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WE-G-213CD-03: A Dual Complementary Verification Method for Dynamic Tumor Tracking on Vero SBRT.

PURPOSE
to use complementary cine EPID and gimbals log file analysis for in-vivo tracking accuracy monitoring.


METHODS
A clinical prototype of dynamic tracking (DT) was installed on the Vero SBRT system. This prototype version allowed tumor tracking by gimballed linac rotations using an internal-external correspondence model. The DT prototype software allowed the detailed logging of all applied gimbals rotations during tracking. The integration of an EPID on the vero system allowed the acquisition of cine EPID images during DT. We quantified the tracking error on cine EPID (E-EPID) by subtracting the target center (fiducial marker detection) and the field centroid. Dynamic gimbals log file information was combined with orthogonal x-ray verification images to calculate the in-vivo tracking error (E-kVLog). The correlation between E-kVLog and E-EPID was calculated for validation of the gimbals log file. Further, we investigated the sensitivity of the log file tracking error by introducing predefined systematic tracking errors. As an application we calculate gimbals log file tracking error for dynamic hidden target tests to investigate gravity effects and decoupled gimbals rotation from gantry rotation. Finally, calculating complementary cine EPID and log file tracking errors evaluated the clinical accuracy of dynamic tracking.


RESULTS
A strong correlation was found between log file and cine EPID tracking error distribution during concurrent measurements (R=0.98). We found sensitivity in the gimbals log files to detect a systematic tracking error up to 0.5 mm. Dynamic hidden target tests showed no gravity influence on tracking performance and high degree of decoupled gimbals and gantry rotation during dynamic arc dynamic tracking. A submillimetric agreement between clinical complementary tracking error measurements was found.


CONCLUSIONS
Redundancy of the internal gimbals log file with x-ray verification images with complementary independent cine EPID images was implemented to monitor the accuracy of gimballed tumor tracking on Vero SBRT. Research was financially supported by the Flemish government (FWO), Hercules Foundation and BrainLAB AG.