SRS MapCHECK™

StereoPHAN™ & MultiMet-WL Cube

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
Stereotactic Platform Key Solutions
MultiMet-WL Cube

Assures targeting accuracy

for off-axis SRS targets

MR Distortion & Image

SRS MapCHECK™ Fusion Head Phantom

Unmatched detector resolution Assess MR image distortion

for filmless SRS/SBRT QA in SRS Planning

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
StereoPHAN™

Link to SRS Presentation

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
StereoPHAN™
• Applications:
– Stereotactic (SRS/SRT/SBRT) end-to-end testing
and patient-specific QA
– QA of image fusion algorithms for CT and MRI
imaging modalities
– Absolute, relative and point dose dosimetry
QA measurements at isocenter with ion chambers
o Relative dose distribution using film
– Comprehensive evaluation of geometric
accuracy including:
o Optical and geometric isocenter
o Laser alignment
o Indexed table positioning alignment
and positioning coordinates
o CBCT and MV/kV isocenter alignment

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
End-to-end Testing
Stereotactic body radiation therapy: The report of AAPM Task Group
101
• Overall concept – treat the phantom
as you would a patient
– Goal: simulate treatment process
– Determine: spatial and dose accuracy
• Imaging & localization of phantom
– Test of imaging/fusion and planning
– IGRT and frame systems (as appropriate)
• Delivery accuracy
– Ion chamber for dose determination
– Film measurements for spatial
distribution

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
StereoPHAN™

CHAMBER INSERT

EXTERNAL ORIENTATION
MARKERS

UNIVERSAL SPACER
INSERT

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
Imaging Accuracy – Spatial Accuracy and Fusion

SNC StereoPHAN with CT/MRI insert

• Simple qualitative assessment of spatial accuracy
• Test of image registration tools
• Small structure(s) for targeting in end-to-end tests

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
Dosimetric Accuracy – Small Fields
Stereotactic body radiation therapy: The report of AAPM Task Group
101
• Ion chambers
– Relatively large volumes/dimensions
otherwise
– All > 1mm – A16 smallest @ 2.4mm
diameter
– Small volume readings can be unreliable
• Film
– Useful for verification
– Poor dosimetric abilities
• Stereotactic diodes
– < 0.5 mm high spatial resolution
– Potential energy and field size
dependences

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
Dosimetric Accuracy – Ion Chamber
• Dose measurements
– Measure dose distribution of plans with
ion chamber
– Measure dose distribution with film
• Insert for ion chamber
– Single point measurement but accurate
(consider small field limitations)
• For commissioning:
– Delivery of set of plans onto phantom
– Analysis of any larger differences
– Measure both in and out of field
• For QA, similar process

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
StereoPHAN™ // Inserts

CT/MRI insert verifies the accuracy of

an image fusion algorithm. It includes
three spherical cavities of varying sizes
filled with mineral oil clearly visible in
CT and MRI images

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
StereoPHAN™ // Inserts

Film insert measures MRI Signal Generator

dose profiles and insert filled with copper
features five titanium sulphate aids in MRI image
fiducial markers and acquisition
orientation marks.

Universal Spacer insert

Ion Chamber insert features five aluminum
measures dose and spheres at varying depths for
positions active volume image fusion; positions
at geometric center of chamber cord out of the way;
the phantom provides homogeneity behind
other inserts

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
Dosimetric Accuracy // Film Analysis
• Insert for film dosimetry
– 75mm square film fits many targets
– Five markers to reference film to RT dose
– Analysis available in SNC patient
– Dose from Ion Chamber can be used to
scale dose to film

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
SRS MapCHECK™
• Small-field digital alternative to film
for SRS and SBRT QA and end-to-end
testing
– Array Size: 7.7 x 7.7cm
– Detectors: 1,013
– Active Detector Area (mm): 0.48 x 0.48
o Volume 0.007 mm3
– Detector spacing: 2.47 mm
o 5 Diodes in 5 mm cone
– No film needed
o Significant time-savings

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
SRS MapCHECK™ // SNC Patient v8.3
• Supported by SNC Patient software, as part of end-to-end solution
• Software corrections for well-known diode response characteristics:
– Angular Dependence → meets TG 218 requirements
– Field size
– Temperature
– Dose rate
Released September 2019:
SNC Patient v8.3

Enhanced capabilities to support:

• CyberKnife®
• Varian HyperArc™
• Vertex delivery beams
for Varian/Elekta

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
SNC Patient v8.4 // Additional Functionality
• Enhanced SRS MapCHECK support:
– QA Setup Tool
– Improved Multi-Met set up
o Preview dose on SRSMC before delivery
o Provides complete guidance for
positioning of SRSMC for off isocenter
workflows
– Off-axis workflow
– Halcyon Support
– 10x/FFF Support (including >45deg)

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
SNC Patient v8.5 // Additional Functionality
• CyberKnife® Machine QA with SRS
MapCHECK®
– MLC QA Garden Fence Test
– Iris Beam QA Test
– Daily Targeting Accuracy QA Test
– MLC and Fixed Cone Beam QA
• Expanded Support
– SRS MapCHECK®
o Varian Medical Systems® Ethos™ Therapy and
Accuray®
TomoTherapy® and Radixact™ System Support*
– ArcCHECK®
o Varian Medical Systems® Halcyon™ System and
Ethos™ Therapy, Accuray ® Radixact™ Support*
• New Data Security Features
– User log in, Event Tracking, Windows
recommended installation

*Does not include Synchrony for CyberKnife or Tomotherapy

Better Quality Management. Better Care.
© 2022 Mirion Technologies. All rights reserved.
Meets Task Group requirements
• Task Group 101 - SBRT • Pros/Cons of SRS detectors:
• Ion chambers
– Relatively large volumes/dimensions
– All diameters >1mm – A16 @ 2.4mm
diameter
– Small volume readings can be unreliable
• Film
– High resolution
– Dose errors >1%
• Task Group 218 – IMRT/VMAT QA • Stereotactic diodes
– Angular Dependence corrections applied – < 1 mm high spatial resolution
– Potential energy and field size
dependences

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
Streamline Your Workflow

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
Case Study - St. Joseph’s/Candler Health System
SNC Patient makes simple work of Multi-Target QA

• The team at St. Joseph’s adopted SRS MapCHECK

• For CyberKnife - Reduced their QA from two hours per

plan using film and chamber to ~20 minutes

• On TrueBeam - Needed support for SIMT plans with as

many as ten lesions

• Used QA Setup Tool within SNC Patient

– provides guidance for ideal setup of SIMT plans, with real-
time visualization

• Can determine the ideal setup(s) for nine or more lesions

in less than five minutes

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
Publications and Abstracts

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
SRS MapCHECK™ Validation
Medical Physics 2020

Clear explanation of SRS

• MapCHECK design, use,
• and accuracy

“The SRS MapCHECK demonstrates near equivalent results to film, validating the SRS MapCHECK as a
PSQA/end-to-end test tool, with good sensitivity to common planning, setup, and dosimetry errors in
small field dosimetry”

“the average agreement between SRS MapCHECK the TPS was found to be 96.1%.”

• Discusses Nyquist Theorem, which shows 2.5mm spacing is adequate for SRS QA

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
SRS MapCHECK™ Validation
Medical Physics 2020

• Common SRS error

sources –Coarse Grid
Spacing

“devices for which the active detector area is smaller than the
typical calculation grid (such as the SRS MapCHECK) can reveal
when calculation grid spacing recommendations like MPPG 9a are
not being followed.”
– Detectors must be smaller than 1mm per TG-101

“SNC Patient software warns the user with importing a dose map
with grid spacing greater than 1x1x1mm3”

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
 Impact of MLC errors on SIMT
SRS MapCHECK used for validation
• Introduced small MLC errors
• +/- 0.09 – 0.94mm
• Evaluated Plan Quality and Deliverability

• “Results: …In two cases, plans that could be considered potentially clinically
unacceptable (i.e., clinical dose constraint violation) were obtained even for projected
offsets as small as 0.19 mm. The performed experimental dosimetry check can detect
potential small systematic leaf errors.”

• “Conclusion: Plan quality indices and dose volume metrics are very sensitive to
systematic sub-millimeter leaf positional inaccuracies, projected at the isocenter plane.”

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
Impact of MLC errors on SIMT
Plan Quality Evaluation SRSMC Evaluation

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
Varian’s Portal Dosimetry is not appropriate for SRS

Conclusion:
• “The agreement of PD to TPS mean dose in the high dose region was found to be dependent on target size. Film
measurements did not exhibit size dependence. All PD plans passed the 3%/2 mm gamma analysis, but caution
should be used when using PD to assess overall dosimetric accuracy of the treatment plan for small targets.”
• “Furthermore, portal dosimetry should not be used for the commissioning and validating of stereotactic beam
models.”
• “Portal dosimetry measurements were found to be target size dependent and could deviate up to 8% from film
measurements for the smallest targets evaluated. While portal dosimetry provides a quick method to evaluate
SRS plans for gross error without the use of a specialized phantom, it does not provide an accurate method for
determining the dosimetric accuracy of the plan when compared to film.”

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
Smaller, higher density arrays are better for SRS QA

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
MultiMet-WL Cube
Targeting Accuracy Check for MultiMet SRS

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
MultiMet-WL Cube // Released September 2019
• New StereoPHAN insert
• Off-axis W/L test
• Quantifies accuracy out to 7cm off-
axis
– 0.1mm precision
• Automated Analysis Software
Included
• Integration into SunCHECK Machine –
Future

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
MultiMet-WL Cube // Design

Six targets enable quantifying the margin of error up to 7 cm off-axis

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
MultiMet-WL Cube // Test Execution
• MLC and Jaw compatible
• RT Plan auto-generated
• Optimized for efficient delivery
– Six W/L take only ~10 minutes to complete
• Identifies setup errors
• Analysis indicates magnitude and
orientation of errors
– Gantry, Couch, or Collimator in 6DOF
• Reports off-axis errors out to 7cm!

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
MultiMet-WL Cube // Test Execution
• Off-axis target accuracy
• RT Plan provided
• Automated multi-target results

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
MultiMet-WL Cube // Results
• Reports 6DOF Setup Error
– Separates out Error Sources:
o Gantry, Collimator, and Couch Rotational Errors
o CBCT Setup Errors

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
Accuracy of your End-to-End SIMT system
Deliver the safest plans for your patients

• Imaging Accuracy
– MR Distortion and Image Fusion
• Off-axis accuracy
– Gantry, Collimator, & Couch rotation tolerances for your unique system
– Detect mechanical changes
• End-to-End Testing
– Cumulative accuracy during commissioning
– Review program annually, or as needed for troubleshooting
• Perform PSQA & still make it home for dinner
– Save time while ensuring excellent patient care

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
Understand your distortion
• Assess MR image distortion in SRS Planning
– Especially important as you get further from isocenter!

• Verify TPS image fusion and deformable

image registration algorithms Large Field Distortion Phantom
– Tissue equivalent, anthropomorphic design closely matches a
clinical imaging scenario

• End-to-End testing
– Can be imaged using X-ray, CT and MRI for continuity
– Can be used with frame or mounting devices and is suitable
for frameless SRS QA

Head Distortion Phantom

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
Distortion Check Software
Automated Analysis Of Distortion
• Quantifies the geometric distortion present in MRI images
• Uses either a CT scan as ground truth for distortion grid
locations
• Generates 3D distortion vector fields
• Exports DICOM overlays for import to 3rd party software, such
as a DICOM viewer or image fusion software

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
Large Field MR Image Distortion Phantom
• Provides a tissue-like imaging environment
– for assessing geometric distortion in whole-body MRI
scanners

• Sensitive to additional causes of distortion such as

chemical shifts and susceptibility artifacts
– Unlike air-filled phantoms

• Unique orthogonal 3D grid that provides complete

geometric data throughout the imaging volume
– 2152 control points

• Marked for ease of alignment to position lasers

Better Quality Management. Better Care.

© 2022 Mirion Technologies. All rights reserved.
Better Quality Management. Better Care.
© 2022 Mirion Technologies. All rights reserved.