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Siponimod, through S1PR modulation, targets MS by inhibiting auto-reactive lymphocyte migration to the CNS and may have direct neurobiological effects.2,3 ... (2 mg) and supratherapeutic (10 mg) doses of siponimod versus placebo.
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psychosocial support after diagnostic disclosure. Interviews were conducted, transcribed, and analyzed through content analysis using sotfware NVivo Pro 11.
[3] Leonard, R. J., McArthur, C., & Hochuli, D. F. (2016). Exposure to wind alters insect herbivore behaviour in larvae of Uraba lugens (Lepidoptera: Nolidae).
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Stability of the Imaging and Radiation Isocentre for Elekta Synergy® Linear Accelerators S. Ramsay & R. Sims Auckland Radiation Oncology, 98 Mountain Road, Epsom, Auckland, New Zealand
Introduction The MV radiation isocentre size, stability and coincidence with the kV imaging isocentre is critical for accurate and precise delivery of radiation therapy. This is particularly important for the small targets and high dose gradients associated with stereotactic radiation therapy (SRT). We report our long-term results for radiation isocentre size and kV/MV coincidence for two Elekta Synergy® linear accelerators at Auckland Radiation Oncology (ARO).
Methods The Winston-Lutz test is performed using the customer acceptance procedure[1] and analysed with our in-house software to determine the diameter of the radiation isocentre. With the same phantom setup the BB is then imaged using the XVI system to determine the offset between the MV and kV isocentres. Both of these tests are performed weekly and recorded into a web-based QA tracking software tool.
Figure 1 – The Winston-Lutz Phantom
Machine 1.
Results The results from the weekly test of the radiation isocentre between May 2016 and August 2017 are demonstrated in Figure 2. The mean diameter of the radiation isocentre for both machines is within the 1.4mm Elekta specification[3] in all directions. The largest results for machine 1 occurred in the G-T and C-F directions as expected. Of note are the larger A-B results for machine 2. When a 2SD error is applied, the value exceeds the specification. Test results exceeding 1.4mm however were seen only 5 times and these were all in the A-B direction for machine 2 (maximum diameter 1.6mm).
Machine 2.
To investigate the observations from machine 2 further, the Winston-Lutz test was repeated with intentional 2T steering errors applied. This resulted in a subsequent change in A-B beam symmetry of 1% and 3% in relation to the nominal value. The repeated test showed that the radiation isocentre diameter can vary up to 0.62mm in the A-B direction with a 3% change in symmetry due to steering error [Table 1].
Table 1 – The effect of 2T Steering error on radiation isocentre locus diameter
Figure 2 – The mean Winston-Lutz locus diameter for two Elekta Synergy® Linear Accelerators at ARO.
The average vector magnitude of the kV/MV isocentre offset is 0.36±0.26mm (2SD) with both machines agreeing to within 0.1mm. Results exceeding 0.5mm in any one direction occurred only 2 times over the 15 month period (0.55mm maximum). This is within both the ±1mm tolerance stipulated by the AAPM Task Group 142 report[2] and Elekta’s specification[3].
Table 2 – The offset between the imaging and radiation isocentres for two Elekta Synergy® Linear Accelerators at ARO
Conclusions The long-term stability of the kV/MV isocentre congruence is excellent and the mean radiation isocentre diameter remains within specification over the same time period. While a gross effect was not seen, we note the sensitivity of this technique to 2T steering errors and suggest that the lookup tables, gain and balance of the steering system is optimised and mechanical isocentre measurements are still performed. The high degree of accuracy and precision observed on the Elekta Synergy® platform at ARO is especially significant in the setting of highly conformal, contemporary techniques such as stereotactic radiation therapy. Scan the QR code provided below to access a copy of this poster and associated data.
Figure 3 – Screenshot of the in-house software used for Winston-Lutz analysis at ARO
References [1] Elekta CAT document [2] Klein et al, (2009) AAPM Task Group 142 report: Quality assurance of medical accelerators, http://dx.doi.org/10.1118/1.3190392 [3] Elekta Versa HD Product Data Specification
