by the Octa were accurate within 3% when benchmarked against the SRS diode and MC calculations. CONCLUSIONS: The Octa was shown to be an accurate dosimeter for measurements with a 6 MV FFF beam delivered with a CyberKnife system. The detector enabled real-time dosimetric verification for the variable aperture Iris collimator, yielding OFs and DPs consistent with those obtained with alternative methods.

On the measurement of dose in-air for small radiation fields: choice of mini-phantom material.

The purpose of this work was to determine the effect of choice of mini-phantom material on the measurement and calculation of in-air output factors (Sc) in small fields. Monte Carlo simulations in conjunction with a theoretical determination of Sc were used to validate previously reported measurements. Options for alternative mini-phantom materials were compared. A 6 MV beam from a Varian Novalis linear accelerator operating in stereotactic (SRS) mode was modelled. Phase-space data were used to determine the theoretical value of Sc. To validate previously reported Sc measurements the data were used to model the fibre-optic detector and brass mini-phantom. The impact of mini-phantom material was investigated by comparing the energy spectra of electrons entering the detector volume as a function of field size, and comparing the simulated Sc-measurement to the theoretical calculation. In order to determine factors leading to changes in Sc with field size, the origins of particles in the beam as incident on the mini-phantom were determined. Sc values derived from simulated measurements using a brass mini-phantom on a fibre-optic detector agreed with the measured Sc to within 0.7%. For simulation of measurement for all other mini-phantom materials, Sc values agreed with the theoretically calculated values to within 0.6%. The dominant processes responsible for a decrease in Sc with field size is occlusion of the focal and primary collimator contributions, while the secondary scatter, from the flattening filter and cone collimators, has minimal effect. The secondary electron spectrum is affected by the choice of mini-phantom material, but is almost independent of field size. For cone-collimated small fields in the Novalis beam (<30 mm), the decrease in Sc with field size is primarily due to collimation of the focal radiation beam and scatter from the primary collimator. A fibre optic detector with either a brass, gold or lead mini-phantom with at least d(max) equivalent height is suited to measure Sc for small SRS fields. The use of materials with higher electron/physical density can be used to reduce the size of the mini-phantom and reduce spatial averaging.

Small field in-air output factors: the role of miniphantom design and dosimeter type.

PURPOSE: The commissioning of treatment planning systems and beam modeling requires measured input parameters. The measurement of relative output in-air, Sc is particularly difficult for small fields. The purpose of this study was to investigate the influence of miniphantom design and detector selection on measured Sc values for small fields and to validate the measurements against Monte Carlo simulations. METHODS: Measurements were performed using brass caps (with sidewalls) or tops (no sidewalls) of varying heights and widths. The performance of two unshielded diodes (60012 and SFD), EBT2 radiochromic film, and a fiber optic dosimeter (FOD) were compared for fields defined by MLCs (5-100 mm) and SRS cones (4-30 mm) on a Varian Novalis linear accelerator. Monte Carlo simulations were performed to theoretically predict Sc as measured by the FOD. RESULTS: For all detectors, Sc agreed to within 1% for fields larger than 10 mm and to within 2.3% for smaller fields. Monte Carlo simulation matched the FOD measurements for all size of cone defined fields to within 0.5%. CONCLUSIONS: Miniphantom design is the most important variable for reproducible and accurate measurements of the in-air output ratio, S(c), in small photon fields (less than 30 mm). Sidewalls are not required for fields ≤ 30 mm and tops are therefore preferred over the larger caps. Unlike output measurements in water, S(cp), the selection of detector type for Sc is not critical, provided the active dosimeter volume is small relative to the field size.