Immobilization precision of a modified GTC frame

The purpose of this study was to evaluate and quantify the interfraction reproducibility and intrafraction immobilization precision of a modified GTC frame. The error of the patient alignment and imaging systems were measured using a cranial skull phantom, with simulated, predetermined shifts. The kV setup images were acquired with a room-mounted set of kV sources and panels. Calculated translations and rotations provided by the computer alignment software relying upon three implanted fiducials were compared to the known shifts, and the accuracy of the imaging and positioning systems was calculated. Orthogonal kV setup images for 45 proton SRT patients and 1002 fractions (average 22.3 fractions/patient) were analyzed for interfraction and intrafraction immobilization precision using a modified GTC frame. The modified frame employs a radiotransparent carbon cup and molded pillow to allow for more treatment angles from posterior directions for cranial lesions. Patients and the phantom were aligned with three 1.5 mm stainless steel fiducials implanted into the skull. The accuracy and variance of the patient positioning and imaging systems were measured to be 0.10 ± 0.06 mm, with the maximum uncertainty of rotation being ±0.07°. 957 pairs of interfraction image sets and 974 intrafraction image sets were analyzed. 3D translations and rotations were recorded. The 3D vector interfraction setup reproducibility was 0.13 mm ± 1.8 mm for translations and the largest uncertainty of ± 1.07º for rotations. The intrafraction immobilization efficacy was 0.19 mm ± 0.66 mm for translations and the largest uncertainty of ± 0.50º for rotations. The modified GTC frame provides reproducible setup and effective intrafraction immobilization, while allowing for the complete range of entrance angles from the posterior direction.