Performance assessment of a programmable five degrees-of-freedom motion platform for quality assurance of motion management techniques in radiotherapy

  • Chen-Yu Huang
  • Paul Keall
  • Adam Rice
  • Emma Colvill
  • Jin Aun Ng
  • Jeremy T. BoothEmail author
Scientific Paper


Inter-fraction and intra-fraction motion management methods are increasingly applied clinically and require the development of advanced motion platforms to facilitate testing and quality assurance program development. The aim of this study was to assess the performance of a 5 degrees-of-freedom (DoF) programmable motion platform HexaMotion (ScandiDos, Uppsala, Sweden) towards clinically observed tumor motion range, velocity, acceleration and the accuracy requirements of SABR prescribed in AAPM Task Group 142. Performance specifications for the motion platform were derived from literature regarding the motion characteristics of prostate and lung tumor targets required for real time motion management. The performance of the programmable motion platform was evaluated against (1) maximum range, velocity and acceleration (5 DoF), (2) static position accuracy (5 DoF) and (3) dynamic position accuracy using patient-derived prostate and lung tumor motion traces (3 DoF). Translational motion accuracy was compared against electromagnetic transponder measurements. Rotation was benchmarked with a digital inclinometer. The static accuracy and reproducibility for translation and rotation was <0.1 mm or <0.1°, respectively. The accuracy of reproducing dynamic patient motion was <0.3 mm. The motion platform’s range met the need to reproduce clinically relevant translation and rotation ranges and its accuracy met the TG 142 requirements for SABR. The range, velocity and acceleration of the motion platform are sufficient to reproduce lung and prostate tumor motion for motion management. Programmable motion platforms are valuable tools in the investigation, quality assurance and commissioning of motion management systems in radiation oncology.


Tumor motion 5 Degrees-of-freedom motion platform Quality assurance Motion management 



This work was supported by a Cancer Australia Grant 1085360 and the Australian Fellowship from the Australian National Health and Medical Research Council. No commercial support was received for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Kupelian P, Willoughby T, Mahadevan A, Djemil T, Weinstein G, Jani S, Enke C, Solberg T, Flores N, Liu D, Beyer D, Levine L (2007) Multi-institutional clinical experience with the calypso system in localization and continuous, real-time monitoring of the prostate gland during external radiotherapy. Int J Radiat Oncol Biol Phys 67:1088–1098CrossRefPubMedGoogle Scholar
  2. 2.
    Plathow C, Schoebinger M, Fink C, Hof H, Debus J, Meinzer H-P, Kauczor H-U (2006) Quantification of lung tumor volume and rotation at 3D dynamic parallel MR imaging with view sharing: preliminary results. Radiology 240:537–545CrossRefPubMedGoogle Scholar
  3. 3.
    Sonke J-J, Lebesque J, Van Herk M (2008) Variability of four-dimensional computed tomography patient models. Int J Radiat Oncol Biol Phys 70:590–598CrossRefPubMedGoogle Scholar
  4. 4.
    Huang C-Y, Tehrani JN, Ng JA, Booth J, Keall P (2015) Six degrees-of-freedom prostate and lung tumor motion measurements using kilovoltage intrafraction monitoring. Int J Radiat Oncol Biol Phys 91:368–375CrossRefPubMedGoogle Scholar
  5. 5.
    Qiu P, D D’Souza W, McAvoy TJ, Liu KR (2007) Inferential modeling and predictive feedback control in real-time motion compensation using the treatment couch during radiotherapy. Phys Med Biol 52:5831–5854CrossRefPubMedGoogle Scholar
  6. 6.
    Keall P, Kini V, Vedam S, Mohan R (2002) Potential radiotherapy improvements with respiratory gating. Australas Phys Eng Sci Med 25:1–6CrossRefPubMedGoogle Scholar
  7. 7.
    Keall PJ, Chang M, Benedict S, Thames H, Vedam SS, Lin PS (2008) Investigating the temporal effects of respiratory-gated and intensity-modulated radiotherapy treatment delivery on in vitro survival: an experimental and theoretical study. Int J Radiat Oncol Biol Phys 71:1547–1552CrossRefPubMedGoogle Scholar
  8. 8.
    Colvill E, Booth JT, O’Brien R, Eade TN, Kneebone AB, Poulsen PR, Keall PJ (2015) Multileaf collimator tracking improves dose delivery for prostate cancer radiation therapy: results of the first clinical trial. Int J Radiat Oncol Biol Phys 92:1141–1147CrossRefPubMedGoogle Scholar
  9. 9.
    Hoogeman M, Prévost J-B, Nuyttens J, Pöll J, Levendag P, Heijmen B (2009) Clinical accuracy of the respiratory tumor tracking system of the cyberknife: assessment by analysis of log files. Int J Radiat Oncol Biol Phys 74:297–303CrossRefPubMedGoogle Scholar
  10. 10.
    Mukumoto N, Nakamura M, Sawada A, Takahashi K, Miyabe Y, Takayama K, Mizowaki T, Kokubo M, Hiraoka M (2012) Positional accuracy of novel X-ray-image-based dynamic tumor-tracking irradiation using a gimbaled MV X-ray head of a Vero4drt (MHI-TM2000). Med Phys 39:6287–6296CrossRefPubMedGoogle Scholar
  11. 11.
    Keall PJ, Colvill E, O’Brien R, Ng JA, Poulsen PR, Eade T, Kneebone A, Booth JT (2014) The first clinical implementation of electromagnetic transponder-guided MLC tracking. Med Phys 41:020702CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Booth JT, Caillet V, Hardcastle N, O’Brien R, Szymura K, Crasta C, Harris B, Haddad C, Eade T, Keall PJ (2016) The first patient treatment of electromagnetic-guided real time adaptive radiotherapy using MLC tracking for lung SABR. Radiother Oncol 121:19–25CrossRefPubMedGoogle Scholar
  13. 13.
    Keall PJ, Ng JA, Juneja P, O’Brien RT, Huang C-Y, Colvill E, Caillet V, Simpson E, Poulsen PR, Kneebone A (2016) Real-time 3D image guidance using a standard LINAC: measured motion, accuracy, and precision of the first prospective clinical trial of kilovoltage intrafraction monitoring–guided gating for prostate cancer radiation therapy. Int J Radiat Oncol Biol Phys 94:1015–1021CrossRefPubMedGoogle Scholar
  14. 14.
    Nakayama H, Mizowaki T, Narita Y, Kawada N, Takahashi K, Mihara K, Hiraoka M (2008) Development of a three-dimensionally movable phantom system for dosimetric verifications. Med Phys 35:1643–1650CrossRefPubMedGoogle Scholar
  15. 15.
    Malinowski K, Noel C, Lu W, Lechleiter K, Hubenschmidt J, Low D, Parikh P (2007) Development of the 4D Phantom for patient-specific, end-to-end radiation therapy QA. Medical imaging. In: International society for optics and photonics, pp 65100E–65109EGoogle Scholar
  16. 16.
    Ngar DYK, Cheung ML-M, Kam MK-M, Poon W-S, Chan AT-C (2014) A novel compound 6D-offset simulating phantom and quality assurance program for stereotactic image-guided radiation therapy system. J Appl Clin Med Phys 14:100–116CrossRefGoogle Scholar
  17. 17.
    Belcher AH, Liu X, Grelewicz Z, Pearson E, Wiersma RD (2014) Development of a 6DoF robotic motion phantom for radiation therapy. Med Phys 41:121704CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Cetnar AJ, James J, Wang B (2016) Commissioning of a motion system to investigate dosimetric consequences due to variability of respiratory waveforms. J Appl Clin Med Phys 17:283–292CrossRefPubMedGoogle Scholar
  19. 19.
    Kutcher GJ, Coia L, Gillin M, Hanson WF, Leibel S, Morton RJ, Palta JR, Purdy JA, Reinstein LE, Svensson GK (1994) Comprehensive QA for radiation oncology: report of AAPM radiation therapy committee task group 40. Med Phys 21:581–581CrossRefPubMedGoogle Scholar
  20. 20.
    Klein EE, Hanley J, Bayouth J, Yin F-F, Simon W, Dresser S, Serago C, Aguirre F, Ma L, Arjomandy B (2009) Task group 142 report: quality assurance of medical accelerators. Med Phys 36:4197–4212CrossRefPubMedGoogle Scholar
  21. 21.
    Kim J, Wen N, Jin J-Y, Walls N, Kim S, Li H, Ren L, Huang Y, Doemer A, Faber K (2012) Clinical commissioning and use of the Novalis Tx linear accelerator for SRS and SBRT. Appl Clin Med Phys 13:124–151CrossRefGoogle Scholar
  22. 22.
    Antypas C, Pantelis E (2008) Performance evaluation of a CyberKnife® G4 image-guided robotic stereotactic radiosurgery system. Phys Med Biol 53:4697–4718CrossRefPubMedGoogle Scholar
  23. 23.
    Solberg TD, Medin PM, Ramirez E, Ding C, Foster RD, Yordy J (2014) Commissioning and initial stereotactic ablative radiotherapy experience with Vero. Appl Clin Med Phys 15:205–225CrossRefGoogle Scholar
  24. 24.
    Balter JM, Wright JN, Newell LJ, Friemel B, Dimmer S, Cheng Y, Wong J, Vertatschitsch E, Mate TP (2005) Accuracy of a wireless localization system for radiotherapy. Int J Radiat Oncol Biol Phys 61:933–937CrossRefPubMedGoogle Scholar
  25. 25.
    Franz AM, Schmitt D, Seitel A, Chatrasingh M, Echner G, Oelfke U, Nill S, Birkfellner W, Maier-Hein L (2014) Standardized accuracy assessment of the calypso wireless transponder tracking system. Phys Med Biol 59:6797–6810CrossRefPubMedGoogle Scholar
  26. 26.
    Langen KM, Willoughby TR, Meeks SL, Santhanam A, Cunningham A, Levine L, Kupelian PA (2008) Observations on real-time prostate gland motion using electromagnetic tracking. Int J Radiat Oncol Biol Phys 71:1084–1090CrossRefPubMedGoogle Scholar
  27. 27.
    James J, Cetnar A, Dunlap NE, Huffaker C, Nguyen VN, Potts M, Wang B (2016) Validation and implementation of a wireless transponder tracking system for gated stereotactic ablative radiotherapy of the liver. Med Phys 43:2794–2801CrossRefPubMedGoogle Scholar
  28. 28.
    Ng JA, Booth JT, O’Brien RT, Colvill E, Huang C-Y, Poulsen PR, Keall PJ (2014) Quality assurance for the clinical implementation of kilovoltage intrafraction monitoring for prostate cancer VMAT. Med Phys 41:111712CrossRefPubMedGoogle Scholar
  29. 29.
    Keall PJ, Aun Ng J, O’Brien R, Colvill E, Huang C-Y, Rugaard Poulsen P, Fledelius W, Juneja P, Simpson E, Bell L, Alfieri F, Eade T, Kneebone A, Booth JT (2015) The first clinical treatment with kilovoltage intrafraction monitoring (KIM): a real-time image guidance method. Med Phy 42:354–358CrossRefGoogle Scholar

Copyright information

© Australasian College of Physical Scientists and Engineers in Medicine 2017

Authors and Affiliations

  • Chen-Yu Huang
    • 1
  • Paul Keall
    • 1
  • Adam Rice
    • 2
  • Emma Colvill
    • 1
    • 2
  • Jin Aun Ng
    • 1
  • Jeremy T. Booth
    • 2
    • 3
    Email author
  1. 1.School of MedicineUniversity of SydneySydneyAustralia
  2. 2.Northern Sydney Cancer CentreRoyal North Shore HospitalSydneyAustralia
  3. 3.School of PhysicsUniversity of SydneySydneyAustralia

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