An end-to-end examination of geometric accuracy of IGRT using a new digital accelerator equipped with onboard imaging system

Lei Wang, Kayla N. Kielar, Ed Mok, Annie Hsu, Sonja Dieterich, Lei Xing

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


The Varian's new digital linear accelerator (LINAC), TrueBeam STx, is equipped with a high dose rate flattening filter free (FFF) mode (6 MV and 10 MV), a high definition multileaf collimator (2.5 mm leaf width), as well as onboard imaging capabilities. A series of end-to-end phantom tests were performed, TrueBeam-based image guided radiation therapy (IGRT), to determine the geometric accuracy of the image-guided setup and dose delivery process for all beam modalities delivered using intensity modulated radiation therapy (IMRT) and RapidArc. In these tests, an anthropomorphic phantom with a Ball Cube II insert and the analysis software (FilmQA (3cognition)) were used to evaluate the accuracy of TrueBeam image-guided setup and dose delivery. Laser cut EBT2 films with 0.15 mm accuracy were embedded into the phantom. The phantom with the film inserted was first scanned with a GE Discovery-ST CT scanner, and the images were then imported to the planning system. Plans with steep dose fall off surrounding hypothetical targets of different sizes were created using RapidArc and IMRT with FFF and WFF (with flattening filter) beams. Four RapidArc plans (6 MV and 10MV FFF) and five IMRT plans (6 MV and 10MV FFF; 6 MV, 10 MV and 15 MV WFF) were studied. The RapidArc plans with 6 MV FFF were planned with target diameters of 1cm (0.52 cc), 2cm (4.2 cc) and 3cm (14.1 cc), and all other plans with a target diameter of 3cm. Both onboard planar and volumetric imaging procedures were used for phantom setup and target localization. The IMRT and RapidArc plans were then delivered, and the film measurements were compared with the original treatment plans using a gamma criteria of 3%/1 mm and 3%/2 mm. The shifts required in order to align the film measured dose with the calculated dose distributions was attributed to be the targeting error. Targeting accuracy of image-guided treatment using TrueBeam was found to be within 1 mm. For irradiation of the 3cm target, the gammas (3%, 1 mm) were found to be above 90% in all plan deliveries. For irradiations of smaller targets (2cm and 1cm), similar accuracy was achieved for 6 MV and 10 MV beams. Slightly degraded accuracy was observed for irradiations with higher energy beam (15 MV). In general, gammas (3%, 2 mm) were found to be above 97% for all the plans. Our end-to-end tests showed an excellent relative dosimetric agreement and sub-millimeter targeting accuracy for 6 MV and 10 MV beams, using both FFF and WFF delivery methods. However, increased deviations in spatial and dosimetric accuracy were found when treating lesions smaller than 2cm or with 15 MV beam.

Original languageEnglish (US)
Pages (from-to)757-769
Number of pages13
JournalPhysics in Medicine and Biology
Issue number3
StatePublished - Feb 7 2012
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology


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