© 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!