Virtual CT Simulator QA – 2

topics Electromechanical
Performance and
Virtual CT simulation software
Image quality
Virtual Simulator CT QA
Alex Markovic, PhD

Director, Medical Radiation Physics Program,

Rosalind Franklin University, North Chicago, IL

Lead Therapeutic Physicist,

NorthShore University Health System, Evanston, IL

CT operator console

Alex Prasad

Original Simulators What is Virtual CT Simulator

(VSim)?
TG66:Quality assurance for computed-tomography
X ray tube
simulators and the computed tomography-
simulation process

“A virtual simulator is a set of software which

Image intensifier
recreates the treatment machine and which allows
import, manipulation, display, and storage of
images from CT and/or other imaging modalities.”

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 Examples of VSim software VSim Software Features
packages: • DRR generation
• Varian SomaVision • Automatic structure segmentation
• GE Advantage SIM • Interpolation of contours
• Elekta Group - CMS • Manual and semi-automatic (eg. “smart
Focal brush”) contouring tools
• Phillips AcQSim3 • Volume expansion to apply margins
• Siemens syngo RT • 4D Visualization of organ motion
Oncologist • Isocenter placement, design of treatment
fields
Phillips
AcQSim • Moving laser support
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Advantages of VSim Relevant Guidance Documents

• No guidance document dedicated to Vsim QA
• TG 2(1993): Specification and acceptance testing of CT
• Efficient workflow scanners
• Doctors are usually present during the CT scan • TG 53(1998) – QA of treatment planning
• Good time to have them complete their • NCRP report #99: Quality Assurance for Diagnostic
contouring and planning work. Imaging
• TG 66 (2003): QA for CT-simulators and CT simulation
• Poor scans can be repeated process
• Doctors’ work is less likely to be delayed • TG 117 (in progress): The Use of MRI Data in Treatment
• Vsim software can be installed on doctor’s PC or Planning and Stereotactic Procedures – Spatial Accuracy
can be accessed through Citrix and Quality Control Procedures
• TG132 (In progress): Use of Image Registration and Data
Fusion Algorithms and Techniques in Radiotherapy
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Treatment Planning
 VSim Quality Management
Why Perform QA on the VSim? Program
• Acceptance testing - manufacturer procedure , if it
exists

• Ensure data to and from VSim

• Commissioning - resident physicist establishes
transfers correctly procedures baseline values , mostly for
• Reduce possibility of treatment errors electromechanical/imaging system components
due to inaccurate transfer of data
• Periodic QA – ensures consistency of baseline values
• Ensure complete dataset is sent
• End of warranty tests - 6 weeks prior to end of
warranty

9 • Post service/upgrade tests 10

Data Transfer from CT to VSim

Node Setup
VSim IP address

Data transfer

VSim AE Title

CT scanner DICOM export configuration screen

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 Data Transfer Issues Data Transfer from VSim to TPS
trouble in paradise DICOM RT
Information standard to move images, etc

• VSim hosts file does not include CT Images: CTs, DRRs

scanner IP
• Routers are mac layered Structure sets: Points of interest, bolus, 3D objects
• Dicom service has stopped on VSim
• IT has secretly upgraded the router
• When in doubt – reboot! Plan parameters: Tx fields, tolerance tables, Rx,
patient orientation, fractionation, machine ID,
accessories
VSim hosts file

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Data Transfer issues from VSim

Network Transfer Glossary Eg: Beam to TPS
energy does not transfer

• SOP: service object pair (CT -> Vsim)

• SCP: Service Class Provider (eg VSim)
• SCU: Service Class User (eg CT) GE Advantage sim DICOM conformance
statement
• ftp: file transfer protocol
• UID: Unique identifier (transfer session
ID)
XiO TPS DICOM conformance
statement

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 VSim Acceptance Testing VSim Acceptance Testing
patient orientation
• Patient orientation HFS

• Machine definition • Ensure images are transferred

• Movable lasers to VSim and TPS correctly
• Structure and they display correct FFS
segmentation orientation
• DRR accuracy
• 4DCT HFP
• SRS • Implications:
• Reversed beam orientation
• Contours drawn on wrong
side of patient
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VSim Acceptance Testing VSim Acceptance Testing

patient orientation machine definition
• Available beam energies
• Position and limits of jaws
• Collimator rotation
• MLC type (52,58, 82 120, 120 HD, m3, 160 leaf)
• Angle convention (IEC 601-2-1, IEC 1217 or
non-IEC)
CT screen TPS screen
• Tolerance levels should be tight
• Implications are numerous: missing or incorrect
Incorrect patient orientation
beam parameters transferred to TPS
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 VSim Acceptance Testing VSim Acceptance Testing
machine definition machine definition

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VSim Acceptance Testing VSim Acceptance Testing

machine definition - verification movable lasers
1) Set up beams in VSim
• Mechanical system
2) Transfer to TPS
3) Verify Parameters: • Absolute, relative position accuracy
• Machine/energy
• scale • Scan phantom with radio-opaque
• gantry angle
• rotations
reference point and mm markings
• field size
• etc • Test system through its maximum
TPS mechanical extents
• Implications: incorrect isocenter markings
which may not be caught until film is
reviewed
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 VSim Acceptance Testing VSim Acceptance Testing
movable lasers structure delineation
• Bifurcating structures or disconnected structures
• Contouring in sagittal cuts
Scales • Contour interpolating
• Double contours (external skin)
• Copy structures, expansion, Boolean operations
• Unclosed contours
• Accurate volume reporting
Radiopaque markers

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VSim Acceptance Testing VSim Acceptance Testing

structure delineation – contour interpolation structure delineation – double contours

Ensure correct TPS – single contour

TPS - Shifted external contour
position
axial

Does the TPS allow

double contours? TPS - Shifted external contour
sagittal
VSim - Before interpolation VSim -After interpolation

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 VSim Acceptance Testing VSim Acceptance Testing
structure delineation – volume reporting DRR accuracy
• Contour object of known Physicians rely on accurate DRRs
dimensions in VSim to:
VSim
• Verify volume, dimensions • delineate blocking
• Ensure same volume, • set field size dimensions
dimensions are reported in
• view organ projections
TPS Incorrect
windowing Implications:
• Set CT image level to ½ of
object’s max, set window to • Under or over coverage of
<50 TPS disease
• Implication: •Inadequate sparing of healthy
tissue
• incorrect DVH reporting
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VSim Acceptance Testing VSim acceptance testing

DRR accuracy 4DCT

Scan plate between plastic slabs

• Acquires >10 images per
couch position
• Accurate tracking of motion
surrogate
• Analyze motion in three
Radiopaque markers
AP DRR on VSim workstation
planes

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 VSim Acceptance testing VSim Acceptance testing
4DCT SRS/SBRT
• Test to verify that total 11 mm • Image quality
measure
deflection of movement d – High contrast resolution
is being acquired by deflection
– Low contrast detectability, noise
4DCT system
• Should be done in 3 • Image fusion
axes – Accuracy of fusion module
• Implications: incorrect – MRI distortion
size of MIP (maximum
intensity projection)
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Use of VSim in SRS Use of VSim in SRS

Image fusion - distortion Image fusion - distortion
• TG 117 (in progress): The use of MRI Data in
Treatment Planning and Stereotactic Procedures • Implications of image Acceptable registration
– Spatial Accuracy and Quality Control distortion:
Procedures MRI CT
- Incorrect anatomical
• TG132 (In progress): Use of Image Registration rendering
and Data Fusion Algorithms and Techniques in
Radiotherapy Treatment Planning MRI test phantom
Poor registration

• Deformable/translational or translational
only
• QA of MRI to test image distortion Fused image sets

• Evaluate fusion with MRI/CT phantom

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 VSim Periodic QA Questions?

• Low likelihood of VSim

parameters changing over
time
• Yearly: repeat acceptance
tests
• Focus on testing after
upgrades and external system
changes

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Next Talk:
CT Sim: Electromechanical, image
quality
Guru Prasad

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