SU-E-CAMPUS-J-01: TG142 Complied Comprehensive Commissioning and Quality Assurance Procedure for Respiratory Gating




To develop and establish a comprehensive gating commissioning and quality assurance procedure in compliance with TG142.


Quality assurance tests on three Varian LINACs included beam output and energy constancy, calibration of surrogate, as well as phase and amplitude gating temporal accuracy. A diode array (MapCHECK 2) and film (Gafchromic EBT2) were used to measure the temporal accuracy of phase and amplitude gating windows. A motion simulation device (MotionSim) was used to simulate respiratory motion for both detectors. An end-to-end test was also performed on all three machines. The overall accuracy and uncertainty was analyzed and compared.


The end-to-end test using an anthropomorphic lung phantom (CIRS) results in an OSL dose difference reading within 5% (within measurement uncertainty) for both phase and amplitude gated treatment. Film results showed < 1% agreement between profiles for gated delivery and predicted dose. The diode array demonstrated an 80% passing rate for gamma criteria of 2%/0.2 mm, which results in a 111 msec temporal accuracy. However, the diode array is limited by its spatial resolution of measurements, due to its 7.07 mm diode spacing. Film provided higher measuring resolution, thus demonstrated a temporal accuracy of <100 msec.


Results showed consistent respiratory gating stability and accuracy. MapCHECK 2 may not be sufficient for the temporal accuracy test in the respiratory gating treatment in order to meet the corresponding tolerance in TG142. One would need to decrease respiratory motion speed from the surrogate or tighten the gating window in order to be within tolerance of 100 msec temporal accuracy per TG-142. The end-to-end test offers insight to the overall accuracy and uncertainties with a gated protocol. Compared to static delivery, respiratory motion increases the overall uncertainty of treatment delivery from 3% to 5% dose difference.