title: Investigating the spatial accuracy of CBCT-guided cranial radiosurgery: A phantom end-to-end test study.
abstract: OBJECTIVE
  To evaluate the spatial accuracy of a frameless cone-beam computed tomography (CBCT)-guided cranial radiosurgery (SRS) using an end-to-end (E2E) phantom test methodology.
  
  
  METHODS
  Five clinical SRS plans were mapped to an acrylic phantom containing a radiochromic film. The resulting phantom-based plans (E2E plans) were delivered four times. The phantom was setup on the treatment table with intentional misalignments, and CBCT-imaging was used to align it prior to E2E plan delivery. Comparisons (global gamma analysis) of the planned and delivered dose to the film were performed using a commercial triple-channel film dosimetry software. The necessary distance-to-agreement to achieve a 95% (DTA95) gamma passing rate for a fixed 3% dose difference provided an estimate of the spatial accuracy of CBCT-guided SRS. Systematic (∑) and random (σ) error components, as well as 95% confidence levels were derived for the DTA95 metric.
  
  
  RESULTS
  The overall systematic spatial accuracy averaged over all tests was 1.4mm (SD: 0.2mm), with a corresponding 95% confidence level of 1.8mm. The systematic (Σ) and random (σ) spatial components of the accuracy derived from the E2E tests were 0.2mm and 0.8mm, respectively.
  
  
  CONCLUSIONS
  The E2E methodology used in this study allowed an estimation of the spatial accuracy of our CBCT-guided SRS procedure. Subsequently, a PTV margin of 2.0mm is currently used in our department.
authors.affiliation: Departamento de Oncología Radioterápica, Hospital Quirón, Barcelona, Spain. Electronic address: jfcdrr@yahoo.es.
authors.forename: Juan-Francisco
authors.initials: JF
authors.lastname: Calvo-Ortega
authors.affiliation: Servicio de Física y Protección Radiológica, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors.forename: Marcelino
authors.initials: M
authors.lastname: Hermida-López
authors.affiliation: Departamento de Oncología Radioterápica, Hospital Quirón, Barcelona, Spain.
authors.forename: Sandra
authors.initials: S
authors.lastname: Moragues-Femenía
authors.affiliation: Departamento de Oncología Radioterápica, Hospital Quirón, Barcelona, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Pozo-Massó
authors.affiliation: Departamento de Oncología Radioterápica, Hospital Quirón, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Casals-Farran
mesh_terms: D054893:Cone-Beam Computed Tomography / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005373:Film Dosimetry; D006801:Humans; D019047:Phantoms, Imaging; D016634:Radiosurgery / Q000295:instrumentation / Q000379:methods*; D061089:Radiotherapy, Image-Guided / Q000295:instrumentation / Q000379:methods*; D012886:Skull / Q000000981:diagnostic imaging* / Q000601:surgery*; D012984:Software; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*
keywords: CBCT; End-to-end; Margin; Radiochromic; SRS