Traditional CyberKnife (CK) calibration uses TG‐51, which requires kQ to be defined using the standard reference condition of 100 cm SSD in a 10 cm×10 cm field. Since the CK is calibrated using a 6 cm fixed‐aperture collimating cone at 80 cm SAD, the BJR‐25 method is commonly used to relate circular‐field PDDs to square‐field PDDs for kQ determination. Using the InCise MLC system, the CK is able to deliver rectangular fields, allowing a more direct measurement of %ddfalse(10 cmfalse) using conventional reference conditions. We define the PDD correction factor (CPDD) as the ratio of %ddfalse(10 cmfalse) measured using CK reference conditions to that measured using standard TG‐51 reference conditions. Using four ionization chambers (A1SL, CC08, CC13, and A19), %ddfalse(10 cmfalse) is measured using a 6 cm fixed cone at 80 cm SSD and at 100 cm SSD using an effective 10 cm×10 cm MLC‐collimated field. These values are used to calculate CPDD, while the latter is used to directly calculate a kQ value. This direct kQ value is then compared to values determined using the BJR‐25 method. Using the MLC system, this study demonstrates conversion between the %ddfalse(10 cmfalse) measured using CyberKnife reference conditions and TG‐51 reference conditions. These values provide the means for derivation of a kQ curve as a function of direct measurements of %ddfalse(10 cmfalse) using a 6 cm fixed‐aperture collimating cone at 80 cm SSD.PACS number: 87.55.Qr

Purpose: Absolute calibration of the CyberKnife is performed using a 6cm‐diameter cone defined at 80cm SAD. Since kQ is defined using PDD values determined using 10×10 cm fields at 100cm SSD, the PDD must be corrected in order to correctly apply the quality conversion factor. The accepted method is based on equivalent field‐size conversions of PDD values using BJR25. Using the new InCise MLC system, the CK is capable of generating a rectangular field equivalent to 10×10 cm square field. In this study, a comparison is made between kQ values determined using the traditional BJR25 method and the MLC method introduced herein. Methods: First, kQ(BJR) is determined: a PDD is acquired using a 6cm circular field at 100cm SSD, its field size converted to an equivalent square, and PDD converted to a 10×10cm field using the appropriate BJR25 table. Maintaining a consistent setup, the collimator is changed, and the MLC method is used. Finally, kQ is determined using PDDs acquired with a 9.71×10.31cm at 100cm SSD. This field is produced by setting the field to a size of 7.77×8.25cm (since it is defined at 80cm SAD). An exact 10×10cm field since field size is relegated to increments of its leaf width (0.25cm). This comparison is made using an Exradin A1SL, IBA CC08, IBA CC13, and an Exradin A19. For each detector and collimator type, the beam injector was adjusted to give 5 different beam qualities; representing a range of clinical systems. Results: Averaging across all beam qualities, kQ(MLC) differed from kQ(BJR) by less than 0.15%. The difference between the values increased with detector volume. Conclusion: For CK users with standard cone collimators, the BJR25 method has been verified. For CK users the MLC system, a technique is described to determine kQ. Primary author is the President/Owner of Spectrum Medical Physics, LLC, a company which maintains contracts with Siemens Healthcare and Standard Imaging, Inc.