introduction of rapidarc : an example of commissioning and ... proce… · 1 introduction of...
TRANSCRIPT
![Page 1: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/1.jpg)
1
Introduction of RapidArcTM: an example of commissioning and implementing a QA programme for a new technology
Philip MaylesClatterbridge Centre for Oncology,
Wirral, UK
![Page 2: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/2.jpg)
2
What is RapidArc (or VMAT) ?• An isocentric treatment in which the
dose rate, gantry speed, and MLC leaf positions are all changing
• Treatment carried out in a single rotation– Two rotations may improve distribution
• Substantially reduced treatment time
![Page 3: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/3.jpg)
3
Step One• Establish a multidisciplinary team
– Doctors– Physicists– Radiation Technologists
![Page 4: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/4.jpg)
4
The Team• Clinical Oncologist
– Isabel Syndikus• Physicists
– Helen Mayles, Richard Clements, Julie Kirk, Simon Temple, Stephen Riley
• Radiation Technologists– Ruth Clements, Angela Heaton
• Their contributions to this talk are gratefully acknowledged
![Page 5: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/5.jpg)
5
Tasks for the Team• Requirements for the treatment machine to
deliver VMAT accurately• Quality control procedures• Planning system parameters that may need
to be known more accurately• Phantom measurements to verify achievable
accuracy• Requirements and methodology for ongoing
quality assurance of patient treatment plans• Patient setup and verification
![Page 6: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/6.jpg)
6
How does it work ?• MLC leaf positions are linked to the gantry
rotation angle• Gantry rotation is linked to dose delivered• Control points have a cumulative dose value,
MLC leaf positions and gantry angle• Machine calculates gantry speed and dose
rate
![Page 7: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/7.jpg)
7
![Page 8: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/8.jpg)
8
![Page 9: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/9.jpg)
9
What can go wrong
• MLC leaf speed• Gantry speed • Dose rate control• MLC leaf calibration
![Page 10: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/10.jpg)
10
Machine Tests
Following Ling et al IJROBP 72 575-581 2008
![Page 11: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/11.jpg)
Variable Leaf Speed Test
• 4 dynamic segments (From Right to Left)
– Field width 30 mm– 4.6 mm/s 138 MU/min– 9.2 mm/s 277 MU/min– 18.4 mm/s 554 MU/min– Field width 45 mm– 27.6 mm/s 554 MU/min
![Page 12: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/12.jpg)
RADR
Dose Rate Test
• 7 segments– 111 MU/min for 90°– 222 MU/min for 45°– 332 MU/min for 30°– 443 MU/min for 22.5°– 554 MU/min for 18°– 600 MU/min for 15°
at 5°/s– 600 MU/min for 12.9°
at 4.3°/s• Equivalent to 0.33, 0.67,
1.0, 1.33, 1.67, 2 and 2.33 MU/°
![Page 13: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/13.jpg)
Static Rapid Arc
![Page 14: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/14.jpg)
Static Rapid Arc
![Page 15: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/15.jpg)
Static Rapid Arc
![Page 16: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/16.jpg)
Static Rapid Arc
![Page 17: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/17.jpg)
![Page 18: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/18.jpg)
18
Comparative Patient Plans• Aim to demonstrate that RapidArc
produces plans that are better or at least equally good
• Consider different sites one by one
![Page 19: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/19.jpg)
Rapid Arc IMRTProstate Simultaneous Boost
![Page 20: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/20.jpg)
Prostate Simultaneous BoostBoost
Prostate + Seminal Vesicles
Bowel
Bladder
Rectum
Femoral Heads
RapidArc
IMRT
![Page 21: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/21.jpg)
Prostate and Pelvic nodesRapid Arc IMRT
![Page 22: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/22.jpg)
Prostate and Pelvic nodes
RapidArc
IMRT
Bowel
Bladder Rectum
ProstateProstate + Seminal Vesicles
Pelvic nodes
Femoral Heads
RapidArc
IMRT
Bladder
RapidArc
IMRT
Bowel
Bladder
RapidArc
IMRT
Femoral Heads
Bowel
Bladder
RapidArc
IMRT
Pelvic nodes
Femoral Heads
Bowel
Bladder
RapidArc
IMRT
Rectum
Pelvic nodes
Femoral Heads
Bowel
Bladder
RapidArc
IMRT
Prostate + Seminal Vesicles
Rectum
Pelvic nodes
Femoral Heads
Bowel
Bladder
RapidArc
IMRT
ProstateProstate + Seminal Vesicles
Rectum
Pelvic nodes
Femoral Heads
Bowel
Bladder
RapidArc
IMRT
![Page 23: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/23.jpg)
23
Individual Patient QA• Many current systems just allow one beam to be
analysed• We need to look at the composite beam in 3D
– Delta4 has been specially adapted for RapidArc including gantry angle monitoring
![Page 24: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/24.jpg)
Delta4 3D Diode Phantom
![Page 25: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/25.jpg)
![Page 26: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/26.jpg)
Couch Model
![Page 27: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/27.jpg)
Effect of couch correction
![Page 28: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/28.jpg)
Effect of couch correction
![Page 29: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/29.jpg)
29
Individual Patient QA• Many current systems just allow one beam to be
analysed• We need to look at the composite beam in 3D
– Delta4 has been specially adapted for RapidArc including gantry angle monitoring
– We have also mounted it on a carriage that allows us to observe the effect of breathing
![Page 30: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/30.jpg)
Delta4 Mounted on a Moving Carriage to Simulate Respiration
![Page 31: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/31.jpg)
31
Individual Patient QA• Many current systems just allow one beam to be
analysed• We need to look at the composite beam in 3D
– Delta4 has been specially adapted for RapidArc including gantry angle monitoring
– We have also mounted it on a carriage that allows us to observe the effect of breathing
• For absolute dose measurements it is useful to have a patient shaped phantom
![Page 32: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/32.jpg)
Water Phantoms for QA
![Page 33: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/33.jpg)
33
Individual Patient QA• Many current systems just allow one beam to be
analysed• We need to look at the composite beam in 3D
– Delta4 has been specially adapted for RapidArc including gantry angle monitoring
– We have also mounted it on a carriage that allows us to observe the effect of breathing
• For absolute dose measurements it is useful to have a patient shaped phantom
• It is also important to check reproducibility of delivery
![Page 34: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/34.jpg)
Repeatability
![Page 35: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/35.jpg)
35
Individual Patient QA• Many current systems just allow one beam to be
analysed• We need to look at the composite beam in 3D
– Delta4 has been specially adapted for RapidArc including gantry angle monitoring
– We have also mounted it on a carriage that allows us to observe the effect of breathing
• For absolute dose measurements it is useful to have a patient shaped phantom
• It is also important to check reproducibility of delivery• For some patients geometric accuracy is a key factor
![Page 36: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/36.jpg)
Multiple Brain Metastases
![Page 37: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/37.jpg)
![Page 38: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/38.jpg)
![Page 39: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/39.jpg)
![Page 40: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/40.jpg)
![Page 41: Introduction of RapidArc : an example of commissioning and ... proce… · 1 Introduction of RapidArc TM: an example of commissioning and implementing a QA programme for a new technology](https://reader031.vdocuments.net/reader031/viewer/2022041104/5f04746b7e708231d40e0ce8/html5/thumbnails/41.jpg)
41
Conclusions• New techniques need new approaches to QA• Assessment of the risks can highlight those
areas that need to be assessed• A well documented process should be
followed with independent review• Machine QA should be ongoing• The benefits of RapidArc appear to outweigh
the potential risks