<scp>COMP</scp> report: <scp>CPQR</scp> technical quality control guidelines for Gamma Knife radiosurgery

Berndt, Anita; Prooijen, Monique van; Guillot, Mathieu

doi:10.1002/acm2.12406

Cited by 5 publications

(6 citation statements)

References 2 publications

(1 reference statement)

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“…Various quality assurance (QA) guidelines have been published for SRS 4–7 . These guidelines are primarily “recipe” based and include a list of QA tasks with suggested tolerances and action levels.…”

Section: Introductionmentioning

confidence: 99%

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8+ Year Performance of the Gamma Knife Perfexion/Icon Patient Positioning System and Possibilities for Preemptive Fault Detection Using Statistical Process Control

et al. 2021

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Background: The large fractional doses, steep dose gradients, and small targets found in intracranial radiosurgery require extremely low beam delivery uncertainty. In the case of Gamma Knife radiosurgery (GKRS), this includes minimizing patient positioning system (PPS) positioning uncertainty. Existing QA techniques are recipe based, and feature point in time pass/fail tolerances. However, modern treatment machines, including the Gamma Knife Perfexion/Icon systems, record extensive internal data in treatment logs. These data can be analyzed through statistical process control (SPC) methods which are designed to detect changes in process behavior. The purpose of this study was to characterize the long-term (8+ year) performance of a Perfexion/Icon unit and use SPC methods to determine if performance changes could be detected at levels lower than existing QA and internal manufacturer performance tolerances. Methods: In-house software was developed to parse Perfexion/Icon log-files and store relevant information on shot delivery in a relational database. A last-in, first-out (LIFO) queuing algorithm was created to heuristically match messages associated with a given delivered shot. Filtering criteria were developed to filter QA and uncompleted shots. The resulting matched shots were extracted. Achieved versus planned PPS position was determined for each PPS motor as well as for the vector magnitude difference in PPS position. Exponentially weighted moving average (EWMA) control charts were plotted to determine when process behavior changed over time. Results: 53833 shots were delivered over an 8+ year span in the study. The mean vector magnitude PPS difference was 32.7 µm, with 97.5% of all shots within 70.1 µm. Several changes in PPS positioning behavior were observed over time, corresponding with control system faults on several occasions requiring PPS recalibration. EWMA control charts clearly demonstrate that these faults could be identified and possibly predicted as many as 3 years before there were faults beyond control system tolerance. Conclusion:The PPS of Gamma Knife Perfexion/Icon systems has extremely low positioning uncertainties. EWMA control chart method can be utilized to track PPS performance over time and can potentially detect changes in performance that may indicate a component requiring maintenance. This would allow planned service visits to mitigate problems and prevent unplanned downtime.

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Section: Introductionmentioning

confidence: 99%

“…3 Various quality assurance (QA) guidelines have been published for SRS. [4][5][6][7] These guidelines are primarily "recipe" based and include a list of QA tasks with suggested tolerances and action levels. However, they do not always include a basis for the included tolerances and action levels or how they were determined.…”

Section: Introductionmentioning

confidence: 99%

8+ Year Performance of the Gamma Knife Perfexion/Icon Patient Positioning System and Possibilities for Preemptive Fault Detection Using Statistical Process Control

et al. 2021

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“…Recently, comprehensive small-field dosimetry and systemspecific quality assurance guidelines have been published for stereotactic radiotherapy [172,187,188,201,208,209,[220][221][222]. However, the translation from the old to the new methods has only just begun and the clinical implications are not yet fully understood (e.g., when correcting the output factors and hence changing the absolute dose for high-dose small-field SRS for trigeminal neuralgia).…”

Section: Discussionmentioning

confidence: 99%

“…Once the stereotactic radiotherapy device is fully commissioned, regular checks of the geometric and dosimetric accuracy have to be performed in order to ensure the system's integrity and to find system drifts and inaccuracies early before clinical consequences can arise. There are a wide range of system specific recommendations available which are considered mandatory state-of-the-art practice for each of the systems in description [172,187,188,201,209,221,222]. Parts of these recommendations are specific details on daily quality assurance which minimally requires verification of the consistency of the stereotactic frame and/or the image-guidance system with the treatment isocenter (which is a modern version of the so called Winston-Lutz test [223], normally reduced in number of inspected axes for a daily check).…”

Section: Dedicated Quality Assurance Measuresmentioning

confidence: 99%

Technological quality requirements for stereotactic radiotherapy

et al. 2020

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This review details and discusses the technological quality requirements to ensure the desired quality for stereotactic radiotherapy using photon external beam radiotherapy as defined by the DEGRO Working Group Radiosurgery and Stereotactic Radiotherapy and the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The covered aspects of this review are 1) imaging for target volume definition, 2) patient positioning and target volume localization, 3) motion management, 4) collimation of the irradiation and beam directions, 5) dose calculation, 6) treatment unit accuracy, and 7) dedicated quality assurance measures. For each part, an expert review for current state-of-the-art techniques and their particular technological quality requirement to reach the necessary accuracy for stereotactic radiotherapy divided into intracranial stereotactic radiosurgery in one single fraction (SRS), intracranial fractionated stereotactic radiotherapy (FSRT), and extracranial stereotactic body radiotherapy (SBRT) is presented. All recommendations and suggestions for all mentioned aspects of stereotactic radiotherapy are formulated and related uncertainties and potential sources of error discussed. Additionally, further research and development needs in terms of insufficient data and unsolved problems for stereotactic radiotherapy are identified, which will serve as The authors D. Schmitt and O. Blanck contributed equally to the manuscript.

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“…Regardless of technology, the success of an SRS program hinges on a thorough and ongoing QA program to ensure that the treatment unit is in compliance with the recommendations of the treatment unit manufacturer and within specified clinical tolerances based on international and national guidelines and recommendations, [36][37][38]50,51 The responsible medical physicist should determine that the appropriate testing procedure is used and documentation is maintained. Specific to SRS, the most essential elements of treatment delivery QA are:…”

Section: Imaging and Simulationmentioning

confidence: 99%

A Cancer Care Ontario Organizational Guideline for the Delivery of Stereotactic Radiosurgery for Brain Metastasis in Ontario, Canada

Sahgal

Kellett²,

Ruschin

et al. 2020

Practical Radiation Oncology

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In Ontario, Canada, there is increasing demand for stereotactic radiosurgery (SRS) for brain metastases. Recommendations for safe SRS delivery are needed to ensure that patients receive an equitable level of care across the province. This guideline presents the minimal recommendations for the organization and delivery of SRS with respect to the multidisciplinary team, applicable technologies, imaging requirements, quality assurance program, and patient follow-up. Methods and Materials: The recommendations are based on the consensus opinion of the Cancer Care Ontario SRS for Brain Metastasis Guideline Development Group and clinical evidence when available. Primary consideration was given to the perceived benefits for patients and the small likelihood of harm arising from recommendation implementation. With the exception of the magnetic resonance imaging (MRI) follow-up strategy, all evidence was considered indirect and was provided by the working group in conjunction with their collective expertise in the field of SRS. Results: The application of SRS requires a multidisciplinary team consisting of a radiation oncologist, neurosurgeon, neuroradiologist, medical physicist, radiation therapist, and medical dosimitrist. Volumetric imaging scanning parameters must be set to ensure sufficient spatial resolution, geometric fidelity, and contrast signal for brain metastases to be adequately and reliably visualized, contoured, and planned. The MRI-to-treatment time interval should be as short as possible, ideally no more than 7 days and certainly no more than 14 days as a maximum. Quality assurance programs must ensure that the treatment unit is in compliance with the manufacturer and with national and international guidelines. Follow-up of patients undergoing SRS should consist of routine clinical visits with an MRI every 2 to 3 months for the first year; every 3 to 4 months for the second and third year; and thereafter as determined by the multidisciplinary case conference. Sources of support: The Program in Evidence-Based Care is a provincial initiative of Cancer Care Ontario supported by the Ontario Ministry of Health. All work produced by the Program in Evidence-Based Care and the Radiation Treatment Program is editorially independent from the Ontario Ministry of Health. Disclosures: Dr Sahgal has received honoraria for past educational seminars from Elekta AB, Accuray, Inc, and Varian Medical Systems and research grants from Elekta AB. Dr Sahgal also belongs to the Elekta MR Linac Research Consortium. Dr Greenspoon has been principal investigator on some studies related to radiosurgery and brain metastases at McMaster University (CEC.3, and involved in CE.7) and in-house smaller studies and has been involved in the Accuracy Fellowship at McMaster University, where the fellowship focus is stereotactic radiosurgery and stereotactic body radiation therapy. Dr Ruschin is the coinventor of and owns associated intellectual property specific to the image guidance system on the Gamma Knife Icon and is coinvestigator on Elekt...

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COMP report: CPQR technical quality control guidelines for Gamma Knife radiosurgery

Cited by 5 publications

References 2 publications

8+ Year Performance of the Gamma Knife Perfexion/Icon Patient Positioning System and Possibilities for Preemptive Fault Detection Using Statistical Process Control

8+ Year Performance of the Gamma Knife Perfexion/Icon Patient Positioning System and Possibilities for Preemptive Fault Detection Using Statistical Process Control

Technological quality requirements for stereotactic radiotherapy

A Cancer Care Ontario Organizational Guideline for the Delivery of Stereotactic Radiosurgery for Brain Metastasis in Ontario, Canada

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