ArticleRadiological physics and technology2026
End to end dosimetric and geometric verification of single isocenter multitarget stereotactic radiosurgery using an anthropomorphic phantom: external audit validation.
Article in Radiological physics and technology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Our study aimed to perform a comprehensive end-to-end (E2E) dosimetric and geometric evaluation of the newly commissioned Varian Edge linear accelerator (LINAC) with the HyperArc™ VMAT system for multi-target stereotactic radiosurgery (SRS) to ensure clinical accuracy and safety in the treatment of multiple brain metastases. E2E testing was conducted using the MAX-EA anthropomorphic phantom, incorporating ion chamber and film inserts. The phantom was immobilized with a Q-fix Encompass system and scanned with a 0.625 mm CT protocol. Five spherical PTVs range between (0.3-9.2 cc) were planned using Eclipse™ v18.01 with 6 MV-FFF beams and optimized via the Photon Optimizer algorithm with Acuros XB (1.25 mm grid). A HyperArc™ plan prescribing 15 Gy to each target was generated. Ionization chamber, Gafchromic EBT-XD film, portal dosimetry (EPID), and Multi-Target Winston-Lutz (W-L) tests were used to evaluate dosimetric and geometric accuracy. The measured-to-calculated dose difference was - 3.3% for the HyperArc plan. Film analysis yielded average gamma pass rates > 94.9% (2%/2 mm), > 96.5% (3%/1 mm) and > 98.68% (3%/2 mm). Portal dosimetry achieved > 96.05% average gamma pass (2%/2 mm). The W-L test all targets demonstrated localization accuracy within 0.5 mm and MPC measurements confirmed sub-millimeter isocenter accuracy within 0.29 mm. E2E evaluation of the Edge LINAC with HyperArc VMAT demonstrated submillimeter geometric precision and robust dosimetric accuracy. Also, the Results met AAPM-RSS benchmarks. While rigid phantom validation inherently idealizes real patient-specific anatomical and setup variations. These high-quality baseline results support the clinical accuracy of the treatment workflow.
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