Quality control methods for linear accelerator radiation and mechanical axes alignment

The delivery accuracy of highly conformal dose distributions generated using intensity modulation and collimator, gantry, and couch degrees of freedom is directly affected by the quality of the alignment between the radiation beam and the mechanical axes of a linear accelerator. For this purpose, quality control (QC) guidelines recommend a tolerance of ±1 mm for the coincidence of the radiation and mechanical isocenters. Traditional QC methods for assessment of radiation and mechanical axes alignment (based on pointer alignment) are time consuming and complex tasks that provide limited accuracy. In this work, an automated test suite based on an analytical model of the linear accelerator motions was developed to streamline the QC of radiation and mechanical axes alignment.

The proposed method used the automated analysis of megavoltage images of two simple task-specific phantoms acquired at different linear accelerator settings to determine the coincidence of the radiation and mechanical isocenters. The sensitivity and accuracy of the test suite were validated by introducing actual misalignments on a linear accelerator between the radiation axis and the mechanical axes using both beam steering and mechanical adjustments of the gantry and couch.

The validation demonstrated that the new QC method can detect sub-millimeter misalignment between the radiation axis and the three mechanical axes of rotation. A displacement of the radiation source of 0.2 mm using beam steering parameters was easily detectable with the proposed collimator rotation axis test. Mechanical misalignments of the gantry and couch rotation axes of the same magnitude (0.2 mm) were also detectable using the new gantry and couch rotation axis tests. For the couch rotation axis, the phantom and test design allow detection of both translational and tilt misalignments with the radiation beam axis. For the collimator rotation axis, the test can isolate the misalignment between the beam radiation axis and the mechanical collimator rotation axis from the impact of field size asymmetry. The test suite can be performed in a reasonable time (30-35 min) due to simple phantom setup, prescription-based beam delivery, and automated image analysis. As well, it provides a clear description of the relationship between axes. After testing the sensitivity of the test suite to beam steering and mechanical errors, the results of the test suite were used to reduce the misalignment errors of the linac to less than 0.7-mm radius for all axes.

The proposed test suite offers sub-millimeter assessment of the coincidence of the radiation and mechanical isocenters and the test automation reduces complexity with improved efficiency. The test suite results can be used to optimize the linear accelerator's radiation to mechanical isocenter alignment by beam steering and mechanical adjustment of gantry and couch.