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      The Mobius AIRO mobile CT for image‐guided proton therapy: Characterization & commissioning

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          Abstract

          Purpose

          The purpose of this study was to characterize the Mobius AIRO Mobile CT System for localization and image‐guided proton therapy. This is the first known application of the AIRO for proton therapy.

          Methods

          Five CT images of a Catphan ®504 phantom were acquired on the AIRO Mobile CT System, Varian EDGE radiosurgery system cone beam CT ( CBCT), Philips Brilliance Big Bore 16 slice CT simulator, and Siemens SOMATOM Definition AS 20 slice CT simulator. Dose LAB software v.6.6 was utilized for image quality analysis. Modulation transfer function, scaling discrepancy, geometric distortion, spatial resolution, overall uniformity, minimum uniformity, contrast, high CNR, and maximum HU deviation were acquired. Low CNR was acquired manually using the CTP515 module. Localization accuracy and CT Dose Index were measured and compared to reported values on each imaging device. For treatment delivery systems (Edge and Mevion), the localization accuracy of the 3D imaging systems were compared to 2D imaging systems on each system.

          Results

          The AIRO spatial resolution was 0.21 lp mm −1 compared with 0.40 lp mm −1 for the Philips CT Simulator, 0.37 lp mm −1 for the Edge CBCT, and 0.35 lp mm −1 for the Siemens CT Simulator. AIRO/Siemens and AIRO/Philips differences exceeded 100% for scaling discrepancy (191.2% and 145.8%). The AIRO exhibited higher dose (>27 mGy) than the Philips CT Simulator. Localization accuracy (based on the MIMI phantom) was 0.6° and 0.5 mm. Localization accuracy (based on Stereophan) demonstrated maximum AIRO‐ kV/ kV shift differences of 0.1 mm in the x‐direction, 0.1 mm in the y‐direction, and 0.2 mm in the z‐direction.

          Conclusions

          The localization accuracy of AIRO was determined to be within 0.6° and 0.5 mm despite its slightly lower image quality overall compared to other CT imaging systems at our institution. Based on our study, the Mobile AIRO CT system can be utilized accurately and reliably for image‐guided proton therapy.

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          Imaging doses from the Elekta Synergy X-ray cone beam CT system.

          A. Amer, T Marchant, J. Sykes … (2007)
          The Elekta Synergy is a radiotherapy treatment machine with integrated kilovoltage (kV) X-ray imaging system capable of producing cone beam CT (CBCT) images of the patient in the treatment position. The aim of this study is to assess the additional imaging dose. Cone beam CT dose index (CBDI) is introduced and measured inside standard CTDI phantoms for several sites (head: 100 kV, 38 mAs, lung: 120 kV, 152 mAs and pelvis: 130 kV, 456 mAs). The measured weighted doses were compared with thermoluminescent dosimeter (TLD) measurements at various locations in a Rando phantom and at patients' surfaces. The measured CBDIs in-air at the isocentre were 9.2 mGy 100 mAs(-1), 7.3 mGy 100 mAs(-1) and 5.3 mGy 100 mAs(-1) for 130 kV, 120 kV and 100 kV, respectively. The body phantom weighted CBDI were 5.5 mGy 100 mAs(-1) and 3.8 mGy 100 mAs(-1 )for 130 kV and 120 kV. The head phantom weighted CBDI was 4.3 mGy 100 mAs(-1) for 100 kV. The weighted doses for the Christie Hospital CBCT imaging techniques were 1.6 mGy, 6 mGy and 22 mGy for the head, lung and pelvis. The measured CBDIs were used to estimate the total effective dose for the Synergy system using the ImPACT CT Patient Dosimetry Calculator. Measured CBCT doses using the Christie Hospital protocols are low for head and lung scans whether compared with electronic portal imaging (EPI), commonly used for treatment verification, or single and multiple slice CT. For the pelvis, doses are similar to EPI but higher than CT. Repeated use of CBCT for treatment verification is likely and hence the total patient dose needs to be carefully considered. It is important to consider further development of low dose CBCT techniques to keep additional doses as low as reasonably practicable.
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            Characteristics of a novel treatment system for linear accelerator–based stereotactic radiosurgery

            Ning Wen, Haisen Li, Kwang Song … (2015)
            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 D max 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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              An investigation of image guidance dose for breast radiotherapy

              Rosemerie Alvarado, Jeremy T. Booth, Regina Bromley … (2013)
              Cone‐beam computed tomography (CBCT) is used for external‐beam radiation therapy setup and target localization. As with all medical applications of ionizing radiation, radiation exposure should be managed safely and optimized to achieve the necessary image quality using the lowest possible dose. The present study investigates doses from standard kilovoltage kV radiographic and CBCT imaging protocol, and proposes two novel reduced dose CBCT protocols for the setup of breast cancer patients undergoing external beam radiotherapy. The standard thorax kV and low‐dose thorax CBCT protocols available on Varian's On‐Board Imaging system was chosen as the reference technique for breast imaging. Two new CBCT protocols were created by modifying the low‐dose thorax protocol, one with a reduced gantry rotation range (“Under breast” protocol) and the other with a reduced tube current‐time product setting (“Low dose thorax 10ms” protocol). The absorbed doses to lungs, heart, breasts, and skin were measured using XRQA2 radiochromic film in an anthropomorphic female phantom. The absorbed doses to lungs, heart, and breasts were also calculated using the PCXMC Monte Carlo simulation software. The effective dose was calculated using the measured doses to the included organs and the ICRP 103 tissue weighting factors. The deviation between measured and simulated organ doses was between 3% and 24%. Reducing the protocol exposure time to half of its original value resulted in a reduction in the absorbed doses of the organs of 50%, while the reduced rotation range resulted in a dose reduction of at least 60%. Absorbed doses obtained from “Low dose thorax 10ms” protocol were higher than the doses from our departments orthogonal kV‐kV imaging protocol. Doses acquired from “Under breast” protocol were comparable to the doses measured from the orthogonal kV‐kV imaging protocol. The effective dose per fraction using the CBCT for standard low‐dose thorax protocol was 5.00 ± 0.30   m S v ; for the “Low dose thorax 10ms” protocol it was 2.44 ± 0.21   m S v ; and for the “Under breast” protocol it was 1.23 ± 0.25   m S v when the image isocenter was positioned at the phantom center and 1.17 ± 0.30   m S v when the image isocenter was positioned in the middle of right breast. The effective dose per fraction using the orthogonal kV‐kV protocol was 1.14 ± 0.16   m S v . The reduction of the scan exposure time or beam rotation range of the CBCT imaging significantly reduced the dose to the organs investigated. The doses from the “Under breast” protocol and orthogonal kV‐kV imaging protocol were comparable. Simulated organ doses correlated well with measured doses. Effective doses from imaging techniques should be considered with the increase use of kV imaging protocols in order to support the use of IGRT. PACS numbers: 87.55.Qr, 87.55.ne, 87.53Bn, 87.55.kh
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                Author and article information

                Contributors
                Twyla R. Willoughby: Twyla.Willoughby@OrlandoHealth.com
                Journal
                Journal ID (nlm-ta): J Appl Clin Med Phys
                Journal ID (iso-abbrev): J Appl Clin Med Phys
                Journal ID (doi): 10.1002/(ISSN)1526-9914
                Journal ID (publisher-id): ACM2
                Title: Journal of Applied Clinical Medical Physics
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 1526-9914
                Publication date (Electronic): 24 April 2017
                Publication date Collection: May 2017
                Volume: 18
                Issue: 3 ( doiID: 10.1002/acm2.2017.18.issue-3 )
                Pages: 130-136
                Affiliations
                [ 1 ] Department of Radiation Oncology UF Health Cancer Center – Orlando Health Orlando FL USA
                Author notes
                [*] [* ] Author to whom correspondence should be addressed. Twyla R. Willoughby

                E‐mail: Twyla.Willoughby@ 123456OrlandoHealth.com ; Telephone: 321 841 8861.

                Article
                Publisher ID: ACM212084
                DOI: 10.1002/acm2.12084
                PMC ID: 5689854
                PubMed ID: 28436155
                SO-VID: 59d9e361-8c0d-47af-9817-2a8bef7c8c69
                Copyright © © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.
                License:

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 30 November 2016
                Date revision received : 12 January 2017
                Date accepted : 06 February 2017
                Page count
                Figures: 3, Tables: 6, Pages: 7, Words: 5239
                Categories
                Subject: 87.53.Bn
                Subject: 87.57.c-
                Subject: 87.57.n-
                Subject: 87.57.q-
                Subject: Radiation Oncology Physics
                Subject: Radiation Oncology Physics
                Custom metadata
                source-schema-version-number 2.0
                component-id acm212084
                cover-date May 2017
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.2.5 mode:remove_FC converted:16.11.2017

                Keywords: airo,igpt,mobile ct,proton therapy
                Data availability:
                Keywords: airo, igpt, mobile ct, proton therapy

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