Modern treatment methods go along with high resolution imaging, image merging from different sources, sophisticated treatment planning and dynamic beam delivery with time saving ARC modalities using unflattened high dose rate beams.
And there is the trend for adaptive treatment, and with tracking/gating devices also treatment of moving tumours.
So there are a variety of different QA and verification jobs to be done in Radiataion Therapy.
The QA process starts in the Imager. The cancer patient is imitated by a phantom with 'virtual Tumor'. smartIMRT with a set of modules offers thousands of variations for size, shape, texture, density, position and orientation. This are all standards, as in contrary to human tumor the 'virtual tumor as plastic object does not change it's properties.
The smartCTQA can be positioned inside the smartIMRT in 8 orientations. The picture above show a setup with point dose measurement with farmer chamber in the phantom center. When using smartCUBE-VT more orientations are possible, also off-axis positions for sCUBE and vTumor. The detectors can be inserted from the from the freont and rear, and with little modification on the smartIMRT side panels also 2 simultaneous measurements in target and rist organ.
The smartTOOLs are metal free and can be used also in MRI scanner and so in combined treatmet units as VierRay. Typical setup is the cylindrical smartIMRT with various device-specific tests inside smartCTQA and smartCUBE.
The smartCUBE families provide models which are specific for the imager. As example the virual tumors for MRI are of different design and can be soaked with water before performing the mesasurement.
The smartCUBEs for check of parameters as resolution and contrast are made after German standards and in the 7cm cubical size. Benefit: the checks can be done in different cube orientations, so all 3 main axis.
movingSKIN and movingTARGET have predictable and adjustable motion patterns and so ideal for dynamic 4D imaging checks.
The phantom can be used in all imager types as the motor, packed in a smartCUBE housing, can be fixed far outside the MRI magnetic field, so at the foot couch end. The transmission is via simple carbonfiber cardan shaft.
The setup above shows the ideal combinations of smartIMRT with STAR-devices or 2D-Arrays for fast checks on Symmetry, Flatness and more. Films can be used inside the smartFILM phantom, whic is in ISO center position inside the smartIMRT.
The smartIMRT is connected to the Linac gantry via carbon tube link and used without the cylinder segments, so as flat box.
Absolute dosimetry can be done with the smartSLAB, but also inside the rotating smartIMRT with reference to gantry at 0º. So it can be tested if the dose rate is the same on every gantry angle, and also the absorption of the couch.
Different options are available for Linac Imager QA using smartIMRT as box in 90º position in respect to the gantry, smartQA, smartQA, smartCUBE and smartFILM. smartQA+ checks resolution in the center, positioning and image distortion. When the test objects rotate with the gantry further checks on ISO center stability can be made, so checks on imager stability during rotation.
GOOD NEWS !The TPS have been improved in the past few years to highest precision and reliability. The calculated dose distributions including DVH are optimized by sophisticated algorithms with the result that pre-treatment verification can now go back to normal and simple. No more 3D dose reconstruction or estimation required, the 2D-planar composite dose verification is sufficient!
The smartIMRT as cylinder, rotating with the gantry is the most efficient and simpe solution on the market. smartIMRT is compatible to all 2D-Arrays from PTW, IBA and SunNuclear, precise adapters position the arrays accurately in the ISO center.
No inclinometer calibration, no complex software: just start beam delivery for all modalities including latest ARC and compare the measured dose map with your TPS calculation. So easy !
The 'Virtual Patient' allows perfect simulation of pateint plan adaptations. You have defined the initial setup of tumor inside smartCUBE inside smartCTQA inside smartIMRT. perform some documeted amendments, as changes of inhomogeneity rod positions and slight rotation change of the smartIMRT body. Replan and irradiate. The results of dosimetry will show you if your procedures are right.
Important to know: with every CT or MRI scan you have the full information for device properties in your DICOM image file. So you focus on the volume around the target, but in case of deviations you can also check all other parameters which are in other sections of the 'Virtual Patient'.
Imagine the 'virtual tumor' as above with it's onion-like structure. The shells represent individual densities and textures.
You can position the smartCUBE with this VT in hundreds positions and orientations on the couch, and much more inside the smartIMRT. As the VT has it's long term constancy you have the reference and can check it the auto countouring algorihm is woking fine at all orientations.
Image fusion and merging is a complex procedure provided by software and crucial for perfect definition of the target volume and risk organs. The 'virtual tumors' ar of good help, as they are irregualar objects which can be precisely measured in advance. So you have a reference volume which should be kept as the result after the merging. For MRI scans the vt can be immersed in water for better signals, and as the 3D-printing process is easy we can provide 2 identical pieces, one for CT and one for MRI.