Development and multi-institutional evaluation of a new phantom for verifying beam-positioning errors at...

Single-isocenter stereotactic radiotherapy for multiple brain metastases requires highly accurate treatment delivery at off-isocenter positions (off-iso). This study aimed to verify the beam-positioning errors at off-iso using a newly developed phantom tested at multiple institutions.

The off-iso phantom comprised five stainless-steel balls with a 3-mm diameter placed at the center and at four peripheral positions on a diagonal line. Each ball was placed 3.5 cm apart along each of the three axes. Two patterns of the phantom setup were defined as 0° and 90° phantom rotations to evaluate the beam-positioning error, which is the distance between the center of the ball and the irradiated field on the electronic portal imaging device. Furthermore, the reproducibility of the beam-positioning errors was verified by evaluating their standard deviation (SD) at a single institution, which included five measurements for two treatment machines. The errors were evaluated at multiple institutions using eight treatment machines.

The measurement time from setup to image acquisition was approximately 20 min for two patterns. The SD of the beam-positioning errors in the reproducibility tests was 0.41 mm. In the multi-institutional evaluation, the beam-positioning error at the isocenter position was within 1.00 mm of the AAPM-RSS tolerance, with the exception of two linacs. The largest beam-positioning error (1.36 mm) was observed 7.5 cm away from the isocenter in three directions at a gantry angle of 180°.

The developed phantom can be applied as a new tool for establishing beam-positioning errors in single-isocenter stereotactic radiotherapy at off-isocenter positions.