Trujillo-Bastidas Christian D, Taylor Michael J, Díaz-Londoño Gloria M
Clínica de Oncología Astorga, Departamento de Radioterapia/Universidad Nacional de Colombia - Sede Medellín, Facultad de Ciencias, Departamento de Física, Grupo de Investigación de Física Radiológica, Medellín, Colombia.
Accuray Inc., Deparment of Radiation Oncology, Madison, Wisconsin, USA.
J Appl Clin Med Phys. 2025 Jan;26(1):e14545. doi: 10.1002/acm2.14545. Epub 2024 Oct 3.
The installation and testing of the first Radixact with Synchrony system in Colombia marked a significant milestone in Latin America's medical landscape. There was a need to devise a robust quality assurance protocol to comprehensively evaluate both dose delivery and motion tracking accuracy. However, testing experiences under clinical conditions have not been extensively reported. Additionally, there are limited recommended measuring devices for Synchrony evaluation.
To validate and implement an alternative setup for dynamic-PSQA while testing Synchrony's functionality under clinical scenarios, including real-patient motion traces, and to provide guidance to new centers undergoing clinical implementation of Helical Synchrony.
This approach involves using the Iba miniPhantomR with strategically placed fiducial markers for configuring Gafchromic-films and array-based setups. When paired with the CIRS Dynamic Platform, this enables an innovative dynamic setup with trackable features for Synchrony delivery testing. Assessment scenarios, including compensation (M1S1) and no-motion compensation (M1S0), were evaluated using 2D-gamma pass rate analysis with multiple clinical gamma criteria. The Synchrony-Simulation feature was used to assess pre-treatment performance and capture the patient's target motion pattern. Synchrony for common clinical cases with patient's motion-traces was validated.
The results for M1S0 and M1S1 demonstrated consistency with previous studies evaluating Synchrony functionality. Analysis using different gamma criteria unveiled dosimetric differences and impacts across various motion ranges. The application of effective kV-dose subtraction for array-based methods is of upmost importance when evaluating dynamic-PSQA with stringent gamma-criteria. However, no significant kV-dose impact on EBT3-Film was detectable.
Two implemented configurations for dynamic-PSQA setups were validated and successfully integrated into our clinic. We addressed both the benefits and limitations of array-based and film-based methods. The functionality and limitations of Synchrony were evaluated using the proposed setups. The potential utility of Synchrony-Simulation, along with the proposed patient-case classification table, can offer valuable support for new users during the clinical implementation of Synchrony treatments.
哥伦比亚首台带有同步系统的Radixact的安装和测试是拉丁美洲医学领域的一个重要里程碑。需要设计一个强大的质量保证方案，以全面评估剂量输送和运动跟踪精度。然而，临床条件下的测试经验尚未得到广泛报道。此外，用于同步评估的推荐测量设备有限。
在临床场景下测试同步功能时，包括真实患者的运动轨迹，验证并实施一种用于动态物理剂量学质量保证（dynamic-PSQA）的替代设置，并为正在进行螺旋同步临床实施的新中心提供指导。
该方法涉及使用带有精心放置基准标记的Iba miniPhantomR来配置加弗罗奇变色胶片（Gafchromic-films）和基于阵列的设置。与CIRS动态平台配合使用时，这实现了一种具有可跟踪功能的创新动态设置，用于同步输送测试。使用具有多个临床伽马标准的二维伽马通过率分析评估了包括补偿（M1S1）和无运动补偿（M1S0）在内的评估场景。同步模拟功能用于评估治疗前性能并捕捉患者的靶区运动模式。对具有患者运动轨迹的常见临床病例的同步进行了验证。
M1S0和M1S1的结果与先前评估同步功能的研究一致。使用不同伽马标准的分析揭示了不同运动范围内的剂量差异和影响。在使用严格伽马标准评估动态-PSQA时，基于阵列的方法应用有效的千伏剂量减法至关重要。然而，未检测到千伏剂量对EBT3胶片有显著影响。
两种实施的动态-PSQA设置配置得到了验证，并成功集成到我们的诊所。我们阐述了基于阵列和基于胶片方法的优点和局限性。使用所提出的设置评估了同步的功能和局限性。同步模拟的潜在效用以及所提出的患者病例分类表，可以在同步治疗的临床实施过程中为新用户提供有价值的支持。
