Performance of a new commercial high-definition 3D patient specific quality assurance system for CyberKnife robotic radiotherapy and radiosurgery

Conventional two dimensional and low-definition measurement techniques for dosimetric verification of radiotherapy treatment deliveries are no longer adequate in the era of hypofractionation and extremely high dose gradients. New quality assurance (QA) tools with 3D capability and high definition are urgently needed. The purpose of this study was to evaluate the performance of one of the first such commercial systems as applied to CyberKnife (CK) radiotherapy/radiosurgery system. This study employed the recently developed commercial 3D patient-specific quality assurance (PSQA) system. Tissue-equivalent radiochromic polymer gel dosimeters, sealed in light protective thin-wall glass spheres (CrystalBalls), were mounted in a high-precision acrylic QA stand. Patient treatment plans were superimposed on the simulator CT scan of one selected CrystalBall and were irradiated in CK machine. CrystalBalls were then scanned using a laser CT scanner (OCTOPUS, MGS Research, Inc., DBA 3D Dosimetry, Madison, CT, USA). The simulator CT scan and the laser CT scan of the CrystalBall were registered in 6D using the VOLQA (MGS Research, Inc., DBA 3D Dosimetry, Madison, CT, USA) software. Planned and delivered dose distributions were compared by means of 3D gamma passing rates at user-selected acceptance criteria. Cumulative 3D dose-volume histograms and overlays of orthogonal profiles and isodoses both in 2D and in 3D were also generated, along with voxel statistics for dose difference and distance-to-agreement criteria. Twelve stereotactic radiosurgery/stereotactic radiotherapy/stereotactic body radiation therapy patients were selected randomly such that each set of two represented one of the six diagnoses: brain metastasis, trigeminal neuralgia, spine metastasis, prostate cancer, lung cancer and liver cancer. The validation of the 3D system was carried out by comparing the 2D gamma passing rates for all the patients using EBT3 films sandwiched between PMMA slabs and then analyzed with PTW VeriSoft software. The 3D gamma passing rate averaged over all patients studied was (90.5 ± 6.7) % at acceptance criteria of 2% (local) dose difference and 2 mm distance-to-agreement down to 20% isodose. For 3% (local) dose difference and 3 mm distance-to-agreement (also down to 20% cutoff dose), the average passing rate was (96.0 ± 3.1) %. The results of the study presented here form part of the information needed to assess suitability of a system and hence, the results suggest that the ne