End-to-end test for lung SBRT: An Italian multicentric pilot experience

Area of Science:

• Medical Physics
• Radiation Oncology
• Radiotherapy Quality Assurance

Background:

• Stereotactic body radiation therapy (SBRT) for lung cancer requires precise dose delivery.
• End-to-end (e2e) testing is crucial for validating radiotherapy workflows.
• Standardized e2e tests are needed to ensure quality and consistency in lung SBRT across institutions.

Purpose of the Study:

• To establish a comprehensive end-to-end (e2e) testing protocol for lung SBRT.
• To validate the feasibility and effectiveness of this e2e test through a multicenter study.
• To gather user feedback on the test's usability and suitability for clinical practice.

Main Methods:

• A multicenter group of medical physicists designed and implemented an e2e test protocol.
• Four participating centers (PCs) used the ADAM breathing phantom, microDiamond detector, and radiochromic films.
• PCs simulated, planned, and irradiated the phantom according to the protocol, uploading data for centralized analysis.

Main Results:

• All participating centers successfully completed the e2e lung SBRT test in both static and dynamic modes.
• Measured-to-planned dose ratios were generally close to unity across centers and modes.
• Gamma passing rates (3% global, 3mm) demonstrated high accuracy, with most values exceeding 94% in static and dynamic conditions.

Conclusions:

• The proposed end-to-end (e2e) test for lung SBRT is robust and feasible for multicenter validation.
• User feedback indicated the test and protocol were well-suited and clearly described.
• The successful multicenter implementation validates the proposed e2e test for quality assurance in lung SBRT.