Technical note: TROG 15.01 SPARK trial multi-institutional imaging dose measurement

The Trans-Tasman Radiation Oncology Group (TROG) 15.01 Stereotactic Prostate Adaptive Radiotherapy utilizing Kilovoltage intrafraction monitoring (SPARK) trial is a multicenter trial using Kilovoltage Intrafraction Monitoring (KIM) to monitor prostate position during the delivery of prostate radiation therapy. KIM increases the accuracy of prostate radiation therapy treatments and allows for hypofractionation. However, an additional imaging dose is delivered to the patient. A standardized procedure to determine the imaging dose per frame delivered using KIM was developed and applied at four radiation therapy centers on three different types of linear accelerator.

Dose per frame for kilovoltage imaging in fluoroscopy mode was measured in air at isocenter using an ion chamber. Beam quality and dose were determined for a Varian Clinac iX linear accelerator, a Varian Trilogy, four Varian Truebeams and one Elekta Synergy at four different radiation therapy centers. The imaging parameters used on the Varian machines were 125 kV, 80 mA, and 13 ms. The Elekta machine was measured at 120 kV, 80 mA, and 12 ms. Absorbed doses to the skin and the prostate for a typical SBRT prostate treatment length were estimated according to the IPEMB protocol.

The average dose per kV frame to the skin was 0.24 ± 0.03 mGy. The average estimated absorbed dose to the prostate for all five treatment fractions across all machines measured was 39.9 ± 2.6 mGy for 1 Hz imaging, 199.7 ± 13.2 mGy for 5 Hz imaging and 439.3 ± 29.0 mGy for 11 Hz imaging.

All machines measured agreed to within 20%. Additional dose to the prostate from using KIM is at most 1.3% of the prescribed dose of 36.25 Gy in five fractions delivered during the trial.