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The aim of this paper is to assess the overall geometric accuracy of the Novalis system using the Robotic Tilt Module in terms of the uncertainty in frameless stereotactic radiotherapy. We analyzed the following three metrics: (1) the correction accuracy of the robotic couch, (2) the uncertainty of the isocenter position with gantry and couch rotation, and (3) the shift in position between the isocenter and central point detected with the ExacTrac x-ray system. Based on the concept of uncertainty, the overall accuracy was calculated from these values. The accuracy in positional correction with the robotic couch was 0.07 +/- 0.22 mm, the positional shift of the isocenter associated with gantry rotation was 0.35 mm, the positional shift of the isocenter associated with couch rotation was 0.38 mm and the difference in position between the isocenter and the ExacTrac x-ray system was 0.30 mm. The accuracy of intracranial stereotactic radiosurgery with the Novalis system in our clinic was 0.31 +/- 0.77 mm. The overall geometric accuracy based on the concept of uncertainty was 0.31 +/- 0.77 mm, which is within the tolerance given in the American Association of Physicists in Medicine report no. 54.

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Abdominal compression was effective for reducing the amplitude of tumor motion. However, in most of the authors' patients, the use of abdominal compression seemed to increase the interfraction variation in tumor position, despite reducing lung tumor motion. The daily tumor position deviated more systematically from the tumor position in the planning CT scan in the lateral and longitudinal directions in patients treated with abdominal compression compared to those treated without compression. Therefore, target matching is required to correct or minimize the interfraction variation.

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Tungsten functional paper (TFP) is a novel paper‐based radiation‐shielding material. We measured the shielding ability of TFP against x‐rays and gamma rays. The TFP was supplied in 0.3‐mm‐thick sheets that contained 80% tungsten powder and 20% cellulose (C6H10O5) by mass. In dose measurements for x‐rays (60, 80, 100, and 120 kVp), we measured doses after through 1, 2, 3, 5, 10, and 12 TFP sheets, as well as 0.3 and 0.5 mm of lead. In lead equivalence measurements, we measured doses after through 2 and 10 TFP sheets for x‐rays (100 and 150 kVp), and 0, 7, 10, 20, and 30 TFP sheets for gamma rays from cesium‐137 source (662 keV). And then, the lead equivalent thicknesses of TFP were determined by comparison with doses after through standard lead plates (purity >99.9%). Additionally, we evaluated uniformity of the transmitted dose by TFP with a computed radiography image plate for 50 kVp x‐rays. A single TFP sheet was found to have a shielding ability of 65%, 53%, 48%, and 46% for x‐rays (60, 80, 100, and 120 kVp), respectively. The lead equivalent thicknesses of two TFP sheets were 0.10 ± 0.02, 0.09 ± 0.02 mmPb, and of ten TFP sheets were 0.48 ± 0.02 and 0.51 ± 0.02 mmPb for 100 and 150 kVp x‐rays, respectively. The lead equivalent thicknesses of 7, 10, 20, and 30 sheets of TFP for gamma rays from cesium‐137 source were estimated as 0.28, 0.43, 0.91, and 1.50 mmPb with an error of ± 0.01 mm. One TFP sheet had nonuniformity, however, seven TFP sheets provided complete shielding for 50 kVp x‐rays. TFP has adequate radiation shielding ability for x‐rays and gamma rays within the energy range used in diagnostic imaging field.

Tungsten functional paper (TFP), which contains 80% tungsten by weight, has radiation‐shielding properties. We investigated the use of TFP for the protection of operators during interventional or therapeutic angiography. The air kerma rate of scattered radiation from a simulated patient was measured, with and without TFP, using a water‐equivalent phantom and fixed C‐arm fluoroscopy. Measurements were taken at the level of the operator's eye, chest, waist, and knee, with a variable number of TFP sheets used for shielding. A Monte Carlo simulation was also utilized to analyze the dose rate delivered with and without the TFP shielding. In cine mode, when the number of TFP sheets was varied through 1, 2, 3, 5, and 10, the respective reduction in the air kerma rate relative to no TFP shielding was as follows: at eye level, 24.9%, 29.9%, 41.6%, 50.4%, and 56.2%; at chest level, 25.3%, 33.1%, 34.9%, 46.1%, and 44.3%; at waist level, 45.1%, 57.0%, 64.4%, 70.7%, and 75.2%; and at knee level, 2.1%, 2.2%, 2.1%, 2.1%, and 2.1%. In fluoroscopy mode, the respective reduction in the air kerma rate relative to no TFP shielding was as follows: at eye level, 24.8%, 30.3%, 34.8%, 51.1%, and 58.5%; at chest level, 25.8%, 33.4%, 35.5%, 45.2%, and 44.4%; at waist level, 44.6%, 56.8%, 64.7%, 71.7%, and 77.2%; and at knee level, 2.2%, 0.0%, 2.2%, 2.8%, and 2.5%. The TFP paper exhibited good radiation‐shielding properties against the scattered radiation encountered in clinical settings, and was shown to have potential application in decreasing the radiation exposure to the operator during interventional radiology.

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