Quality and safety considerations in stereotactic radiosurgery and stereotactic body radiation therapy: Executive summary

Solberg, Timothy D.; Balter, James M.; Benedict, Stanley H; Fraass, Benedick A.; Kavanagh, Brian D.; Miyamoto, Curtis; Pawlicki, Todd; Potters, Louis; Yamada, Yoshiya

doi:10.1016/j.prro.2011.06.014

Cited by 183 publications

(121 citation statements)

References 39 publications

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“…The mean values and standard deviations of the average deviation and maximum deviation are

0.20 \pm 0.03 mm

and

0.66 \pm 0.18 mm

, respectively. The deviations were consistent and within the tolerance (0.75 mm average and 1.0 mm maximum) recommended from TG 142 and the ASTRO quality and safety guidelines for SRS/SBRT 33 , 36 …”

Section: Resultssupporting

confidence: 80%

Characteristics of a novel treatment system for linear accelerator–based stereotactic radiosurgery

Song

Chin-Snyder

et al. 2015

J Applied Clin Med Phys

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The purpose of this study is to characterize the dosimetric properties and accuracy of a novel treatment platform (Edge radiosurgery system) for localizing and treating patients with frameless, image‐guided stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT). Initial measurements of various components of the system, such as a comprehensive assessment of the dosimetric properties of the flattening filter‐free (FFF) beams for both high definition (HD120) MLC and conical cone‐based treatment, positioning accuracy and beam attenuation of a six degree of freedom (6DoF) couch, treatment head leakage test, and integrated end‐to‐end accuracy tests, have been performed. The end‐to‐end test of the system was performed by CT imaging a phantom and registering hidden targets on the treatment couch to determine the localization accuracy of the optical surface monitoring system (OSMS), cone‐beam CT (CBCT), and MV imaging systems, as well as the radiation isocenter targeting accuracy. The deviations between the percent depth‐dose curves acquired on the new linac‐based system (Edge), and the previously published machine with FFF beams (TrueBeam) beyond Dmax were within 1.0% for both energies. The maximum deviation of output factors between the Edge and TrueBeam was 1.6%. The optimized dosimetric leaf gap values, which were fitted using Eclipse dose calculations and measurements based on representative spine radiosurgery plans, were 0.700 mm and 1.000 mm, respectively. For the conical cones, 6X FFF has sharper penumbra ranging from 1.2−1.8 mm (80%‐20%) and 1.9−3.8 mm (90%‐10%) relative to 10X FFF, which has 1.2−2.2 mm and 2.3−5.1 mm, respectively. The relative attenuation measurements of the couch for PA, PA (rails‐in), oblique, oblique (rails‐out), oblique (rails‐in) were: −2.0%, −2.5%, −15.6%, −2.5%, −5.0% for 6X FFF and −1.4%, −1.5%, −12.2%, −2.5%, −5.0% for 10X FFF, respectively, with a slight decrease in attenuation versus field size. The systematic deviation between the OSMS and CBCT was −0.4±0.2 mm, 0.1±0.3 mm, and 0.0±0.1 mm in the vertical, longitudinal, and lateral directions. The mean values and standard deviations of the average deviation and maximum deviation of the daily Winston‐Lutz tests over three months are 0.20±0.03 mm and 0.66±0.18 mm, respectively. Initial testing of this novel system demonstrates the technology to be highly accurate and suitable for frameless, linac‐based SRS and SBRT treatment.PACS number: 87.56.J‐

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“…The mean values and standard deviations of the average deviation and maximum deviation are

0.20 \pm 0.03 mm

and

0.66 \pm 0.18 mm

Section: Resultssupporting

confidence: 80%

Characteristics of a novel treatment system for linear accelerator–based stereotactic radiosurgery

Song

Chin-Snyder

et al. 2015

J Applied Clin Med Phys

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“…End‐to‐end target evaluation that incorporates CT, planning, and image guidance has become the standard for assessing overall system localization uncertainties 12 , 13 , 14 , 35 , 36 , 37 , 38 , 39 . To facilitate end‐to‐end evaluation of the Vero, the radio‐opaque spheres located within the head and thorax phantoms were identified on the respective planning CTs.…”

Section: Methodsmentioning

confidence: 99%

“…SABR requires the use of technology at a standard above that routinely considered necessary for conformal radiotherapy and IMRT applications 12 , 13 , 14 . Furthermore, the processes often involve a number of disparate, but interconnected, elements including: immobilization, motion management, image guidance, small field dosimetry, and dose calculation through complex heterogeneities.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the processes often involve a number of disparate, but interconnected, elements including: immobilization, motion management, image guidance, small field dosimetry, and dose calculation through complex heterogeneities. The selection, installation, integration, testing, and clinical application of technology are critical to ensuring safe and effective SRS/SBRT delivery 13 , 14 …”

Section: Introductionmentioning

confidence: 99%

“…In this work we describe the clinical commissioning of the Vero system for SABR applications, using key AAPM and ASTRO documents to guide the process 13 , 14 . We focus specifically on beam data acquisition and dosimetric commissioning of the treatment planning system and end‐to‐end evaluation of IGRT localization capabilities.…”

Section: Introductionmentioning

confidence: 99%

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Commissioning and initial stereotactic ablative radiotherapy experience with Vero

Solberg

Medin

Ramirez

et al. 2014

J Applied Clin Med Phys

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The purpose of this study is to describe the comprehensive commissioning process and initial clinical performance of the Vero linear accelerator, a new radiotherapy device recently installed at UT Southwestern Medical Center specifically developed for delivery of image‐guided stereotactic ablative radiotherapy (SABR). The Vero system utilizes a ring gantry to integrate a beam delivery platform with image guidance systems. The ring is capable of rotating ± 60° about the vertical axis to facilitate noncoplanar beam arrangements ideal for SABR delivery. The beam delivery platform consists of a 6 MV C‐band linac with a 60 leaf MLC projecting a maximum field size of 15×15 cm2 at isocenter. The Vero planning and delivery systems support a range of treatment techniques, including fixed beam conformal, dynamic conformal arcs, fixed gantry IMRT in either SMLC (step‐and‐shoot) or DMLC (dynamic) delivery, and hybrid arcs, which combines dynamic conformal arcs and fixed beam IMRT delivery. The accelerator and treatment head are mounted on a gimbal mechanism that allows the linac and MLC to pivot in two dimensions for tumor tracking. Two orthogonal kV imaging subsystems built into the ring facilitate both stereoscopic and volumetric (CBCT) image guidance. The system is also equipped with an always‐active electronic portal imaging device (EPID). We present our commissioning process and initial clinical experience focusing on SABR applications with the Vero, including: (1) beam data acquisition; (2) dosimetric commissioning of the treatment planning system, including evaluation of a Monte Carlo algorithm in a specially‐designed anthropomorphic thorax phantom; (3) validation using the Radiological Physics Center thorax, head and neck (IMRT), and spine credentialing phantoms; (4) end‐to‐end evaluation of IGRT localization accuracy; (5) ongoing system performance, including isocenter stability; and (6) clinical SABR applications.PACS number: 87.53.Ly

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A Roadmap to a Non‐invasive Radiosurgical Approach to Ablate the Pulmonary Vein Antra for an Effective Treatment of Atrial Fibrillation

2019

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Quality and safety considerations in stereotactic radiosurgery and stereotactic body radiation therapy: Executive summary

Cited by 183 publications

References 39 publications

Characteristics of a novel treatment system for linear accelerator–based stereotactic radiosurgery

Characteristics of a novel treatment system for linear accelerator–based stereotactic radiosurgery

Commissioning and initial stereotactic ablative radiotherapy experience with Vero

A Roadmap to a Non‐invasive Radiosurgical Approach to Ablate the Pulmonary Vein Antra for an Effective Treatment of Atrial Fibrillation

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