Minimization of target positioning error in accelerator-based radiosurgery

The stereotactic radiosurgery system used at the Mallinckrodt Institute of Radiology is patterned after that developed at the Joint Center for Radiation Therapy (Brigham & Women's Hospital, Boston, MA) and uses the Brown-Roberts-Wells computed tomography (CT) stereotactic system. The patient's head is attached to a stand that rotates with the treatment couch. The irradiation is conducted using a set of converging arcs of irradiation. Because of mechanical limitations, no accelerator or treatment couch is capable of placing the center of the radiation beam at precisely the same point for all gantry and couch angles and a compromise must be made when locating the nominal isocenter. The stand settings are checked by placing a radiopaque QA sphere at the desired target location. The QA sphere is imaged using a series of eight films exposed at a set of couch and gantry angles that encompass the treatment angles. The distances between the QA sphere image and the center of the radiation field indicate if the correct coordinates were set on the stand and if the radiation beam converges to a sufficiently small region (< 0.1-cm diameter) for treatment. A mathematical procedure has been developed to use the film-measured position errors to determine a stand offset that will minimize the distance between the accelerator isocenter and the target. The technique is capable of reducing the average placement error, as measured by imaging the QA sphere, to 0.035 cm with a maximum deviation of 0.07 cm.