© 2017 IBA SA

myQA iON

* Internal code name, not to use with customers

Automation for efficient

Daily and Patient QA

ESTRO 2019, Milan

Simon Marcelis

Director Particle Therapy

IBA Dosimetry

spend doing QA?How much time do you

▪ Extensive analysis of QA common practices

PT Site DS US PBS Frequence Test Tolerance Device Comment

Site C ✔ ✔ Yearly Dose Rate ± 30 % PPC05 + WP One field per option

Site A ✔ Yearly Field Size > 30×40 Film Largest Field Size > 30×40

Site B ✔ Monthly Test Pattern γ 2%/2mm 98% Lynx160MeV 5cm solid water, 226.7MeV

5cm solid water

Site A ✔ Monthly Spot Sigma < 10% or 0.5 mm Lynx< 10% or 0.5 mm, whichever is

smaller

Site C ✔ ✔ Yearly Modulation ± 3mm or ± 3% PPC05 + WP

Site A ✔ Daily Spot Sigma ± 20% I'mRT MatriXX + Buildup CPASS ± 10 %

Site F ✔ Daily Spot Sigma ± 10% Daily QA 3 4 spots (220 MeV), Field size diodes

Site C ✔ ✔ Yearly Snout Motion ≤ 5 mm Ruler

Site C ✔ ✔ Monthly Modulation± 3.0 mm or ± 3

%PPC05 + WP 2 ref field + 1 other field (rotation)

Site C ✔ ✔ Weekly Modulation± 3.0 mm or ± 3

%Zebra 2 ref field + 1 other field (rotation)

Site A ✔ Daily Modulation ± 3 mm I'mRT MatriXX + Buildup CPASS ± 2 mm

Site A ✔ Daily Flatness ± 3 % I'mRT MatriXX + Buildup CPASS ± 2 %

Site A ✔ Daily Symmetry ± 3 % I'mRT MatriXX + Buildup CPASS ± 2 %

Site D ✔ Daily Symmertry ± 3 % Daily QA 3 2 electron energy chambers @ mid-

Site A ✔ Daily Range ± 3 mm I'mRT MatriXX + Buildup • Distal, Proximal, Middle

• CPASS ± 2 mm

Site C ✔ ✔ Daily Output ± 3% Daily QA 3 + Buildup

Site D ✔ Daily Output ± 3 % Daily QA 3 + Buildup SOBP Mid

Site B ✔ Daily Output ± 2% MatriXX

Site C ✔ ✔ Monthly Symmetry ± 2 % MatriXX 2 ref field, 1 GTR angle

Site C ✔ ✔ Yearly Symmetry ± 2% MatriXX + Buildup Mid SOBP, one field per option

Site A ✔ DailyPPS Absolute

Position± 2 mm I'mRT MatriXX + Buildup

Goto Setup ⇒ X-ray ⇒ CV ⇒ Goto

Correction

Site A ✔ Monthly Snout Position ± 2 mm 2 Snouts

Site F ✔ Daily Output ± 2 % Daily QA 3 + Buildup 3cmx3cm, 159MeV, 1g/cm² buildup

Site B ✔ Monthly Snout ± 2 mm Ruler

Site C ✔ ✔ Yearly Output ± 2 % PPC05 + WP One field per option

Site E ✔ Monthly Symmetry 0.02 MatriXX 1 angle, 8 energies, 3 sizes

Site C ✔ ✔ Weekly First Scatterer ± 2 mm Range Verifier Compare range ‘all in’ to ‘all out’

Site D ✔ Daily Lasers ± 2 mm .

Site A ✔ Monthly Test Pattern γ 1.5% 1.5mm Lynx G 1.5%/1.5mm for 95% of the points

Site C ✔ ✔ Monthly Range ± 1.5 mm PPC05 + WP 2 ref field + 1 other field (rotation)

Site C ✔ ✔ Monthly X-ray vs Proton ± 1.5 mm FilmDouble‐exposure x‐ray and proton

on film

Site A ✔ Daily Lasers ± 1.5 mm I'mRT MatriXX + Buildup

Site C ✔ ✔ Weekly X-ray vs LF ± 1.5 mm Crosshair + Aperture Different Snout sizes (rotation)

Site C ✔ ✔ Weekly X-ray vs Proton ± 1.5 mm Crosshair + Aperture Different Snout sizes (rotation)

Site C ✔ ✔ Monthly Alignment ± 1.5 mm Plastic box with bb’sSet up phantom at setup angle, go

to tx angle, verify

Site A ✔ Monthly PPS Isocentricity ± 1.5 mm

Site C ✔ ✔ Yearly Range ± 1.5 mm PPC05 + WP

Site F ✔ Daily Spot Position ± 1.5 mm Daily QA 3 • 4 spots (220 MeV)

• Field size diodes

Site A ✔ Monthly PPS Translation ± 1.5 mm

Site C ✔ ✔ Daily Range ± 1.5 mm Range Verifier

Site C ✔ ✔ Daily X-ray vs PPS ± 1.5 mm Daily QA 3 + index bar Drive PPS to predefined position

Site C ✔ ✔ Weekly PPS Isocentricity ± 1.5 mm Iso-AlignAlign target at rot 0, rotate to 90 and

check

Site C ✔ ✔ Weekly Range ± 1 mm Zebra 2 ref field + 1 other field (rotation)

Site G ✔ Daily X-ray vs Proton ± 1 mm . MatriXX align with X-rays

Site E ✔ Monthly PPS Translation 1 mm . Markings on PPS mount

Site E ✔ Monthly PPS Isocentricity 1 mm LF + Crosshair + Laser LF projection crosshair & pointer

Site E ✔ Monthly PPS Isocentricity 1 mm LF + Crosshair LF projection of crosshair

Site B ✔ Monthly PPS Translation ± 1 mm

Site E ✔ Monthly Snout Motion 1 mm LF + Crosshair LF projection of crosshair

Site C ✔ ✔ Daily Lasers ± 1 mm Markers on Daily QA 3

Site C ✔ ✔ Yearly Lasers ± 1 mm Iso-Align Iso-Align aligned with X-rays

Site B ✔ Daily Spot Position ± 1 mm MatriXX

Site C ✔ ✔ Yearly X-ray vs Proton ± 1 mm Film • All snouts (4)

• 3 gantry angles per snout

Site D ✔ Daily Range ± 1 mm Daily QA 3 + Buildup SOBP Distal

Site D ✔ Daily X-ray vs PPS ± 1 mm .“4 metal bb’s in Daily QA 3 holder +

index to couch”

Site F ✔ Daily Range ± 1 mm Daily QA 3

“electron energy chambers, 187

MeV and 201 MeV, Different

buildup (entrance&distal fall‐off)”

Site D ✔ Daily Couch Motion ± 1 mm .

Site C ✔ ✔ Yearly Output ± 1 % Farmer Chamber + WP IAEA TRS 398 protocol

Site C ✔ ✔ Yearly LF vs X-ray ± 1 mm Film

Site C ✔ ✔ Yearly Output vs Dose ± 1 % Farmer Chamber + WP 1 – 3 Gy/min

Site G ✔ Daily Range ± 1 mm MatriXX + Buildup SOBP Distal (cube)

Site A ✔ Monthly Spot Position ± 1 mm Lynx

Site C ✔ ✔ Yearly PPS Movement ± 0.5 mm Ruler

Site C ✔ ✔ Yearly PPS Isocentricity ≤0.5 mm Plastic Sphere • Plastic sphere and X‐ray system

• Rot center to iso: ≤0.5 mm

• Radius rot. center: ≤0.5 mm

Site C ✔ ✔ Yearly GTR Angle ± 0.5 ° Digital Level .

Site C ✔ ✔ YearlySymmetry

vs GTR Angle± 0.5 % MatriXX + Buildup Cardinal angles plus one inbetween

Site C ✔ ✔ YearlyFlatness

vs GTR Angle± 0.5 % MatriXX + Buildup Cardinal angles plus one inbetween

Site C ✔ ✔ Yearly Output ± 0.5 % PPC05 + WP

Site I ✔ Weekly Spot Sigma . Custom (Pyramid) 2 PX-2 + BC-100 + Motion Rail

Site B ✔ Monthly X-ray vs Proton Lynx

Site I ✔ Weekly Spot Direction . Custom (Pyramid) 2 PX-2 + BC-100 + Motion Rail

Site I ✔ Weekly Spot Shape . Custom (Pyramid) 2 PX-2 + BC-100 + Motion Rail

Site I ✔ Weekly Spot Position . Custom (Pyramid) 2 PX-2 + BC-100 + Motion Rail

Site C ✔ ✔ YearlySnout Motion

(perp. axis)≤0.5 mm X-ray

Site C ✔ ✔ Yearly Dose Linearity ±0.5 MU, ± 0.2 % Farmer Chamber + WP • Offset: ±0.5 MU

Site I ✔ Weekly Output . Custom (Pyramid) 2 PX-2 + BC-100 + Motion Rail

• Max diff from linear fit: ±0.2%, MU:

25, 50, 100,150, 200

Site C ✔ ✔ Yearly GTR Isocentricity 0.5 mm Plastic Sphere • Plastic sphere and x‐ray system

• Radius cross plane: ≤0.5 mm.

• Variation inline: ±0.5mm

Site C ✔ ✔ Yearly PPS Rotation ± 0.2 ° Level

Site B ✔ Monthly PPS Rotation ± 0.2° Level

Site H ✔ Daily Spot Sigma . Gafchromic Films

Site H ✔ Daily Spot Position . Gafchromic Films

Site F ✔ Daily X-ray vs PPS . Daily QA 3 + index bar

Site H ✔ Daily Range . Gafchromic Films Gafchromic set parallel to beam

Site A ✔ Yearly Test Pattern . Lynx 226 MeV, 146 MeV and 116 MeV

Site A ✔ Yearly Spots . Lynx 18 Energies, Iso ±10cm and ±20cm

Site A ✔ Yearly Spots Size . Lynx 18 Energies, Iso ±10cm and ±20cm

Site A ✔ Yearly SAD . Lynx Compared to TPS

Site A ✔ Yearly PDD Consistency . ZebraPDD curves compared with those

from TPS

Site A ✔ Yearly Range . Zebra 10×10 field, 18 energies

Site C ✔ ✔ Yearly SOBP Flatness . PPC05 + WP

Site C ✔ ✔ Yearly X-ray Quality . Leeds Phantom

Site C ✔ ✔ Yearly X-ray Dose . kVp&mAs meter

Site G ✔ Daily Field Size . MatriXX .

Site B ✔ Monthly Symmetry MatriXX

Site B ✔ Monthly Flatness MatriXX

Site A ✔ Yearly Dose Linearity . MatriXX

Five scanned mono-energy 20cm x

20cm field were measured with

MatriXX at 5 cm depth

Site A ✔ Daily Output ± 3 % I'mRT MatriXX + Buildup Mid SOBP. CPASS ± 2 %

Site C ✔ ✔ Monthly Profile Flatness ± 3 % MatriXX 2 ref field, 1 GTR angle

Site B ✔ Monthly Range ZebraR20M10, R31M10, R12M10, R12M10

(with Range Shifter)

Site A ✔ Monthly Uniformity ± 3 % Lynx

Site G ✔ Daily Output ± 3 % MatriXX + Buildup Average of four central chambers

Site C ✔ ✔ Yearly Profile Flatness ± 3% MatriXX + Buildup Mid SOBP, one field per option

Site A ✔ Daily Spot Position ± 3 mm MatriXX + Buildup CPASS ± 2 mm

Site C ✔ ✔ Weekly Output ± 2.5 % Zebra 2 ref field + 1 other field (rotation)

Site C ✔ ✔ Monthly Output ± 2.5 % PPC05 + WP 2 ref field + 1 other field (rotation)

Site B ✔ Monthly Output ± 2% MatriXX• R20M10, R31M10, R12M10, R12M10

(with Range Shifter) 

Site B ✔ Daily Flatness ± 2% MatriXX

Site E ✔ Monthly Profile Flatness 0.02 MatriXX 1 angle, 8 energies, 3 sizes

Site B ✔ Daily Range ± 2 mm MatriXX

Site E ✔ MonthlyOutpus

vs GTR Angle0.02 Farmer Chamber • 4 angles, 8 energies, 3 sizes

Site A ✔ MonthlySpot Position

(max)± 2 mm Lynx

Site A ✔ Monthly Output ± 2 % PPC05

Typical time spent on QA on a PT Site

0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170

Hours

3

h

3

h

3

h

3

h

3

h

3

h

3

h

3

h

3

h

3

h

3

h

3

h

3 h/month

→ 36 h/year

16h/year

30 min/day

→ 125 h/year (≈ 16 days/year)

Machin

e Q

A

Daily

Month

lyY

early

Patient

QA 3 h/week

→ 150 h/year (≈ 18 days)

Example 1

Daily QA

DAILY

MACHINE QAEnergy

Spots

Positions

Spots

Sizes

Spots

SymmetryOutput

Imaging

System

Beam vs

X-ray

Zebra

Lynx

PPC05+ solid water

Example 1: Daily QA

OBJECTIVE

≈ 30 min/day (16days/year)

FASTER and WITHOUT QUALITY COMPROMISE

IN COLLABORATION WITH:

✓ Energy

✓ Spots Size

✓ Spots Position

✓ Spots Symmetry

✓ Absolute dose

✓ X-ray vs Proton

✓ Lasers

✓ Uniformity

✓ Imaging system

✓ Couch translation

AAPM TG 224 (draft) ready

0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170

30 min/day

→ 125 h/year (≈ 16 days/year)

Typical Machine QA times

3 h/month

→ 36 h/year

16h/year

Machin

e Q

A

Daily

Month

lyY

early

0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170

Sphinx

Daily QA in one shot

9

30 min/day

→ 125 h/year (≈ 16 days/year)

3 h/month

→ 36 h/year

16h/year

“Thanks to myQA and

the Sphinx, daily QA

at Orsay is done

within 15 minutes”

Farid Goudjil

Head of Medical Physics

Centre de Protonthérapie d'Orsay

15 min/day

→ 62.5 h/year (≈ 8 days/year)

In collaboration with:

DOPA Automation Server

* DOPA = DOsimetry PT Alliance

Gantry

Couch

BeamImaging

DOPA*

Automation

Server

INTERNAL USE ONLY11

DOPA Automation Server

1st Clinical Installation

UMCG (Groningen)

Feb 2018

INTERNAL USE ONLY12

0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170

Sphinx + DOPA Automation Server

13

30 min/day

→ 125 h/year (≈ 16 days/year)

3 h/month

→ 36 h/year

16h/year

2 h/week

→ 100 h/year (≈ 12 days)

15 min/day

→ 62 h/year (≈ 8 days/year)

+

9 min/day

→ 38 h/year

DOPA

Automation

Server

= Daily QA in < 10 min

= 1 more patient/day !

Example 2

Patient QA

3D

3D Hardware ?

2.5D

DigiPhant

2D

MatriXX

1D

Water Phantom

Evolution of Patient QA

?

1973 2004 2012 2019

Evolution of Patient QA

Logs+

MC

1973 2004 2012 2019

1D 2D 2.5D 3D

Water Phantom MatriXX DigiPhant 3D Hardware ?

Machine Logs+ Monte Carlo Indpt Dose

INTERNAL USE ONLY17

IBA Dosimetry is introducing the first log based

patient QA solution for Proton Therapy

Patient QA

“Combining irradiation logs and an independent dose

recalculation with myQA iON, we intend to reduce the amount of

measurements performed for patient QA by approximately 90%.”

Stefan Both

Professor & Head of Medical Physics

Department of Rad. Oncology, University Medical Center Groningen

IBA Dosimetry is

introducing the first log

based patient QA solution

for Proton Therapy

Released Feb 1st !

Patient QA

Task based workflow Log based QA

Monte Carlo based QA Customizable automation

“Combining irradiation logs and an independent dose

recalculation with myQA iON, we intend to reduce the amount of

measurements performed for patient QA by approximately 90%.”

Stefan Both

Professor & Head of Medical Physics

Department of Rad. Oncology, University Medical Center Groningen

Task Based workflow

Identical tasks grouped together

Clear display of tasks to be performed

Clear display of QA status

Task assignment and deadline definition*

* Not in current version

Monte Carlo based QA

* PBS simulation 10 million protons on provided computation server

Automatic Launch following DICOM transfer

Provided with MCSquare

< 1 min performance*

3D gamma analysis

Log based QA

Automatic transfer of pre-treatment and fraction irradiation logs*

Treatment follow up through log analysis (per fraction) *

Log based dose reconstruction *

Based on nozzle IC readings

* Not in current version

Customizable automation & notifications

Automatic DICOM transfer from TPS

Web based services

Personal (customizable) notification*

Protocol based QA*

* Not in current version (expected Q4 2019)

[myQA iON] WARNING

Irradiation log | Larry James

Patient Larry James

Fraction 12

Type 3D gamma

Last fraction 88%

Expected 98%

Consult full report

Modify my notifactions preferences

Plan, CT, Dose,

Structure

Dose measurement

Machine Logs

pre-treatment + fractions*

myQA iON

Server

Automatic

Background

Processing

TPS dose vs.

Indpt. Dose

(Monte Carlo)

TPS dose vs.

Detector

measurements

Indpt Dose vs.

Machine logs

* Not in current version

Request MatriXX / Logs (Dry Run)

How does it work?

myQA iON combines 3 solutions, you decide which combination to use for your QA

DEMO

DEMO

DEMO

DEMO

© 2017 IBA SA

Thank you !

&

Please stop at the station for a demo!