QA SOFTWARE AND PHANTOM USER'S GUIDE
Contents
1. Original Hi riginal Image Histogram a M m m g 9 o9 Count IsoCenter Cube Analysis Bin Range Size 256 Mean 16087 Min 13715 E oicom image viewer CPESRAS SRSNBSS SHRASTSS SESS SE RASS Max 16382 lEz Histogram Bin Pixel Intensity Mode 5408 16359 Current Date 23 05 2014 Figure 3 QUASAR IsoCenter Cube Analysis Complete Creating Templates For your convenience it is possible to save pass fail threshold settings so that they can easily be recalled for subsequent isocenter cube tests For example if you wish to use threshold settings that are different from the defaults or if you have multiple LINACs and wish to have different threshold settings for each LINAC you can make use of threshold templates Defining a Threshold Template FA e Click the save template settings button window see Figure 4 to display the Add Threshold Template Pass Fail Criteria Threshold Template Custom ss ss si yv ao Waming Distance 1 75 vw Failure Distance 2 00 A mm Y Enter the name of the template in the Template Name field e Enter the warning tolerance level mm in the Measured Distance Tolerance Warning text box e Enter the fail tolerance level mm in the Measure Distance Tolerance Fail text box e Check Uncheck the Default Configuration check box if the template will be recorded as the default threshold template for the application The default thresho2. To perform a full Winston Lutz test for SBRT or SRS treatments several other fields with varying gantry collimator and couch angles should be created R V Setup Create a new patient in your R V system Import the CT scan isocenter set at the centroid of the radiopaque sphere and treatment fields from your TPS Create a CBCT field and add kV imaging fields if desired Finally for EPID measurements add MV port films for each treatment field MV port films should be exposed using the largest source to imager SID distance possible This will result in a greater magnification factor of the exposure and thus each pixel of the EPID image will correspond to a smaller area at isocenter Note This test can be used for both CBCT and kV imaging alignments GC UG3 0 05282014 2014 Modus Medical Devices Inc All rights reserved 7 QUASAR IsoCenter Cube QA Software and Phantom User s Guide IGRT Alignment and Film EPID Exposures Place the QUASAR IsoCenter Cube Phantom directly on the treatment couch The phantom can be aligned at isocenter or offset from isocenter to test couch positioning accuracy Take a high resolution CBCT using the smallest slice width and highest matrix size available or kV image pair Align the IGRT and planning CT radiopaque sphere positions as accurately as possible The exterior of the phantom may or may not align perfectly since the radiopaque sphere alignment is a higher priority to achieve
3. standard copyright notice Click the Next button if you wish to proceed with the installation ICC UG3 0 05282014 2014 Modus Medical Devices Inc All rights reserved 10 QUASAR IsoCenter Cube QA Software and Phantom User s Guide ja QUASAR oCenter Cut n m x Select Installation Folder The installer will install QUASAR IsoCenter Cube to the following folder To install in this folder click Next To install to a different folder enter it below or click Browse Folder C Program Files x86 Modus Medical Devices QUASAR IsoCenter Browse Disk Cost Install QUASAR IsoCenter Cube for yourself or for anyone who uses this computer 0 Everyone 0 Just me Cancel lt Back The next wizard page allows you to select the folder location for the software installation By default it will be under the standard Windows installation folder but you may change this location if you wish If you are using a computer that is shared by multiple users you may also determine whether or not all users or just you can run the QUASAR IsoCenter Cube software By default the software will only be available for you Once you have made your selections click the Next button to proceed ICC UGS8 0 05282014 2014 Modus Medical Devices Inc All rights reserved 11 QUASAR IsoCenter Cube GA Software and Phantom User s Guide Confirm Installation The installer is ready to inst
4. QA Software and Phantom User s Guide Troubleshooting If the isocenter cube analysis engine fails to properly perform the image analysis the result will be labeled as an error in the results list Image Gantry Collimator Couch L R Eror MIN_OIL_PHANTO Figure 6 Analysis Failure For such cases you can retrieve more information about the analysis by examining the analysis image annotations and debug information To view the analysis image annotations right click on the result and select Show Analysis Information from the context menu Edit Angles Delete Image Show Analysis Information The Analysis Information window will appear see Figure 7 It displays a marked up version of the original image The markings highlight the features that the analysis engine was able to detect in the image Itis a good idea to compare the markings from a successful analysis with those of the failed analysis in order to see the differences ICC UG3 0 05282014 2014 Modus Medical Devices Inc All rights reserved 18 QUASAR IsoCenter Cube QA Software and Phantom User s Guide _ Analysis Information G T270 Figure 7 Analysis Information Window lt is also possible to look at the log messages generated by the analysis engine By clicking the show hide debug messages button ji you can reveal a window that contains the log for the last run of the analysis see Figure 8 Often reading through
5. menu to produce the results The results will be displayed in the Selected Images list An annotated version of the image can be viewed by selecting the result from within the list p Click on clear results button or Results gt Clear Results from the menu to begin another test ICC UG3 0 05282014 2014 Modus Medical Devices Inc All rights reserved 15 QUASAR IsoCenter Cube QA Software and Phantom User s Guide Q QUASAR IsoCenter Cube QA Software D bin Modus Medical Devices ICC results RLQA_G90 CO T0 19_1_4 dcm Tools Results Navigation View Exit ii in Pass Fail Criteria g out Da al ICC Threshold Template Custom E j IMA gall results Waming Distance 1 75 gt mm GO CO T270 dcm _ GO CO T315 dem GOCO T90 dem _ RI QA_G270 C0 T0 17_ Selected Images L RIGA G90C0 T0 19 1 120 results 2 Failure Distance 2 00 mm i i 22 vel AE Image Collimator Couch L R Eror l M 3 44 images2 al Sc installer G0 CO T270 dcm gal LRCC GOCO T315 dem gt Penta Guide Processing M Gg complete GO CO T90 dem 4 eror RIGA G270C0 TO 270 isi in RIGA G90C0 T0 1 90 g samples 1 4 QUASAR eQA Client 3 1 QUASAR eGA Server QUASAR Isocenter Cube Plugins Release Notes Zoom 4 z Value 177 i ga Splash s n m ETA Brightness r Contrast r V Show markers on image Value 50 Value 0
6. or the eguivalent directory for the operating system e Double click on the desktop shortcut e After the splash screen and disclaimer the main screen will appear Click on the IsoCenter Cube Analysis button to show the following interface E I Q QUASAR IsoCenter Cube QA Software IsoCenter Cube Analysis Lo Tools Results Navigation View Exit _ Desktop My Documents 5 My Computer Threshold Template Custom oa E a OpenOffice org 3 4 en US Insta Browse Waming Distance 1 mm Pass Fail Criteria Failure Distance 2 00 mm Selected Images Gantry Collimator Couch L R Eror A P Eror S Error Zoom 4 r Value 100 A Brightness Contrast r Value 50 Value 0 i Count IsoCenter Cube Analysis Bin Range Size 256 a Mean a Min EI DICOM Image Viewer Max ee Mode Current Date 23 05 2014 Figure 1 IsoCenter Cube Interface Performing a Test Quick Version In order to perform a test within the QUASAR IsoCenter Cube Software please follow the steps found below e Define the pass fail criteria Pass Fail Criteria Threshold Template Custom M E Waming Distance 1 75 mm Failure Distance 2 00 mm Yv You may accept the default values select a previously saved threshold template or adjust the warning failure distance thresholds e On the left hand directory listing navigate to th
7. the messages will tell you what feature the analysis engine failed to find and you can use this information to improve the image acquisition so that the analysis will succeed ICC UG3 0 05282014 2014 Modus Medical Devices Inc All rights reserved 19 QUASAR IsoCenter Cube QA Software and Phantom User s Guide INFO root lsocenter shift in pixels 1 17031999 4 00617674 INFO root Isocenter shift in mm 0 91753087 3 14084256 DEBUG root reading lt open file D data umages MR BUTLER_ACR_QA 20131101 160127 DEBUG root Computing Otsu threshold 28 WARNING root Failed to find a BB WARNING root lmage modality MR RTIMAGE Ignoring cone test DEBUG root No BBs detected this isn t an isocenter test don t bother finding cones WARNING root lmage modality MR RTIMAGE Ignoring light field test DEBUG root No BBs detected this isn t an isocenter test don t bother finding phantom ERROR root Number of BBs is incorrect 0 1 ERROR root Number of radiation fields is incorrect 0 1 Figure 8 Analysis Log Messages ICC UG3 0 05282014 2014 Modus Medical Devices Inc All rights reserved 20 QUASAR IsoCenter Cube GA Software and Phantom User s Guide Software Updates To download the latest version of the IsoCenter Cube GA Software and user s guide please visit http www modusmed com isocenter cube ga support and sign in with your unique Customer Login ID If you are new to Modus Medical
8. the most accurate results Because there may be slight artifacts caused by the radiopaque sphere IGRT alignment may need to be performed manually If necessary perform couch motions to complete the IGRT alignment Take at least two Winston Lutz exposures using either film or EPID Pictured above is the QUASAR IsoCenter Cube Phantom placed on the treatment couch ICC UG3 0 05282014 2014 Modus Medical Devices Inc All rights reserved 8 QUASAR IsoCenter Cube GA Software and Phantom User s Guide Exposure Analysis Typical Winston Lutz tests can be analyzed on a pass fail basis by manually observing the position of the radiopaque object s edges relative to the radiation field While this technique can be used for IGRT analysis it can be faster and more usetul to perform a software analysis of each exposure Note This test includes inaccuracies due to IGRT isocenter definition MV isocenter variation IGRT software alignment IGRT couch motions TPS centroid isocenter definition CT slice width effects ROI contouring accuracy and MLC stereotactic cone positioning Its results will likely have more variation than standard Winston Lutz tests that do not include IGRT positioning and CT simulation accuracy There are several available software packages that can assist with Winston Lutz exposure analysis Software interpolation and use of ROIs can be helpful in improving the spatial accuracy of EPID images which typicall
9. Devices Inc please visit http www modusmed com create account to create a unigue Customer Login ID by completing the online form Please note Software updates are accessible only for products with a current maintenance agreement If your maintenance agreement has expired please contact Modus Medical Devices Inc to reguest a renewal or Email info modusmed com Subject QA Software Maintenance Renewals Warranty and Support Modus Medical Devices Inc Limited Warranty Modus Medical Devices Inc warrants to the original purchaser that the products sold will be free from defects in material and workmanship for a period of one year from the date of delivery If the product is found to be defective during the warranty period the part s and labor required to repair the product will be provided free of charge This warranty is subject to the following exceptions and limitations e The customer shall be responsible for proper maintenance and handling of the product e No warranty is extended to any equipment that has been altered or modified in any way e No warranty is extended to any equipment that has been misused or damaged This warranty is in lieu of all other warranties express or implied including warranties of merchantability or fitness for a particular purpose and is the sole and exclusive remedy for any claim of damages arising from defects in the Modus product Modus shall have no liability for consequential damages or persona
10. QA SOFTWARE www modusmed com GA SOFTWARE AND PHANTOM USER S GUIDE Version 3 0 IsoCenter Cube Mocluls JU AAA QUASAR IsoCenter Cube QA Software and Phantom User s Guide Legal amp Copyright Notice Information in this manual is subject to change without notice No part of this manual may be reproduced in any form without the written permission of Modus Medical Devices Inc Modus Copyright 2014 Modus Medical Devices Inc All rights reserved QUASAR and the QUASAR logo are trademarks of Modus Medical Devices Inc Modus reserves the right to make any changes without further notice to any products herein Modus makes no representation warranty or guarantee regarding the suitability of its products for any particular purpose nor does Modus assume any liability arising out of the application or use of any product and specifically disclaims any and all liability including without limitation consequential or incidental damages Typical parameters can and do vary in different applications All operating parameters including Typicals must be validated for each customer application by customer s technical experts Modus does not convey in this user s guide any license under its patent rights nor the rights of others GC UG3 0 05282014 2014 Modus Medical Devices Inc All rights reserved 2 QUASAR IsoCenter Cube QA Software and Phantom User s Guide Contents an ae PARHAAT 2 E a E oe see
11. all QUASAR IsoCenter Cube on your computer Click Next to start the installation Cancel lt Back The next wizard page only confirms that you are ready to begin the installation There is no further information reguired Click the Next button to confirm the software installation click the Back button if you wish to modify any of your choices or click the Cancel button if you do not wish to install the software ICC UGS8 0 05282014 2014 Modus Medical Devices Inc All rights reserved 12 QUASAR IsoCenter Cube GA Software and Phantom User s Guide Installation Complete QUASAR IsoCenter Cube has been successfully installed Click Close to exit Please use Windows Update to check for any critical updates to the NET Framework The software will now be installed on your computer You will See progress reported as the installation proceeds and when it is done the wizard page will report whether or not the installation was successful If the installation fails please contact Modus Medical Devices for assistance Toll free 866 862 9682 North America Direct 1 519 438 2409 Email supportt modusmed com ICC UG3 0 05282014 2014 Modus Medical Devices Inc All rights reserved 13 QUASAR IsoCenter Cube GA Software and Phantom User s Guide The desktop will contain a QUASAR IsoCenter Cube shortcut and the program will be available through the Start Menu in Start gt All Programs
12. e location of the images and select the image to be used for the test ICC UG3 0 05282014 2014 Modus Medical Devices Inc All rights reserved 14 QUASAR IsoCenter Cube GA Software and Phantom User s Guide e Once the image has been selected a dialog box Figure 5 will appear The gantry collimator and table rotation parameters can be set in accordance to the parameters of the image If the DICOM header does not contain information about the pixel size you will also be required to enter the image pixel size otherwise you will see the pixel size but be unable to modify it Please choose an image mapping c Gantry Angle Collimator Angle 0 Couch Rotation 270 Pixel Size 0 250 Accept Cancel Figure 2 Gantry Collimator and Table Image Mapping e The selected image name will be displayed in the Selected Images list as well as the angle parameters The image can be viewed within the image viewer displayed on the right side of the screen by selecting the image from within the list Also you can change the angle information by 2 or selecting Edit Angles from the context mode If you decide that an image should be removed from the list click the delete image button Or select Delete Image from the context menu clicking the edit angles button Note Multiple images may be added to the Selected Images list e Click on analyze button or Tools gt Analyze Images from the
13. esis nes E EE E ieee ws cee 5 Villis 00112 16 MCS ae E EE aaa aa taa iu aaa sean 5 OSA i i enon uneneese 5 WH SPO a ZF 8 72101 al OWENS SAM EDIE AAMU UU rem beesaaeeaneeesiaeest 6 8 8 218119 49881148 214 SIONS AMAAN AA tsa oe ange Mt A ia 6 QUASAR ISOC enter Cube SOW al Gun apt eniniaasenat nati vintneta ini linnata peenem kisama 6 OCT Scan MAT AINAIA Cicer ami esineant aimata vk an ais statuses vi kasina re krat kaddis TEORIENE TETT EIEEE visata kanti 7 sissi osi a a epee td aed es wr ec ea cade eon ed eee ona 7 IGRT Alignment and Film EPID Exposures s anccsrsscancennes sosataascaanniansnsienaraiaieaeeniansimemaioaneiemennneeeeens 8 EOS A SIS ma i EE E EAEE EEE aa a aaa 9 Varnan 211X Reproducibility RESUS ritus vaaata vandaali via a aa alia amka dna aaa aka aaa aaa ai alal 9 2 9 844214 94 1112 1 4 PARMA MMM mm TAM m Mm E E ua uu 10 Ferornmning a TeS 89918151 Vrone EE aema 14 Klas BES 98 8 o las Se ST E eee ee ee 2 E 16 Defining a Threshold J CDOT Cras tiecvonsstuspinbarcestramassdenbaediansederareniiauwiiadeinendsteormeseriantadesteveusisdnenles 16 AN Mg E eg secu E E EE ERE E AEE EEE E 17 Ulge 16 tA MEEME N EN E E Ea 18 ch gree pando coh E roca E iterates ae deme 21 Modus Medical Devices Inc Limited Warranty ccssccscecceccecnecneceeceseesnetneteetersersenestetsersstnetetsetaetes 21 tiio e dE es e AE E A ni cater ET sleet T E gt A AE ET 21 ICC UG3 0 05282014 2014 Modus Medical Devices Inc All rights re
14. ion needed to clinically implement a modified Winston Lutz test for IGRT accuracy e Test end to end IGRT positioning accuracy for clinical treatment setups with 0 1 mm precision in less than 5 minutes e The test is performed by aligning a phantom containing radiopaque sphere with IGRT system then capturing radiation field exposures with film or EPID e The test results are used to determine end to end accuracy for frameless SRS SBRT and IGRT treatments ICC UG3 0 05282014 2014 Modus Medical Devices Inc All rights reserved 5 QUASAR IsoCenter Cube QA Software and Phantom User s Guide Winston Lutz Phantom Most Winston Lutz phantoms include holders that attach to the couch or halo Because this test uses the IGRT system to position the phantom a special Winston Lutz phantom without a holder needs to be used The phantom should include a radiopaque sphere embedded in a plastic phantom The radiopaque sphere should be large enough to cast a shadow in MV beam exposures but small enough to not cause significant CBCT artifacts The plastic surrounding the sphere can be scribed with isocenter marks for visual alignment Phantom Dimensions The QUASAR IsoCenter Cube Phantom features a seamless acrylic 5 x 5 x 5 cm unibody enclosure containing one 6 mm diameter tungsten sphere embedded at the central axis It has crosshair scribing on all sides indicating its center and does not cause significant CT or CBCT artifac
15. l injury or for the loss damage or expense directly or indirectly arising from the use of this product No distributor dealer or other party is authorized to make any warranty on behalf of Modus or to assume for Modus any other liability with respect to its products Customer Support If you require service or support for this product please contact Modus Medical Devices Inc at Modus Medical Devices Inc 1570 North Routledge Park London Ontario N6H 5L6 CANADA Phone 1 519 438 2409 Toll free in North America 866 862 9682 www modusmed com support modusmed com GC UG3 0 05282014 2014 Modus Medical Devices Inc All rights reserved 21
16. ld template is automatically loaded when the application is started e Click the Save link to save the Threshold template ICC UG3 0 05282014 2014 Modus Medical Devices Inc All rights reserved 16 QUASAR IsoCenter Cube QA Software and Phantom User s Guide Add Threshold Template Template Name Default settings Measured Distance Tolerance Waming 1 75 Measured Distance Tolerance Fail 2 00 Default Configuration Save Figure 4 Add Edit Threshold Template The Edit Threshold Template functions identical to the Add Threshold Template except that the template name cannot be changed Saving Results The error measurements provided by the software can be saved as a text or PDF file Once a series of images has been analyzed e Click on export results button F bring up the Save Results File Dialog e Navigate to a location to save the file and provide a file name e Click on the Save button to save the file to the specified location or the Results gt Export Results menu item to Ej Isocenter Result Notepad File Edit Format View Help IsoCentre Cube Results Date of Test 20 09 2011 11 33 56 Am LINAC Manufacturer Elekta Shaping Device MLC Angle LeftRightError AntPosError SupInfError Fi leNumber 0 0 270 3 68mm Omm 5 44 1 Figure 5 Example Saved Results ICC UGS8 0 05282014 2014 Modus Medical Devices Inc All rights reserved 17 QUASAR IsoCenter Cube
17. mm 4 Y mm This IGRT end to end test shows the radiation field was always within 1 mm of the IGRT positioned phantom The standard deviation for all exposures was around 0 5 mm Although the AY values of both the AP and lateral images correspond to the same superior inferior direction their mean values differed by almost 0 5 mm This is likely due to radiation field positioning variance with gantry angle ICC UG3 0 05282014 2014 Modus Medical Devices Inc All rights reserved 9 QUASAR IsoCenter Cube QA Software and Phantom User s Guide Software Installation Download the QUASAR IsoCenter Cube installer and extract the following files e QUASAR IsoCenter Cube msi e Setup exe Start the software installation process by double clicking on the setup exe file A wizard style interface will guide you through the installation process FLJ QUASAR IsoCenter Cul mn oe Welcome to the QUASAR IsoCenter Cube Setup Fi l Wizard a The installer will guide you through the steps required to install QUASAR IsoCenter Cube on your computer WARNING This computer program is protected by copyright law and international treaties Unauthorized duplication or distribution of this program or any portion of it may result in severe civil or criminal penalties and will be prosecuted to the maximum extent possible under the law The first wizard page just confirms that QUASAR IsoCenter Cube software will be installed and it displays a
18. served 3 QUASAR IsoCenter Cube QA Software and Phantom User s Guide This Page Intentionally Left Blank ICC UG3 0 05282014 2014 Modus Medical Devices Inc All rights reserved 4 QUASAR IsoCenter Cube QA Software and Phantom User s Guide Background To assure high accuracy of radiation delivery of the medical linear accelerator LINAC a Winston Lutz test can be performed at some regular interval to measure the effective isocenter wander at different gantry collimator and couch angles For image guided radiation therapy IGRT the Modus Medical Devices QUASAR IsoCenter Cube phantom can be used to measure IGRT accuracy The phantom is aligned with the IGRT system using crosshairs inscribed on the surface of the phantom and images are acquired at various gantry collimator and couch angles With the use of the QUASAR IsoCenter Cube software large amounts of data can be taken and processed automatically streamlining the quality assurance QA process The remainder of this manual will describe how to effectively use the QUASAR IsoCenter Cube software Winston Lutz IGRT Test e Nathan Childress Ph D DABR Mobius Medical Management LLC Mobius Medical Systems LP Houston TX e Jimmy Jones M S The Methodist Hospital Houston TX e Stephen Kry Ph D DABR MD Anderson Cancer Center Houston TX Distributed via http www medphysfiles com Updated October 1 2011 Overview e Provide informat
19. ts Additional 3 mm offset laser alignment marks are on 3 faces QUASAR IsoCenter Cube Software The QUASAR IsoCenter Cube Software provides a mechanism in which the user can analyze the EPID images produced from scanning the Winston Lutz phantom The software provides multiple configuration points for setup as well as the ability to analyze images from various vendors and EPIDs The results of the test are provided as error in the anterior posterior left right and superior inferior directions respectively ICC UGS8 0 05282014 2014 Modus Medical Devices Inc All rights reserved 6 QUASAR IsoCenter Cube GA Software and Phantom User s Guide CT Scan and Planning The phantom should be scanned with a clinical CT simulator using a small slice width typically 1 2 mm After verifying the radiopaque sphere is clearly visible in the scan and there are no significant CT artifacts the images should be transferred to a clinical treatment planning system TPS In the TPS carefully create a region of interest ROI of the radiopague sphere Place isocenter at the centroid of the sphere Create small fields the following tests use 2x2 cm that are collimated with your clinical beam shaping device typically MLC or stereotactic cone not the main jaws Export the CT data set isocenter and treatment fields to the clinical record and verify R V system Note Only AP and lateral radiation fields need to be created for routine IGRT testing
20. y have 0 4 mm wide pixels at isocenter Using interpolation and large SIDs 150 180 cm can result in better than 0 1 mm test accuracy High levels of accuracy are not needed to perform pass fail IGRT positioning tests However performing this test with 0 1 mm accuracy on a daily or monthly basis can identify trends in IGRT positioning and allow the IGRT isocenter to be adjusted before failing Varian 211X Reproducibility Results A setup isocenter was placed on the custom Winston Lutz phantom with a 5 mm shift from its marked isocenter in each of the vertical longitudinal and lateral directions The phantom was aligned to the setup isocenter using the room lasers and a CBCT with 1 mm slices was taken with a Varian 211X Varian s IGRT software was used to align the tungsten sphere to the ROI imported from the TPS Automatic couch motions were used to place the phantom at the IGRT system s isocenter and AP and lateral port films were taken with a 2x2 cm2 MLC defined field This process was repeated a total of 10 times The EPID images were analyzed with DoseLab Pro s Multi Image Winston Lutz tool to determine the offset between the radiation field and final position of the tungsten sphere shown in the table below Winston Lutz analysis results of 10 sequential IGRT positioned custom phantom EPID exposures Values are differences between radiation field and tungsten sphere centroids AP EPID image Lateral EPID image AX mm 4 Y mm AX
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