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Elekta Synergy® S
High precision radiation therapy using
Elekta Synergy® S

UMC, Utrecht, Netherlands


The primary application of Elekta Synergy® S
at UMC, Utrecht, is frameless intracranial high
precision radiation therapy, using multi or single
fraction, static or arc techniques. A convergent beam
irradiation(3) technique is used to treat patients
on this machine, using XVI and 3D VolumeViewTM
imaging to verify the patient position, correct the
table position and then reconfirm the new position.

Accuracy study

High precision radiation therapy using Elekta Synergy® S Elekta Synergy® S commissioning team Marjolein Baarda Gijsbert Bol Corine van Es Fred Groen Stephen Kwa Rogier Schokker Gitta van Vliet Eric Westzaan Minique Boere Mark Harms Theo van Soest Hans Welleweerd Arther van Bruggen Erick Kouwenhoven Ties Timmers Andre Wopereis Acceptance tests were performed on the following items to ensure the suitability of Elekta Synergy® S for the job in hand. (far left) absolute positioning error (in 0. • Mechanical/geometrical accuracy – tolerance 0. (left) relative positioning error (in 0. consequently no adjustments have been required.1mm): top – average for every leaf pair bottom – average for every abutment. Method and results Beam modulatorTM Strip test(1) measurements have been performed on Beam ModulatorTM every week since installation to assess the accuracy of the leaf position. gantry and table Sources of errors such as mechanical sag or misalignments are addressed.1mm): top – average for every leaf pair bottom – average for every abutment. .5mm for both relative positioning error (RPE) and absolute positioning error (APE). So far there has been no structural deviation recorded beyond our tolerance of 0.5mm • Field definition: strip test/calibration • Rotational accuracy of diaphragm/collimator. Figure 1: (above) set-up of the strip test.

and a further six beams from 210° to 360°. The isocenter here is defined as ‘the point with the smallest maximum distance to any beam axis’. This was done with the diaphragm at 90° and rotation clockwise and. A fieldsize of 0.08mm Gantry rotation To measure the accuracy of the gantry rotation. 270: dev. 10MV coll.8 x 20 was set and six beams were irradiated at 30° increments from 15° to 165°. The beam axes of the beam were reconstructed using a circular profile(2). a film was placed in the trans axial position. Figure 4: (far left) Spoke film with gantry rotation (left) Gantry rotation ccw. Figure 3: collimator rotation 10MV gantry 0: dev.8 x 20cm was set and 12 beams were irradiated at 15° increments. 90° and 180°.Collimator rotation For acceptance of the diaphragm rotation a film was placed perpendicular to the beam axis on the table. 0.38mm . with the diaphragm at 270° and rotation counter-clockwise. The isocenter is determined by minimizing this maximum distance with movement of the isocenter. Figure 2: (far left) a diaphragm rotation film (left) circular profile of the 12 beams (24 peaks) This was performed with the gantry at 0°. A fieldsize of 0. The diaphragm rotation error is the maximum distance found: every beam-axis should hit the tolerance circle.2mm). The film was scanned into the software at high resolution (0. 0.

0. 0.22mm table rotation 6MV AB gantry 0/180°: dev.Table rotation A similar test was performed to ensure accuracy of the table position. To determine the AB error the test was repeated at gantry angles 0° and 180° and to determine the GT error the test was repeated at 90° and 270°. Figure 5: (top) (bottom) table rotation 6MV GT gantry 90/270°: dev. Table rotations from –90° to +75° were used.36mm . a film was placed in the coronal position.

The ball bearing is then placed in the exact isocenter and the position of the ball bearing is measured on the XVI at all gantry angles. The average distance of the corresponding beam axes was calculated at zero and the measured value was 0.92 and 1. but not over.5mm but this averages out with the convergent beam irradiation (CBI) technique to produce a negligible effect. The flex map can be determined from this data. The ball bearing is positioned at the laser intersection – isocenter and the exact position of the ball bearing relative to the isocenter is determined using MV beams and iViewGTTM. A film was placed on the table in the coronal plane and five strips of 0. Figure 6: (above) (left) 6a: gantry sag measurement with film 6b: influence of gantry sag on penumbra of an AP-PA technique Geometrical calibration of XVI A ball bearing test was used to generate the flex map. The flex map corrects for the sag and flex of the XVI panel during gantry rotation. firstly with the gantry at 0° and then with the gantry at 180°. Figure 7: geometrical calibration of XVI .05mm for 6MV and 10MV. see figure 6b. Gantry sag was 0. the center).Gantry sag Gantry sag can also be a source of error and the extent of this required investigation.8 x 10cm irradiated (extending to.

Finally the film in the phantom was analyzed and by subtracting the dose delivered by the CT and VolumeViewTM scans. Figure 8 shows the scope of the chain test.determining the geometrical error Y-profile. The phantom was then set-up on the Elekta Synergy® S table and a VolumeViewTM image was performed.05mm (right) . containing four aluminium bars and a film placed in mid-plane.XVI image quality The CATPHAN phantom is used to measure the image quality of the Elekta Synergy® S kV images on both contrast and detail resolution. and aluminum bars to mimic bones. Figure 8: scope of the chain test Figure 9: chain text phantom in trans axial. Figure 10: chain test . Detail >7lp/_cm_ and low contrast value < 2%. Chain test This involved executing a full patient procedure using a phantom and film to record the dose. error on center = 0. error on center = 0.24mm (left) X-profile. The phantom used for the chain test was a polystyrene block 30 x 30 x 10. the CBI positioning error could be determined. and then the plan data was sent to Elekta Synergy® S and the XVI workstation. scan data was transferred to Nucletron PLATO where a CBI plan was created centred on the bars and film. coronal and sagittal view The process involved taking a CT scan of the phantom. The phantom position was corrected following image registration on the XVI workstation and then the phantom was irradiated using the plan created in PLATO.

Muller RP. Luyken K. Med. Utrecht is an Elekta research site. meningiomas. Kocker M. was 0.40mm for gantry rotation. An accurate calibration method of the multileaf collimator valid for conformal and intensity modulated radiation treatments. 3 Pastyr O. The chain test demonstrated a geometrical error of less than 1mm. . On isocenter adjustment and quality control in linear accelerator-based radiosurgery with circular collimators and room lasers. Med. 2004 Jun 21: 49(12): 2631-43. 2 Treuer H. Figure 11: results of spoke films for acceptance Figure 12: chain test results Dynamic techniques are work-in-progress and not available on the current product configuration. pituitary. Schlegel W. sturm V. Biol. Schabbert S.Conclusions The chain test is repeated every month. Treuer H. Hartmann GH.35mm. 1989.15mm for the diaphragm rotation and 0. Table isocentric rotation accuracy was defined as 0. Gierich A. Lorenz WJ. (Wien). Acta Neuorochir.99 (1-2): 61-4. lung. Stereotactically-guided convergent beam irradiation with a linear accelerator: localization technique. Hoevels M. the strip test every three weeks and XVI ball bearing test and image quality test are performed weekly. prostate and some ad-hoc high precision patients not only with static treatment techniques. Results showed that the maximum deviation from the center. Biol. Our future plans are to use Elekta Synergy® S to treat brain metastases. References 1 Sastre-Padro M. Phys. Sturm V. for Beam ModulatorTM. Phys. but also with dynamic techniques. This enabled us to conclude that Elekta Synergy® S meets the criteria for high precision radiation therapy as defined by EORTC recommendations. 2000 Aug: 45(8):2331-42.

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