A quality assurance phantom for electronic portal imaging devices

Electronic portal imaging device (EPID) plays an important role in radiation therapy portal imaging, geometric and dosimetric verification. Consistent image quality and stable radiation response is necessary for proper utilization that requires routine quality assurance (QA). A commercial ‘EPID QC’ phantom weighing 3.8 kg with a dimension of 25 × 25 × 4.8 cm3 is used for EPID QA. This device has five essential tools to measure the geometric accuracy, signal‐to‐noise ratio (SNR), dose linearity, and the low‐ and the high‐contrast resolutions. It is aligned with beam divergence to measure the imaging and geometric parameters in both X and Y directions, and can be used as a baseline check for routine QA. The low‐contrast tool consists of a series of holes with various diameters and depths in an aluminum slab, very similar to the Las Vegas phantom. The high‐resolution contrast tool provides the modulation transfer function (MTF) in both the x‐ and y‐dimensions to measure the focal spot of linear accelerator that is important for imaging and small field dosimetry. The device is tested in different institutions with various amorphous silicon imagers including Elekta, Siemens and Varian units. Images of the QA phantom were acquired at 95.2 cm source‐skin‐distance (SSD) in the range 1–15 MU for a 26 × 26 cm2 field and phantom surface is set normal to the beam direction when gantry is at 0° and 90°. The epidSoft is a software program provided with the EPID QA phantom for analysis of the data. The preliminary results using the phantom on the tested EPID showed very good low‐contrast resolution and high resolution, and an MTF (0.5) in the range of 0.3–0.4 lp/mm. All imagers also exhibit satisfactory geometric accuracy, dose linearity and SNR, and are independent of MU and spatial orientations. The epidSoft maintains an image analysis record and provides a graph of the temporal variations in imaging parameters. In conclusion, this device is simple to use and provides testing on basic and advanced imaging parameters for daily QA on any imager used in clinical practice

Impact of use of optical surface imaging on initial patient setup for stereotactic body radiotherapy treatments

Purpose To evaluate the effectiveness of surface image guidance (SG) for pre‐imaging setup of stereotactic body radiotherapy (SBRT) patients, and to investigate the impact of SG reference surface selection on this process. Methods and materials 284 SBRT fractions (SG‐SBRT = 113, non‐SG‐SBRT = 171) were retrospectively evaluated. Differences between initial (pre‐imaging) and treatment couch positions were extracted from the record‐and‐verify system and compared for the two groups. Rotational setup discrepancies were also computed. The utility of orthogonal kVs in reducing CBCT shifts in the SG‐SBRT/non‐SG‐SBRT groups was also calculated. Additionally, the number of CBCTs acquired for setup was recorded and the average for each cohort was compared. These data served to evaluate the effectiveness of surface imaging in pre‐imaging patient positioning and its potential impact on the necessity of including orthogonal kVs for setup. Since reference surface selection can affect SG setup, daily surface reproducibility was estimated by comparing camera‐acquired surface references (VRT surface) at each fraction to the external surface of the planning CT (DICOM surface) and to the VRT surface from the previous fraction. Results The reduction in all initial‐to‐treatment translation/rotation differences when using SG‐SBRT was statistically significant (Rank‐Sum test, α = 0.05). Orthogonal kV imaging kept CBCT shifts below reimaging thresholds in 19%/51% of fractions for SG‐SBRT/non‐SG‐SBRT cohorts. Differences in average number of CBCTs acquired were not statistically significant. The reference surface study found no statistically significant differences between the use of DICOM or VRT surfaces. Conclusions SG‐SBRT improved pre‐imaging treatment setup compared to in‐room laser localization alone. It decreased the necessity of orthogonal kV imaging prior to CBCT but did not affect the average number of CBCTs acquired for setup. The selection of reference surface did not have a significant impact on initial patient positioning

Recent trends, technical concepts and components of computer-assisted orthopedic surgery systems: A comprehensive review

Computer-assisted orthopedic surgery (CAOS) systems have become one of the most important and challenging types of system in clinical orthopedics, as they enable precise treatment of musculoskeletal diseases, employing modern clinical navigation systems and surgical tools. This paper brings a comprehensive review of recent trends and possibilities of CAOS systems. There are three types of the surgical planning systems, including: systems based on the volumetric images (computer tomography (CT), magnetic resonance imaging (MRI) or ultrasound images), further systems utilize either 2D or 3D fluoroscopic images, and the last one utilizes the kinetic information about the joints and morphological information about the target bones. This complex review is focused on three fundamental aspects of CAOS systems: their essential components, types of CAOS systems, and mechanical tools used in CAOS systems. In this review, we also outline the possibilities for using ultrasound computer-assisted orthopedic surgery (UCAOS) systems as an alternative to conventionally used CAOS systems.Web of Science1923art. no. 519