RapidArc in Bergen

Britt Nygaard, Harald Valen and Ellen Wasb Haukeland University Hospital, Bergen, Norway

 2007:
Trilogy with RapidArc option

2008:
Scandidos Delta4 QA tool Aria upgrade: RapidArc on the Trilogy and 23iX

Autumn 2009:
Course in Bellinzona and Zug Stay-and-learn in Copenhagen Eclipse AAA configuration Machine QA and patient QA procedures

2010:
Decisions, decisions.. Which category of patients? Learning RapidArc doseplanning in Eclipse 1st patient on 14th of June 2nd on 22nd of November
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Quality control
Commisioning tests as suggested by Memorial Sloan-Kettering CC and Varian
A picket fence test during RapidArc 7 adjacent fields with varying Dose rate & Gantry speed 4 adjacent fields with varying MLC speed & Gantry speed

Possible to study combined effect of

dose rate and gantry speed dynamic MLC and variable dose rate
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C. C. Ling et. al: Commissioning and Quality Assurance of RapidArc Delivery System. Radiotherapy, Int. J. Radiation Oncology Biol. Phys., Vol. 72, No. 2, pp. 575581, 2008.

Dose rate and Gantry speed variation during RapidArc

MLC speed variation during RapidArc

Analyse results
Dose rate and Gantry speed variation (Test2)

MLC speed variation (Test3)

Clinac 23EX (2004): T2 & T3

Trilogy (2007): T2 & T3

Clinac 23iX (2005): T2 & T3

TrueBeam (2011): T2 & T3

Analyse results
Dynalog files
Log planned and actual leaf positions and leaf speed vs. time Log gantry speed vs. Time How TrueBeam

Tool: Analyse Dynalog

In-house developed (EW) Language: IDL
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Patient QA
Delta4
Daily dose correction Run and measure Verification plan Pass / Fail criteria
Dose deviation
> 85% within 3% deviation

Distance to agreement
> 98% with DTA 3mm

Gamma index 3%, 3mm

> 95% with index 1
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1 arc, 135 to 225, TrueBeam 6MV photons

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Clinac 23EX (2004), RapidArc in 2011: Failed T2 & T3 commissioning tests

Patient QA PAB GB TER GDG EKGP MS Dose dev. within 3% 90,7% 83,7% 95,8% 85,5% 85,9% 83,0% DTA < 3mm 100% 100% 100% 100% 100% 100% < 1 (3%, 3mm) 100% 100% 99,4% 100% 100% 100%
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More patient QA
Independent dose calculation Point check of dose Control of monitor units

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Treatment planning, Autumn 2010:

5 years experience with IMRT
head and neck prostate with and without lymph nodes (LN) ani (and gyn) with LN Sarcoma, lymphoma and other

RA configuration and acceptance tests OK RA installed on 2 Clinacs Patient start up

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Which patient groups?

Increased efficiency for the department
Prostate with LN, 7 splitted fields

Patients unable to keep the supine position for 10-15 min

Head and neck

Less MU and less risk for secondary cancer A category that is easy to create acceptable and standardized plans for
Prostate intermediate risk
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Which patient groups?

Increased efficiency for the department
Prostate with LN, 7 splitted fields

Patients unable to keep the supine position for 10-15 min

Head and neck

Less MU and less risk for secondary cancer A category that is easy to create acceptable and standardized plans for
Prostate intermediate risk
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Prostate intermediate risk, criteria:

Treatment of prostate and seminal vesicles Equal plan or better than IMRT (PTV and rectum) We made two plans, one IMRT (backup) and one RA, 1 arc 135-225 (avoid couch slides) for the 10 first patients PTV 95%-107%, median 100%, Rectum: max 10ml >60 Gy and less than 50 Gy to half the circumference Delta4 measurements OK;
Gamma index 3%, 3mm
> 95% with index 1

Dose deviation
> 85% within 3% deviation
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5 fields IMRT: 574 MU (2.15 Gy x 35)

RA: 1 arc 135-225 494 MU (2.15 Gy x 35)

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5 fields IMRT: 574 MU (2.15 Gy x 35 = 75.25)

RA: 1 arc 135-225 494 MU (2.15 Gy x 35)

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5 fields IMRT:

RA: 1 arc 135-225

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IMRT

RA

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RA today: (2.4 Gy sem.ves. and integrated boost 2.7 Gy prostate) x 25 = 67.5 Gy (EQD2= 81 Gy if /=1.5)

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Measured with Delta4

Gamma: 2mm 2%

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Prostate high risk: 2 Gy to the lymph nodes, integrated boost; 2.4 Gy sem.ves. and 2.7 Gy prost, 25 fractions

7 field-IMRT 1499 MU (2.7 Gy) 555 MU/Gy (calibration factor 130MU/Gy)

2 full arc RA 611 MU (2.7 Gy)

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IMRT

RA

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IMRT

RA

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Dose to rectum

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IMRT

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Future:
We would like to treat our high risk protate with LN with two arcs
Prerequisite: RA plan equal or better than IMRT (PTV and rectum)

This autumn we have been focusing on commissioning TrueBeam..

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