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03 Commissioning - Indonesia Course

The document discusses the process of commissioning a medical linear accelerator and treatment planning system. It describes the purposes of commissioning, minimum data requirements, detectors and equipment used, and tests that should be performed including beam modeling, heterogeneity corrections, IMRT/VMAT tests, and end-to-end testing. Commissioning the accelerator and planning system together is recommended to test all treatment techniques.

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Linda
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33 views58 pages

03 Commissioning - Indonesia Course

The document discusses the process of commissioning a medical linear accelerator and treatment planning system. It describes the purposes of commissioning, minimum data requirements, detectors and equipment used, and tests that should be performed including beam modeling, heterogeneity corrections, IMRT/VMAT tests, and end-to-end testing. Commissioning the accelerator and planning system together is recommended to test all treatment techniques.

Uploaded by

Linda
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Accelerator Commissioning

Geoffrey S. Ibbott, Ph.D.


Chairman, Department of Radiation Physics
Commissioning
o Purposes

o determine and record beam


characteristics
o acquire data for treatment planning,
manual calculations

o How much data is required?


Acceptance Testing &
Commissioning of Accelerator
§ Why do acceptance testing and
commissioning?
o To be sure delivered system meets
purchase specifications
o Be sure we understand equipment
o Avoid surprises after implementation
Commissioning
§ Acceptance testing finished.
§ Treat patients?
Administrator – yes
Radiation Oncologist – yes
Therapist – yes
Physicist – NO

§ Must have minimum dataset necessary for


treatment planning and beam-on time
calculations.
§ Dependent on treatment planning system.
Commissioning
Beam data requirements for treatment planning systems
– General data requirements for commissioning
(Task Group 45) and 3D Planning Systems (Task
Group 53)
- Medical Physics Practice Guideline from AAPM TG-244
- IAEA Report 1583 on Commissioning of RTPS
– Photon beam data
– Electron beam data
Selection of appropriate tools for beam data acquisition
Must Commission Accelerator and
Treatment Planning System Together

o Why?
o Consider all anticipated treatment techniques
o IMRT, VMAT, stereotactic radiosurgery, etc.
o IMRT, SRS, involve the use of very small, heavily
blocked fields. Not always tested during the initial
commissioning
Commissioning

§ Minimum Data Requirements


- calibration (TRS 398 or TG-51)
- CAX depth dose (PDD/TPR)
- dose profiles
- isodose distributions (open/wedge)
- output factors (Sc, Sc,p)
- wedge and tray factors
Commissioning

§ Minimum Data Requirements


- off-axis ratios (open/wedge)
- inverse square law (SSD/VSD)
- entrance dose and buildup region
- selected TPR
- TPS data verification
- special dosimetry (TBI, TSE, SRS, IORT,
etc.)
Draft Medical Physics
Practice Guideline

❖ Defines equipment to be used

❖ Measurements needed for commissioning planning system

❖ Calculations to perform for comparison


Commissioning Tests
Detectors
Commissioning
Dosimetry measurements for acquiring beam data are
best performed in water using appropriate radiation
detectors. The essential features required of any
measuring device are:
(1)sufficient sensitivity;
(2)stability;
(3)negligible leakage;
(4)energy independence;
(5)sufficient spatial resolution, and
(6)linearity.
Valuable Resource
AAPM Task Group 106 Report
Accelerator Beam Data
Commissioning Equipment and
Procedure
Published 2007
Influence of Detector Choice
Equipment required
Commissioning
§ Setting up for measurements
- verify servo movement and electrometer
function initially
- warnings
i) heavy (45 kg empty/500 kg full)
ii) water leakage
iii) distilled or de-ionized water
Commissioning

§ Setting up for measurements


- position tank so that crosshairs are in
center
- level empty phantom (spirit level)
- fill phantom
- adjust SSD
Caution – do not store water in tank for long periods
of time
– do not leave ionization chamber in water
Commissioning
Setting up for measurements
- Detectors
i) field and reference
chambers
ii) mount both chambers
iii) beam direction and
chamber position
Commissioning
§ Setting up for measurements
§ Fine leveling
i) 3D servo frame has
to be leveled relative
to water surface
ii) remove alignment
cap
water
level
Commissioning
Methods for Obtaining a Self-Consistent Dataset
• Design the measurements so that the data required to tie all
the various separate measurements together are obtained
during the same measurement session.
• Make measurements over the shortest time span possible
consistent with obtaining representative dose measurements.
• Use the same equipment and procedures for all similar
measurements.
• Use a reference chamber to account for output fluctuations
when making measurements with a scanning ionization
chamber.
Commissioning
Methods for Obtaining a Self-Consistent Dataset
o Periodically repeat base measurements, such as the dose at
10 cm depth for a 10x10 cm2 field, to monitor the
consistency of the machine output and the measuring
system. Note that this may involve use of temperature
equilibrated water and/or monitoring the barometric
pressure, in certain situations.
Beam model comparison
Photon beam tests in
homogenous medium
Simple square fields
6x and 10x
Irregular fields
Compare in irregular fields
Model inter-leaf
transmission
Photon beam tests
Heterogeneity Corrections
Heterogeneity Phantom
Heterogeneity Plan
Results
VMAT and IMRT
VMAT and IMRT Tolerances
Commissioning - electrons
§Measurements
- measured data summary
i) CAX depth dose
ii) applicator factors
iii) dose profiles
iv) virtual source distance

electron calculations most often


performed manually
Commissioning
Measurements
- establish monthly & daily output check factors
i) full TRS 398 calibration
ii) monthly & daily output check device readings
iii) corrected for TPC

•
DH2 0
CF =
Rdg • PTP
iv) all energies
Commissioning
Special procedures
- TBI
- IORT
- TSE
- SRS
- IMRT

High Tech Devices


- Asymmetric jaws
- small fields
- MLC
- dynamic wedge
3D Conformal Radiotherapy
o Developed in 1980s, widely
implemented in 1990s
o 3D anatomic shapes derived
from CT images
o Beams shaped to conform to
target with a multi-leaf
collimator
Equipment for IMRT Delivery

o Dynamic Multi-leaf
collimator
o Software for converting
intensities into MLC leaf
trajectories
o “Driver” software for
moving leaves during
under computer control
during irradiation
o Special QA procedures
MLC Design
MLC Design (2)
Inspect MLC
leakage with
leaves closed
Leakage without
a proper calibration
Deficiencies/problems

Ø not quantitative
Ø limited accuracy (>0.5mm)
Ø cost
Ø …..
Tongue and Groove

From Bruce Curran


Acceptance Testing:
o Acceptance of What?

o Software, e.g. treatment planning, MU check program, film


analysis software, upgrades to RV system
o IMRT treatment fields cannot be easily entered through
human interface – nearly impossible
o Seamless network connection is required – vendor support
and on- site validation are important

o Hardware, e.g. MLC upgrade, immobilization and/or


localization system
Perform an End-to End Test

❖ If possible, use an anthropomorphic phantom

❖ Plan (2D, 3D, IMRT or VMAT)

❖ Deliver treatment

❖ Compare plan versus measurement


RPC Phantoms

Pelvis (10)

Thorax (13)

Spine (4)

H&N (31)
Liver (2)
SRS Head
MDACC (4)
May 8, 2013
Treat the
phantom as if it
were a patient
Plan vs. Treatment
Recent Phantom Results
Comparison between ins/tu/on’s plan and
delivered dose.

Phantom H&N Lung Prostate Spine

Irradiations 1458 484 411 168


1210 394 352 113
Pass
(83%) (81%) (86%) (67%)
Fail 248 90 59 55
Criteria 7%/4mm 5%/5mm 7%/4mm 5%/3mm
Finally, How long will this
process take?

o An appropriate time must be scheduled


for the proper commissioning:
o The length of time needed depends on
many factors, such as availability and
experience of personnel and proper
instrumentation and type of accelerator.
Finally, How long will this
process take?

o a single energy photon machine can be


commissioned in about 2-4 weeks
o a multimodality accelerator with two
photon energies and several electron
energies can take about 6-8 weeks of
intensive effort (requiring 16-h shifts )
Thorough data acquisition and TPS
commissioning is laborious and
necessary work. In the end, we don’t
want any surprises …
The End

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