SU-E-T-19: A New End-To-End Test Method for ExacTrac for Radiation and Plan Isocenter Congruence




To combine and integrate quality assurance (QA) of target localization and radiation isocenter End to End (E2E) test of BrainLAB ExacTrac system, a new QA approach was devised using anthropomorphic head and neck phantom. This test insures the target localization as well as radiation isocenter congruence which is one step ahead the current ExacTrac QA procedures.


The head and neck phantom typically used for CyberKnife E2E test was irradiated to the sphere target that was visible in CT-sim images. The CT-sim was performed using 1 mm thickness slice with helical scanning technique. The size of the sphere was 3-cm diameter and contoured as a target volume using iPlan V.4.5.2. A conformal arc plan was generated using MLC-based with 7 fields, and five of them were include couch rotations. The prescription dose was 5 Gy and 95% coverage to the target volume. For the irradiation, two Gafchromic films were perpendicularly inserted into the cube that hold sphere inside. The linac used for the irradiation was TrueBeam STx equipped with HD120 MLC. In order to use ExacTrac, infra-red head–array was used to correlate orthogonal X-ray images.


Using orthogonal X-rays of ExacTrac the phantom was positioned. For each field, phantom was check again with X-rays and re-positioned if necessary. After each setup using ExacTrac, the target was irradiated. The films were analyzed to determine the deviation of the radiation isocenter in all three dimensions: superior-inferior, left-right and anterior-posterior. The total combining error was found to be 0.76 mm ± 0.05 mm which was within sub-millimeter accuracy.


Until now, E2E test for ExacTrac was separately implemented to test image localization and radiation isocenter. This new method can be used for periodic QA procedures.