Evaluation of the truebeam machine performance check (MPC): OBI X-ray tube alignment procedure.

Alignment of the On-Board Imager (OBI) X-ray tube is important for ensuring imaging to treatment isocenter coincidence, which in turn is important for accurate Image Guided Radiotherapy (IGRT). Varian introduced a new X-ray tube alignment procedure for the TrueBeam linac in software version 2.5 MR2 as part of the machine performance check (MPC) application. This study evaluated the new procedure against conventional methods and examined the clinical significance of X-ray tube misalignment. Long term stability and short term repeatability of MPC tube alignment was assessed as well as sensitivity of the method to setup error. Standard quality assurance tests expected to be sensitive to tube misalignment were performed before and after tube alignment. These tests included: IsoCal verification; MPC kV imager offset; Winston-Lutz: kV imaging to treatment/radiation isocenter coincidence; CBCT image QA using the Catphan phantom; and OBI image geometric accuracy and center pixel alignment. Tube alignment measurements were performed with MPC, the two-plate method, and wire-on-faceplate method. The X-ray tube was then realigned by approximately 1.01 mm in the tangential plane based upon MPC and the tube alignment and standard quality assurance measurements were repeated. The time taken for each tube alignment method was estimated. The MPC method of tube alignment was found to be repeatable, insignificantly sensitive to phantom setup error and quick and simple to perform. The standard QA tests were generally insensitive to the tube alignment change, possibly because of the IsoCal correction. However, reduction in the magnitude of IsoCal correction and MPC kV imager offset was recorded after tube alignment. There was also apparent improvement in CBCT image uniformity. The MPC procedure is recommended for X-ray tube alignment.

Evaluation of the TrueBeam machine performance check (MPC) beam constancy checks for flattened and flattening filter-free (FFF) photon beams.

Machine Performance Check (MPC) is an automated and integrated image-based tool for verification of beam and geometric performance of the TrueBeam linac. The aims of the study were to evaluate the MPC beam performance tests against current daily quality assurance (QA) methods, to compare MPC performance against more accurate monthly QA tests and to test the sensitivity of MPC to changes in beam performance. The MPC beam constancy checks test the beam output, uniformity, and beam center against the user defined baseline. MPC was run daily over a period of 5 months (n = 115) in parallel with the Daily QA3 device. Additionally, IC Profiler, in-house EPID tests, and ion chamber measurements were performed biweekly and results presented in a form directly comparable to MPC. The sensitivity of MPC was investigated using controlled adjustments of output, beam angle, and beam position steering. Over the period, MPC output agreed with ion chamber to within 0.6%. For an output adjustment of 1.2%, MPC was found to agree with ion chamber to within 0.17%. MPC beam center was found to agree with the in-house EPID method within 0.1 mm. A focal spot position adjustment of 0.4 mm (at isocenter) was measured with MPC beam center to within 0.01 mm. An average systematic offset of 0.5% was measured in the MPC uniformity and agreement of MPC uniformity with symmetry measurements was found to be within 0.9% for all beams. MPC uniformity detected a change in beam symmetry of 1.5% to within 0.3% and 0.9% of IC Profiler for flattened and FFF beams, respectively.

Evaluation of the truebeam machine performance check (MPC) geometric checks for daily IGRT geometric accuracy quality assurance.

Machine Performance Check (MPC) is an automated and integrated image-based tool for verification of beam and geometric performance of the TrueBeam linac. The aims of the study were to evaluate the performance of the MPC geometric tests relevant to OBI/CBCT IGRT geometric accuracy. This included evaluation of the MPC isocenter and couch tests. Evaluation was performed by comparing MPC to QA tests performed routinely in the department over a 4-month period. The MPC isocenter tests were compared against an in-house developed Winston-Lutz test and the couch compared against routine mechanical QA type procedures. In all cases the results from the routine QA procedure was presented in a form directly comparable to MPC to allow a like-to-like comparison. The sensitivity of MPC was also tested by deliberately miscalibrating the appropriate linac parameter. The MPC isocenter size and MPC kV imager offset were found to agree with Winston-Lutz to within 0.2 mm and 0.22 mm, respectively. The MPC couch tests agreed with routine QA to within 0.12 mm and 0.15°. The MPC isocenter size and kV imager offset parameters were found to be affected by a change in beam focal spot position with the kV imager offset more sensitive. The MPC couch tests were all unaffected by an offset in the couch calibration but the three axes that utilized two point calibrations were sensitive to a miscalibration of the size in the span of the calibration. All MPC tests were unaffected by a deliberate misalignment of the MPC phantom and roll of the order of one degree.

Evaluation of the truebeam machine performance check (MPC): mechanical and collimation checks.

Machine performance check (MPC) is an automated and integrated image-based tool for verification of beam and geometric performance of the TrueBeam linac. The aims of the study were to evaluate the performance of the MPC geometric tests relevant to beam collimation (MLC and jaws) and mechanical systems (gantry and collimator). Evaluation was performed by comparing MPC to QA tests performed routinely in the department over a 4-month period. The MPC MLC tests were compared to an in-house analysis of the Picket Fence test. The jaw positions were compared against an in-house EPID-based method, against the traditional light field and graph paper technique and against the Daily QA3 device. The MPC collimator and gantry were compared against spirit level and the collimator further compared to Picket Fence analysis. In all cases, the results from the routine QA procedure were presented in a form directly comparable to MPC to allow a like-to-like comparison. The sensitivity of MPC was also tested by deliberately miscalibrating the appropriate linac parameter. The MPC MLC was found to agree with Picket Fence to within 0.3 mm and the MPC jaw check agreed with in-house EPID measurements within 0.2 mm. All MPC parameters were found to be accurately sensitive to deliberately introduced calibration errors. For the tests evaluated, MPC appears to be suitable as a daily QA check device.

A customizable, open-source Winston-Lutz system for multi-target, single isocentre radiotherapy.

Objective. To present and share an open-source system (phantom and software) for verifying the targeting accuracy of linac-based, single-isocenter, multi-target radiotherapy. This quality assurance test extends the traditional Winston-Lutz test, which considers a single target located at isocentre.Approach. Plans for a 3D-printed phantom are provided, which can be customized to accommodate various target (BB) positions. Given BB positions and gantry/collimator/couch combinations, the software generates multi-leaf collimator positions to facilitate multi-target Winston-Lutz (MTWL) plan creation. The software determines deviations between detected and expected BB positions on MV images resulting from MTWL plan delivery. BBs are located using a Hough circle detection algorithm, which is modified to favour the detection of circles: (1) having a reasonable size, (2) that are contained within the radiation field, and (3) having reasonable pixel intensities. Validation was performed in two ways: (1) using synthetic data with zero targeting errors and (2) by measuring real linac targeting errors and comparing against results obtained using a commercial system.Main results. Validation using the synthetic data yielded a mean (maximum) absolute discrepancy of 0.11 mm (0.21 mm), which is comparable to the synthetic phantom resolution (0.2 mm). The mean (maximum) absolute discrepancy compared to the commercial system is 0.13 mm (0.43 mm). These values are similar to results obtained with repeated deliveries of the same MTWL plan with the same phantom setup. Both validation tests yield reasonable results and are therefore considered successful. The MTWL test was performed independently by three physicists on two linacs to investigate repeatability, resulting in a mean (maximum) absolute discrepancy of 0.14 mm (0.51 mm) among the various attempts.Significance. Successful completion of this quality assurance test, using our customizable and open-source system, provides confidence that multi-target, single isocentre radiotherapy treatments can be delivered with sufficient geometric accuracy according to the chosen tolerance level.

Assessing the dependency of the uncertainties in the Elekta Agility MLC calibration procedure on the focal spot position.

The effectiveness of radiotherapy treatments depends on the accuracy of the dose delivery process. The majority of radiotherapy courses are delivered on linear accelerators with a Multi Leaf Collimator (MLC) in 3D conformal Radiation Therapy, Intensity Modulated Radiation Therapy (IMRT) or Volumetric Modulated Arc Therapy (VMAT) modes that require accurate MLC positioning. This study investigates the MLC calibration accuracy, following manufacturer procedures for an Elekta Synergy linac with the Agility head, against the radiation focal spot offset (alignment with the collimator axis of rotation). If the radiation focal spot is not aligned ideally with the collimator axis of rotation then a systematic error can be introduced into the calibration procedure affecting absolute MLC leaf positions. Calibration of diaphrams is equally affected; however they are not investigated here. The results indicate that an estimated 0.15 mm MLC uncertainty in all MLC leaves positions can be introduced due to uncertainty of the radiation focal spot position of 0.21 mm.