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Evaluation of HyperArc™ using film and portal dosimetry quality assurance

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Abstract

HyperArc™ is a stereotactic radiotherapy modality designed for targeting multiple brain metastases using a single isocenter with multiple non-coplanar arcs. This study aimed to assess the efficacy of two patient-specific quality assurance methods, film and the Varian Portal Dosimetry System with Varian’s HyperArc™ technique and raise important considerations in the customisation of patient-specific quality assurance to accommodate HyperArc™ delivery. Assessment criteria included gamma analysis and mean dose at full width half maximum. The minimum metastasis size, maximum off-axis distance and suitable energy were identified and validated. Patient-specific quality assurance procedures were applied to a range of clinically relevant brain metastasis plans. Initial investigation into energy selection showed no significant differences in gamma pass rates using 6MV, 6MV FFF, or 10MV FFF for metastasis sizes greater than 15 mm diameter at the isocenter. Gamma pass rates (2%/2mm) for 15 mm metastases at the isocenter for all energies were greater than 96.0% for portal dosimetry and greater than 98.7% for film. Fields of size 15 mm placed at various distances (10–70 mm) from the isocenter resulted in a maximum mean dose difference of 1.5% between film and planned. Clinically relevant plans resulted in a maximum mean dose difference for selected metastases of 1.0% between film and plan and a maximum point dose difference of 2.9% between portal dose and plan. Portal dose image prediction was a quick and convenient quality assurance tool for metastases larger than 15 mm near the isocenter but provided diminished geometrical relevance for off-axis metastases. Film QA required exacting procedures but offered the ability to assess the accuracy of geometrical targeting for off-axis metastases and provided dosimetric accuracy for metastases to well below 15 mm diameter.

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Notes

  1. Icon Cancer Care, Gold Coast University Hospital, QLD, Australia.

  2. ICON Cancer Care, Epworth, Vic, Australia.

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Acknowledgements

I would like to thank my employer ICON for the opportunity to be part of an exciting project where the benefits are seen in the hope of the patients. Lastly and most importantly, I would like to thank Emmanuel Baveas for his relentless, patient input that has led me to this final word.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

  1. ICON Cancer Care, Gold Coast University Hospital, Southport, Australia

    Onno Kamst & P. Desai

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  1. Onno Kamst
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  2. P. Desai
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection and analysis were performed by OK, and PD. The first draft of the manuscript was written by OK, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Onno Kamst.

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The authors have no relevant financial or non-financial interests to disclose.

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This research was conducted without the need for 321.2227 human or animal involvement and consequently did not require ethics approval.

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Kamst, O., Desai, P. Evaluation of HyperArc™ using film and portal dosimetry quality assurance. Phys Eng Sci Med 46, 57–66 (2023). https://doi.org/10.1007/s13246-022-01197-1

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