Comprehensive Daily QA: A Comparison between CyberKnife ... · Comprehensive Daily QA: A Comparison...
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Comprehensive Daily QA: A Comparison between CyberKnife ® System and LinAc Techniques Jacob A. Gersh, PhD DABR Gibbs Cancer Center and Research institute – Greer, SC Spectrum Medical Physics, LLC – Greenville, SC Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Transcript of Comprehensive Daily QA: A Comparison between CyberKnife ... · Comprehensive Daily QA: A Comparison...
Comprehensive Daily QA: A Comparison
between CyberKnife ® System and LinAc
Techniques
Jacob A. Gersh, PhD DABR
Gibbs Cancer Center and Research institute – Greer, SC
Spectrum Medical Physics, LLC – Greenville, SC
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Speaker is owner of Spectrum Medical Physics, LLC of Greenville, SC.
Maintains financial and/or consulting relationships with
Standard Imaging
Accuray
Siemens Medical
Integrated Medical Technologies
An honorarium is provided by Accuray for this presentation
Financial Disclosures
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Disclaimer
The views expressed in this presentation are those of the presenters and do
not necessarily reflect the views or policies of Accuray Incorporated or its
subsidiaries. No official endorsement by Accuray Incorporated or any of its
subsidiaries of any vendor, products or services contained in this
presentation is intended or should be inferred.
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Purpose
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Conventional LinAc users have a large assortment of daily QA devices
and software available which provide:
Accuracy
Efficiency
Effortless Trending and Reporting
CyberKnife® System options are limited
Presented is my clinical experience in applying technology and
techniques (many of which have become standard for use with LinAcs) to
the CyberKnife® System, with emphasis on daily QA.
LinAc (Stereotactic TrueBeam)
Quality Assurance Tests
Based on TG-142
Equipment
Standard Imaging QA
BeamChecker+™
Gantry Mount
Flat Panel Imagers (attached to
LinAc)
MV
kV
Winston-Lutz Phantom
CBCT Phantom
CyberKnife® System (M6™ with MLC)
Quality Assurance Tests
Based on TG-135
Does not include recommendations for Iris™ QA and MLC QA
Vendor Recommendations
Equipment
Standard Imaging QA BeamChecker+™
CuttingBoard Fixture
Standard Imaging QA StereoChecker™
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Daily QA
Daily QA
LinAc (Stereotactic TrueBeam)
Safety*
Beam Output
kV and MV Imager Alignment
Field Light and ODI
Laser Alignment
Winston-Lutz (Weekly)
MLC (Weekly)
Dynamic Wedges (Weekly)
CBCT (Weekly)
CyberKnife® System (M6™ with MLC)
Safety*
Beam Output
Alignment (PANDA, AQA™)
Laser Alignment
MLC
Iris™ Variable Aperture Collimator
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Note: Weekly tests are performed during the performance of daily QA
* Safety Tests, while important, and not discussed herein
Daily QA
LinAc (Stereotactic TrueBeam)
Safety*
Beam Output
kV and MV Imager Alignment
Field Light and ODI
Laser Alignment
Winston-Lutz (Weekly)
MLC (Weekly)
Dynamic Wedges (Weekly)
CBCT (Weekly)
CyberKnife® System (M6™ with MLC)
Safety*
Beam Output
Alignment (PANDA, AQA™)
Laser Alignment
MLC
Iris™ Variable Aperture Collimator
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Note: Weekly tests are performed during the performance of daily QA
* Safety Tests, while important, and not discussed herein
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Self-Contained QA System
For Photons and Electrons
Portable and Compact
Wireless and Software-Free
Operation
Available with Gantry Mount
QA BeamChecker+™Standard Imaging, Inc.
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Output Constancy
Flatness
Symmetry
kV Imager Alignment
MV Imager Alignment
Field Light
Crosshair Alignment
ODI Accuracy
Laser Alignment
Dynamic Wedges
LinAc QA Using the QA BeamChecker+™
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Output Constancy
Flatness
Symmetry
kV Imager Alignment
MV Imager Alignment
Field Light
Crosshair Alignment
ODI Accuracy
Laser Alignment
Dynamic Wedges
LinAc QA Using the QA BeamChecker+™
2% Tolerance
(TG-142 Monthly)
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Output Constancy
Flatness
Symmetry
kV Imager Alignment
MV Imager Alignment
Field Light
Crosshair Alignment
ODI Accuracy
Laser Alignment
Dynamic Wedges
LinAc QA Using the QA BeamChecker+™
2% Tolerance
(TG-142 Monthly)
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Output Constancy
Flatness
Symmetry
kV Imager Alignment
MV Imager Alignment
Field Light
Crosshair Alignment
ODI Accuracy
Laser Alignment
Dynamic Wedges
LinAc QA Using the QA BeamChecker+™
2% Tolerance
(TG-142 Monthly)
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Output Constancy
Flatness
Symmetry
kV Imager Alignment
MV Imager Alignment
Field Light
Crosshair Alignment
ODI Accuracy
Laser Alignment
Dynamic Wedges
LinAc QA Using the QA BeamChecker+™
1 mm Tolerance
(TG-142)
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Output Constancy
Flatness
Symmetry
kV Imager Alignment
MV Imager Alignment
Field Light
Crosshair Alignment
ODI Accuracy
Laser Alignment
Dynamic Wedges
LinAc QA Using the QA BeamChecker+™
1 mm Tolerance
(TG-142)
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Output Constancy
Flatness
Symmetry
kV Imager Alignment
MV Imager Alignment
Field Light
Crosshair Alignment
ODI Accuracy
Laser Alignment
Dynamic Wedges
LinAc QA Using the QA BeamChecker+™
1 mm Tolerance
(TG-142)
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Output Constancy
Flatness
Symmetry
kV Imager Alignment
MV Imager Alignment
Field Light
Crosshair Alignment
ODI Accuracy
Laser Alignment
Dynamic Wedges
LinAc QA Using the QA BeamChecker+™
2% Tolerance
(TG-142 Monthly)
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Output Constancy
Flatness
Symmetry
kV Imager Alignment
MV Imager Alignment
Field Light
Crosshair Alignment
ODI Accuracy
Laser Alignment
Dynamic Wedges
LinAc QA Using the QA BeamChecker+™
1 mm Tolerance
(TG-142)
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Output Constancy
Flatness
Symmetry
kV Imager Alignment
MV Imager Alignment
Field Light
Crosshair Alignment
ODI Accuracy
Laser Alignment
Dynamic Wedges
LinAc QA Using the QA BeamChecker+™
1 mm Tolerance
(TG-142)
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Output Constancy
Flatness
Symmetry
kV Imager Alignment
MV Imager Alignment
Field Light
Crosshair Alignment
ODI Accuracy
Laser Alignment
Dynamic Wedges
LinAc QA Using the QA BeamChecker+™
1.5% Tolerance
(Gibbs CC)
Daily QA
LinAc (Stereotactic TrueBeam)
Safety*
Beam Output
kV and MV Imager Alignment
Field Light and ODI
Laser Alignment
Winston-Lutz (Weekly)
MLC (Weekly)
Dynamic Wedges (Weekly)
CBCT (Weekly)
CyberKnife® System (M6™ with MLC)
Safety*
Beam Output
Alignment (PANDA, AQA™)
Laser Alignment
MLC
Iris™ Variable Aperture Collimator
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Note: Weekly tests are performed during the performance of daily QA
* Safety Tests, while important, and not discussed herein
CyberKnife® System Output QA Using the QA BeamChecker+™
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Setup Automated Alignment Beam Delivery Automated Trending
Requires the CuttingBoard Fixture
Output Constancy
Can be tested with MLC, Iris™ Variable Aperture Collimator , or Fixed Collimators.
5 minutes
2% Tolerance (Gibbs CC)
CyberKnife® System Output QA Using the QA BeamChecker+™
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
TG-135 Threshold
Gibbs CC Threshold
Daily QA
LinAc (Stereotactic TrueBeam)
Safety*
Beam Output
kV and MV Imager Alignment
Field Light and ODI
Laser Alignment
Winston-Lutz (Weekly)
MLC (Weekly)
Dynamic Wedges (Weekly)
CBCT (Weekly)
CyberKnife® System (M6™ with MLC)
Safety*
Beam Output
Alignment (PANDA, AQA™)
Laser Alignment
MLC
Iris™ Variable Aperture Collimator
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Note: Weekly tests are performed during the performance of daily QA
* Safety Tests, while important, and not discussed herein
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
CBCT Alignment (kV Imager + Phantom)
MLC Verification (MV Imager)
Winston-Lutz (MV Imager + Phantom)
LinAc QA Using On-Board Imaging
1 mm Tolerance
(TG-142 Monthly)
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
LinAc QA Using On-Board Imaging
Leaf Position Accuracy Tolerance = 1 mm
(TG-142 Monthly)
CBCT Alignment (kV Imager + Phantom)
MLC Verification (MV Imager)
Winston-Lutz (MV Imager + Phantom)
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
LinAc QA Using On-Board Imaging
1.5 mm Tolerance
(Gibbs CC)
CBCT Alignment (kV Imager + Phantom)
MLC Verification (MV Imager)
Winston-Lutz (MV Imager + Phantom)
Daily QA
LinAc (Stereotactic TrueBeam)
Safety*
Beam Output
kV and MV Imager Alignment
Field Light and ODI
Laser Alignment
Winston-Lutz (Weekly)
MLC (Weekly)
Dynamic Wedges (Weekly)
CBCT (Weekly)
CyberKnife® System (M6™ with MLC)
Safety*
Beam Output
Alignment (PANDA, AQA™)
Laser Alignment
MLC
Iris™ Variable Aperture Collimator
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Note: Weekly tests are performed during the performance of daily QA
* Safety Tests, while important, and not discussed herein
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
QA StereoChecker™Standard Imaging, Inc.
Filmless CyberKnife® QA System
High-Resolution Flat Panel Imager (aSi)
200 micron Resolution
High Frame Rate
Portable and Compact
QA results automatically trended
Designed for Physicists and Therapists
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
QA StereoChecker™Standard Imaging, Inc.
Aligned using implanted high-Z markers
Automated alignment using target localization system
Fast and consistent Setup
No manual manipulation of robot
No attachment to collimator housing
Automated Alignment Beam Delivery Image Analysis
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
PANDA TestUsing the QA StereoChecker™
Position and Delivery Analysis
Complete TLS/TDS in 5 minutes
Replaces daily film-based AQA™
Capable of detecting a 0.1mm translational offset
0.5 mm Tolerance (Gibbs CC)
1.0 mm Tolerance (AQA™, TG-135)
PANDA TestUsing the QA StereoChecker™
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Daily QA
LinAc (Stereotactic TrueBeam)
Safety*
Beam Output
kV and MV Imager Alignment
Field Light and ODI
Laser Alignment
Winston-Lutz (Weekly)
MLC (Weekly)
Dynamic Wedges (Weekly)
CBCT (Weekly)
CyberKnife® System (M6™ with MLC)
Safety*
Beam Output
Alignment (PANDA, AQA™)
Laser Alignment
MLC
Iris™ Variable Aperture Collimator
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Note: Weekly tests are performed during the performance of daily QA
* Safety Tests, while important, and not discussed herein
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Laser Alignment VerificationUsing the QA StereoChecker™
Tested separately, or used in conjunction with
Iris™ Variable Aperture Collimator QA.
QASC aligned automatically using TLS.
1 mm tolerance (TG-135)
Daily QA
LinAc (Stereotactic TrueBeam)
Safety*
Beam Output
kV and MV Imager Alignment
Field Light and ODI
Laser Alignment
Winston-Lutz (Weekly)
MLC (Weekly)
Dynamic Wedges (Weekly)
CBCT (Weekly)
CyberKnife® System (M6™ with MLC)
Safety*
Beam Output
Alignment (PANDA, AQA™)
Laser Alignment
MLC
Iris™ Variable Aperture Collimator
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Note: Weekly tests are performed during the performance of daily QA
* Safety Tests, while important, and not discussed herein
Less than 5 minutes
Replaces visual film-based tests
Replaces monthly Garden Fence
Tests
Capable of detecting 0.1mm leaf
variations
0.2 mm Tolerance (Gibbs CC)
0.5 mm Tolerance (Accuray)
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
MLC QAUsing the QA StereoChecker™
0.1 mm 0.1 mm
0.2 mm
0.3 mm
0.4 mm
0.5 mm
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
MLC QAUsing the QA StereoChecker™
0.1 mm Deviation
0.2 mm Deviation
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
MLC QAUsing the QA StereoChecker™
7-Month Study
Daily MLC Garden Fence Test
Maximum daily deviation
superimposed atop the
average of 7 months of
images
Commendable performance
of the InCise™ Multileaf
Collimator
Daily Quality Assurance Tests
LinAc (Stereotactic TrueBeam)
Safety*
Beam Output
kV and MV Imager Alignment
Field Light and ODI
Laser Alignment
Winston-Lutz (Weekly)
MLC (Weekly)
Dynamic Wedges (Weekly)
CBCT (Weekly)
CyberKnife® System (M6™ with MLC)
Safety*
Beam Output
Alignment (PANDA, AQA™)
Laser Alignment
MLC
Iris™ Variable Aperture Collimator
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Note: Weekly tests are performed during the performance of daily QA
* Safety Tests, while important, and not discussed herein
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Setup, Delivery, Analysis, and Breakdown in less
than 7 minutes
Performs Absolute Calculation
Performs Baseline Comparison for all 11 clinical
diameters
Flatness (1.0% Tolerance, Gibbs CC)
Penumbra (0.2 mm Tolerance, Gibbs CC)
Field Width (0.2 mm Tolerance, Accuray)
Iris™ Variable Aperture Collimator QAUsing the QA StereoChecker™
Daily QA
LinAc (Stereotactic TrueBeam)
Safety*
Beam Output
kV and MV Imager Alignment
Field Light and ODI
Laser Alignment
Winston-Lutz (Weekly)
MLC (Weekly)
Dynamic Wedges (Weekly)
CBCT (Weekly)
CyberKnife® System (M6™ with MLC)
Safety*
Beam Output
Alignment (PANDA, AQA™)
Laser Alignment
MLC
Iris™ Variable Aperture Collimator
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
Note: Weekly tests are performed during the performance of daily QA
* Safety Tests, while important, and not discussed herein
DATE: Monday, July 31st
TIME: 12:15pm – 1:45pm
Location: Meeting Rooms 107-109, Colorado Convention Center
QA StereoChecker™ SymposiumSponsored by Standard Imaging, Inc.
Presented at the 2017 Annual Meeting of the AAPM – Denver, CO
