Long-term stability assessment of a 4D tumor tracking system integrated into a gimbaled linear accelerator

We assessed long-term stability of tracking accuracy using the Vero4DRT system. This metric was observed between September 2012 and March 2015. A programmable respiratory motion phantom, designed to move phantoms synchronously with respiratory surrogates, was used. The infrared (IR) markers moved in the anterior-posterior (AP) direction as respiratory surrogates, while a cube phantom with a steel ball at the center, representing the tumor, and with radiopaque markers around it moved in the superior-inferior (SI) direction with one-dimensional (1D) sinusoidal patterns. A correlation model between the tumor and IR marker motion (4D model) was created from the training data obtained for 20 s just before beam delivery. The irradiation field was set to 3 × 3 cm2 and 300 monitor units (MUs) of desired MV X-ray beam were delivered. The gantry and ring angles were set to 0° and 45°, respectively. During beam delivery, the system recorded approximately 60 electronic portal imaging device (EPID) images. We analyzed: 1) the predictive accuracy of the 4D model (EP), defined as the difference between the detected and predicted target positions during 4D model creation, and 2) the tracking accuracy (ET), defined as the difference between the center of the steel ball and the MV X-ray field on the EPID image. The median values of mean plus two standard deviations (SDs) for EP were 0.06, 0.35, and 0.06 mm in the left-right (LR), SI, and AP directions, respectively. The mean values of maximum deviation for ET were 0.38, 0.49, and 0.53 mm and the coefficients of variance (CV) were 0.16, 0.10, and 0.05 in lateral, longitudinal, and 2D directions, respectively. Consequently, the IR Tracking accuracy was consistent over a period of two years. Our proposed method assessed the overall tracking accuracy readily using real-time EPID images, and proved to be a useful QA tool for dynamic tumor tracking with the Vero4DRT system.