EXACTRAC x-ray and beam isocenters-What's the difference?

Purpose: To evaluate the geometric accuracy of the isocenter of an image-guidance system, as implemented in the exactrac system from brainlab, relative to the linear accelerator radiation isocenter. Subsequently to correct the x-ray isocenter of the exactrac system for any geometric discrepancies between the two isocenters.Methods: Five Varian linear accelerators all equipped with electronic imaging devices and exactrac with robotics from brainlab were evaluated. A commercially available Winston-Lutz phantom and an in-house made adjustable base were used in the setup. The electronic portal imaging device of the linear accelerators was used to acquire MV-images at various gantry angles. Stereoscopic pairs of x-ray images were acquired using the exactrac system. The deviation between the position of the external laser isocenter and the exactrac isocenter was evaluated using the commercial software of the exactrac system. In-house produced software was used to analyze the MV-images and evaluate the deviation between the external laser isocenter and the radiation isocenter of the linear accelerator. Subsequently, the deviation between the radiation isocenter and the isocenter of the exactrac system was calculated. A new method of calibrating the isocenter of the exactrac system was applied to reduce the deviations between the radiation isocenter and the exactrac isocenter.Results: To evaluate the geometric accuracy a 3D deviation vector was calculated for each relative isocenter position. The 3D deviation between the external laser isocenter and the isocenter of the exactrac system varied from 0.21 to 0.42 mm. The 3D deviation between the external laser isocenter and the linac radiation isocenter ranged from 0.37 to 0.83 mm. The 3D deviation between the radiation isocenter and the isocenter of the exactrac system ranged from 0.31 to 1.07 mm. Using the new method of calibrating the exactrac isocenter the 3D deviation of one linac was reduced from 0.90 to 0.23 mm. The results were complicated due to routine maintenance of the linac, including laser calibration. It was necessary to repeat the measurements in order to perform the calibration of the exactrac isocenter.Conclusions: The deviations between the linac radiation isocenter and the exactrac isocenter were of an order that may have clinical relevance. An alternative method of calibrating the isocenter of the exactrac system was applied and reduced the deviations between the two isocenters.