Penta-Guide
User’s Guide
[Link]
QUASARTM Penta-Guide Phantom User’s Guide
Legal & Copyright Notice
Information in this manual is subject to change without notice. No part of this
manual may be reproduced in any form without the written permission of Modus
Medical Devices Inc.
Copyright © 2007 Modus Medical Devices Inc.
All rights reserved.
TM
QUASAR and the QUASARTM logo are trademarks of
Modus Medical Devices Inc.
Modus reserves the right to make any changes without further notice to any
products herein. Modus makes no representation, warranty or guarantee
regarding the suitability of its products for any particular purpose, nor does
Modus assume any liability arising out of the application or use of any product,
and specifically disclaims any and all liability, including without limitation
consequential or incidental damages. “Typical” parameters can and do vary in
different applications. All operating parameters, including “Typicals” must be
validated for each customer application by customer’s technical experts. Modus
does not convey in this user’s guide any license under its patent rights nor the
rights of others.
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QUASARTM Penta-Guide Phantom User’s Guide
Table of Contents
Legal & Copyright Notice .................................................................... 2
Introduction ......................................................................................... 5
Phantom Components ........................................................................ 5
Safety, Care & Handling ..................................................................... 6
Handle with care ............................................................................................. 6
Maintenance.................................................................................................... 7
Cleaning Instructions....................................................................................... 7
Operating Conditions ...................................................................................... 7
Description and Principles of Use ....................................................... 8
Orientation Convention ................................................................................... 8
Internal Features ............................................................................................. 9
Surface Features........................................................................................... 10
Spread Sheet ................................................................................................ 12
Recommended Procedure ................................................................ 13
Preparation.................................................................................................... 13
Setup............................................................................................................. 13
Test light field alignment - optional................................................................ 14
Inspect A-P and/or R-Lat projection images.................................................. 14
Measure position of apparent MV isocenter .................................................. 18
Measure CBCT isocenter discrepancy .......................................................... 18
Test automatic table adjustments - optional .................................................. 18
Warranty and Support....................................................................... 19
Modus Medical Devices Inc. Limited Warranty.............................................. 19
Customer Support ......................................................................................... 19
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QUASARTM Penta-Guide Phantom User’s Guide
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QUASARTM Penta-Guide Phantom User’s Guide
Introduction
QUASARTM
The Quality Assurance System for Advanced Radiotherapy (QUASARTM)
supports the testing of a wide variety of dosimetric and nondosimetric functions
of Radiation Therapy Planning Systems and CT Simulators using a set of
innovative QA tools.
The QUASARTM phantoms should be used for regularly scheduled testing, as well
as commissioning new systems and upgrades, and for testing repairs.
The QUASARTM system provides you with confidence that your radiation
treatment planning software and CT simulators are performing to their full
potential.
For more information about all of the QUASARTM phantoms please visit
[Link] or contact Modus Medical Devices Inc.
This Guide
This document is a User’s Guide for the QUASARTM Penta-Guide phantom in
radiotherapy quality assurance applications. This guide provides a description of
the phantom plus instructions for set up and operation.
Important Note
This User’s Guide is not a guide to Radiation Therapy Planning Systems, CT
Simulators, linear accelerators, portal imaging systems, linac based kV imaging
systems or cone beam CT imaging systems. Appropriate Quality Assurance of
these systems depends primarily on the intended clinical use of the systems and
on the skills and knowledge of the operators of these systems. Consequently,
technical competence in the operation of the Penta-Guide phantom must be
supplemented by a thorough understanding of the systems being tested.
Phantom Components
The QUASARTM Penta-Guide phantom consists of the following components:
• Phantom
• Spread Sheet on CD
• Shipping container
• Storage tray
• User’s Guide
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QUASARTM Penta-Guide Phantom User’s Guide
Figure 1 – QUASARTM Penta-Guide phantom in its storage tray
Safety, Care & Handling
Read all warnings, precautions, and instructions carefully before use, and follow
all operating and maintenance procedures described in this guide.
Handle with care
The QUASARTM Penta-Guide phantom is manufactured to very close tolerances
in order to ensure reproducibility, accuracy and good performance for many
years.
The phantom may be damaged by extended exposure to direct sunlight; such
exposure should be avoided.
The material used (acrylic) is susceptible to damage from impact, scratches,
temperature extremes and chemicals including solvents and cleaning products. In
addition acrylic is susceptible to dimensional changes due to the absorption of
moisture.
Proper care must be used when lifting, carrying or positioning the QUASARTM
Penta-Guide phantom to prevent injury to the operator. A storage tray is provided
to assist with safe storage and handling.
If the phantom is dropped or subjected to other mechanical shocks it may be
damaged. If you suspect the phantom has been damaged contact Modus to arrange
for service or repair.
The phantom is delivered in packaging material that is suitable for shipping. Part
of this packaging material is designed to be used as a storage tray (see figure 1).
The phantom should be placed in the storage tray in a safe location when not in
use.
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QUASARTM Penta-Guide Phantom User’s Guide
Maintenance
The QUASARTM Penta-Guide phantom does not contain any removable or field
adjustable components.
Cleaning Instructions
Do not leave the Penta-Guide phantom immersed in water for long periods of
time. The phantom may be immersed in water for a few minutes for cleaning but
should kept dry at all other times.
The phantom can be wiped clean with a mild soap or detergent solution.
1. Use a clean, soft cloth and apply only light pressure.
2. Dry the phantom by blotting with a damp cloth or chamois.
If attempts to clean the phantom using this technique are unsuccessful, please
contact Modus for approved alternatives.
Do NOT use:
• Wax-based or chemical-based cleaners,
• Window cleaning sprays,
• Kitchen scouring compounds, or
• Solvents such as acetone, gasoline, benzene, alcohol, carbon tetrachloride, or
lacquer thinner.
These can scratch the surface and/or weaken the acrylic causing small surface
cracks called "crazing". Damage caused by inappropriate cleaning activities is not
covered by the warranty.
Scratches and the wearing away of paint that occur during normal use and
handling of the phantom should not inhibit its performance. If you are concerned
about the any issue regarding the appearance, care, or performance of the
phantom please contact Modus.
Operating Conditions
The QUASARTM Penta-Guide phantom is designed and manufactured to operate
at normal office or clinic temperature and humidity. Rapid changes in temperature
and humidity may cause temporary or permanent changes in the dimensions of the
phantom. For this reason we recommend that the phantom be stored in the office
or clinic where it is used. If conditions change, time is required to allow the
phantom to become stable in the new conditions. We recommend that the
phantom be stored and used in the following environmental conditions:
• Temperature: 15 degrees to 30 degrees Celsius
• Humidity: 30% to 80% relative humidity (non-condensing).
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QUASARTM Penta-Guide Phantom User’s Guide
Description and Principles of Use
The QUASARTM Penta-Guide phantom is designed for daily quality assurance of
linac based Cone Beam CT (CBCT) imaging systems. Tests include the
registration and alignment of crossed kV and MV imaging systems and isocenter
alignment of cone beam CT.
Procedures for using the phantom, which are described in the sections that follow,
should be implemented as part of a thorough quality assurance program.
NOTE: The Penta-Guide phantom should not be expected to expose every
potential problem associated with the linac based imaging systems being tested.
Skilled operators should develop quality assurance tests and procedures to address
the full set of features and functions of the equipment being tested.
Orientation Convention
In the following sections we use the frame of reference defined in IEC 1217 as
shown in figure 2.
Figure 2 - IEC 1217 frame of reference (diagram used with permission
from Elekta)
Each of the phantom faces is named with respect to this reference frame. The
names of the faces correspond to a patient lying in the supine position with head
towards the gantry. In this orientation positive x is towards patient left, positive y
is superior (towards the gantry) and positive z is anterior (upwards). This is
shown in figure 3
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QUASARTM Penta-Guide Phantom User’s Guide
The phantom is designed to be used with the center of the phantom aligned with
the isocenter at location (0,0,0)
Anterior Anterior
Right Superior
Inferior Left
Figure 3 - Names of faces on Penta-Guide, Posterior not shown
Internal Features
Within the phantom there are five air filled spheres. Each of the spheres has two
corresponding rings embedded in the left and posterior faces of the phantom. The
spheres and rings are designed to appear on kV and MV projection images of the
phantom as well as on kV and MV cone beam CT images of the phantom. The
use of air filled spheres ensures sufficient image contrast without high density
streak artifacts on CT images.
In anterior – posterior (A-P) and right lateral (R-Lat) projection images of the
phantom the image of each sphere appears in the center of the image of the
corresponding ring if the phantom and the imaging system(s) are properly aligned.
This is a simple, quick test that reveals the existence of alignment problems.
Registration of A-P and R-Lat MV projection images of the phantom with
digitally reconstructed radiographs is used to measure the MV isocenter
discrepancy relative to the planning isocenter.
Registration of CBCT images of the spheres with planning CT images is used to
measure the displacement of the CBCT imaging isocenter relative to the planning
isocenter.
Spheres
There is a sphere at the center of the phantom - the isocenter - at location (0, 0, 0).
There are two spheres superior to the isocenter at locations (-1.0, 3.0, 2.0) and (-
2.0, 6.0, 4.0). There are two spheres inferior to the isocenter at (0.0, -3.0, 0.0) and
(0.0, -6.0, 0.0) - all dimensions are in cm.
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QUASARTM Penta-Guide Phantom User’s Guide
The central sphere is 1.2 cm in diameter. The remaining spheres are 0.8 cm
diameter.
Rings
The five rings on the left face of the phantom are shown in figure 4. There are
also five rings on the posterior surface which are hidden under the rubber base.
The rings are placed to align with the spheres on A-P and R-Lat images at 100 cm
source to axis distance (SAD). Their dimensions have been chosen to provide
sufficient contrast on these images for the tests described in the recommended
procedures.
ring
Figure 4 - Rings in the left face
Surface Features
The surface features of the phantom are either black or white. White markings
are demagnified for a 100 cm source to axis distance (SAD). For example the
phantom is a 16 cm cube so the 10 cm x 10 cm light field is demagnified by
92/100. The black cross hairs and the black rings are not demagnified. Figure 5
shows the anterior face of the phantom with the various features labeled in the
image.
Orientation Labels
The anterior face of the phantom has been labeled with directions to assist the
operator with orientation of the phantom during Setup;
• SUP is superior, towards the gantry
• L and R are patient Left and Right respectively
• INF is inferior.
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QUASARTM Penta-Guide Phantom User’s Guide
Laser Alignment Marks
Isocenter cross hairs and bulls-eye rings appear on the left, right, anterior,
superior and inferior faces. These are used to align the phantom with the linac
lasers. The bulls-eye rings are 2 mm, 4 mm, 6 mm, 8 mm and 10 mm diameter.
These features are not demagnified for 100 cm SAD
Orientation
label
Light field
Off-center
cross hairs
Isocenter
cross hairs
Bulls-eye
rings
Level
indicator
Figure 5 - Anterior face surface features
Light Field Alignment Squares
Light field alignment squares are provided on the Anterior and Right faces of the
phantom. The squares are 4 x 4 cm2, 10 x 10 cm2 and 12 x 12 cm2 in the isocenter
plane. The squares are demagnified for a 100 cm SAD since the surfaces of the
phantom are not in the isocenter plane.
Each line on the light field squares has tolerance bars built in at ± 1 mm, and 2
mm.
Level Indicator
There is a level indicator built in to the anterior face of the phantom.
Off-center Cross Hairs
The off-center cross hairs align with a point that is a known displacement from
the center of the phantom. There is no internal feature that corresponds to this
location.
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QUASARTM Penta-Guide Phantom User’s Guide
The location is (-1.0, 1.4, 1.2) in cm.
The off-center cross hairs are not demagnified for 100 cm SAD.
Spread Sheet
The person responsible for QA at each site should determine the best approach to
record keeping for that site.
A simple spread sheet for recording isocenter discrepancies and tracking these
values over time is available by email from Modus. The spread sheet is in
Microsoft Excel format. To receive your copy of the spreadsheet send an email
message to info@[Link]
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QUASARTM Penta-Guide Phantom User’s Guide
Recommended Procedure
The following recommended test procedure can be performed by a therapist every
morning during the warm up cycle.
For each pass/fail criteria in the recommended procedure there is a recommended
level at which the test is passed. This recommended pass level is a typical value
provided for reference only. The person responsible for QA should establish the
level at which the test is passed based on site specific conditions.
Modus recommends that users of the QUASARTM Penta-Guide phantom seek
guidance from published recommendations and peer reviewed journal articles as
well as the manufacturer of the system being tested.
The full procedure and frequency of testing as well as the level at which each test
is passed should be established by the person responsible for QA.
Preparation
The following tests make use of a CT image and digitally reconstructed
radiographs (DRRs) of the phantom. These reference images are the standard
against which the daily A-P, R-Lat and CBCT images are compared. As such it is
essential that high quality reference images of the phantom be acquired and saved
for repeated use. The reference images should be updated periodically to ensure
that there is no change in the isocenter as defined by the CT scanner and therapy
planning system (TPS).
Place the Penta-Guide at the isocenter of your CT Scanner and acquire a CT scan
of the phantom. Export the CT scan to the TPS.
Within the TPS place the isocenter at the center of the phantom (the center of the
central sphere).
Create DRRs for A-P and R-Lat with a field size at least as large as the phantom.
Export the DRRs to the portal imaging system and save them there for daily QA.
Export the CT image to the CBCT imaging system and save it there for daily QA.
Setup
Place the phantom on the linac couch and use the laser alignment marks with the
room lasers to align the phantom with the isocenter.
Check the level indicator to ensure that the phantom is level. If level adjustment
is required - for example if the phantom is resting on an uneven table top - the
phantom can be leveled using paper shims under the corners. To get an accurate
indication be sure to view the level indicator from directly above with uniform
lighting.
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QUASARTM Penta-Guide Phantom User’s Guide
The phantom must be set up accurately. Rotational or translational misalignment
of the phantom with respect to the isocenter will lead to inaccurate results.
Test light field alignment - optional
Set the light field opening to correspond to one of the light field alignment marks
(4 cm x 4 cm, 10 cm x 10 cm or 12 cm x 12 cm - in the isocenter plane) on the
anterior and right faces of the phantom. The light field alignment marks have been
demagnified for 100 cm SAD.
The light field lines have areas of different width. The different widths
correspond to ± 1 mm, and ± 2 mm so it is easy to see if the light field is within
tolerance.
Pass/fail criteria for this test should be set by the person responsible for QA.
Inspect A-P and/or R-Lat projection images
Acquire kV and/or MV projection images of the phantom in either A-P or R-Lat.
Inspect these images to see if the phantom and imaging system(s) are properly
aligned.
In these images of the phantom the projection of each sphere should be in the
center of its corresponding ring as shown in Figures 6 and 7. The sphere and ring
are visible at energies from kV to MV although adjustment of window and level
in the display may be required.
This test is quite sensitive to angular misalignment, less sensitive to magnification
misalignment (this is useful on machines in which the tube distance can be 80 cm
or 100 cm SAD) and not very sensitive to translational misalignment.
Misalignment may be caused by improper setup of the phantom, laser
misalignment or - most importantly - by improper positioning of the source with
respect to the isocenter. This test will tell you if the x-ray tube is in the wrong
position or if the lasers have been knocked out of alignment.
Misalignment of the spheres and rings should be investigated and resolved before
continuing. Typically if the spheres and rings indicate alignment to within 1
degree or 2 mm the test has been passed indicating the phantom has been set up
properly with respect to the imaging system.
The person responsible for QA should establish the pass/fail level for this test.
The following images show angular and translational misalignments. They are
included here to assist with interpreting the projection images in this section.
Rotational misalignment is most evident in the change in appearance of the
spheres and rings as shown in Figures 8 and 9.
Translational misalignment is most evident in the change in appearance of the
outer edge of the phantom and the lack of change in the appearance of the spheres
and rings as shown in Figures 10 and 11
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QUASARTM Penta-Guide Phantom User’s Guide
Figure 6 – 6 MV A-P
Figure 7 – kV R-Lat (100kVp, 50 mA, 20 ms
SAD = 100cm, SDD – 150 cm)
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QUASARTM Penta-Guide Phantom User’s Guide
Figure 8 – 6MV A-P with 1 degree gantry rotation
Figure 9 – 6 MV A-P with 2 degree gantry rotation
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QUASARTM Penta-Guide Phantom User’s Guide
Figure 10 – 6MV A-P with 2 mm longitudinal shift
Figure 11 – 6 MV A-P with 5 mm lateral shift
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QUASARTM Penta-Guide Phantom User’s Guide
Measure position of apparent MV isocenter
Acquire A-P and R-Lat MV projection images of the phantom. Use automatic 2D
image matching to register these images with the appropriate reference DRRs.
The image matching feature will show the x, y, z discrepancie of the MV
isocenter relative to the planning isocenter. Record these values in the
spreadsheet.
These values typically should be less than 2 mm in any one direction. The
pass/fail level for this test should be set by the person responsible for QA.
Measure CBCT isocenter discrepancy
Acquire and reconstruct a CBCT image of the phantom. In this image the spheres
will be clearly visible and easily segmented.
Use the automated tool for registration of the CBCT image with the reference CT
scan of the phantom. To save time during registration use a region of interest that
contains just the five spheres. If further time saving is required it is possible to
use a smaller region of interest containing just the three spheres closest to the
center of the phantom.
The registration tool will determine the x, y, z discrepancy between the CBCT
and TPS isocenter. Record these values in the spreadsheet. Typically this offset
should be less than 2 mm in each direction.
The spreadsheet will automatically calculate the isocenter discrepancy which
should typically be less than 2 mm.
The person responsible for QA should set the pass/fail level for this test at an
appropriate level for the site.
The offsets that are measured may be used as the table offsets for the day. These
daily offsets should be recorded. The person responsible for QA should monitor
these records periodically to see if there is drift or significant shifts in the system.
Test automatic table adjustments - optional
Align the phantom with the off-center cross hairs. Acquire a CBCT image of the
phantom and register it with the reference CT image of the phantom. The
phantom should be off-center by the known amount (-1.0, 1.4, 1.2) cm.
Use the automatic table adjustment feature to reposition the phantom. Acquire
another CBCT image of the phantom and register it with the reference CT image
of the phantom. The phantom should now be at the isocenter within 2 mm.
The person responsible for QA should schedule this test based on site specific
requirements. Weekly or monthly testing may be sufficient.
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QUASARTM Penta-Guide Phantom User’s Guide
Warranty and Support
Modus Medical Devices Inc. Limited Warranty
Modus Medical Devices Inc. warrants to the original purchaser that the products
sold will be free from defects in material and workmanship for a period of one
year from the date of delivery. If the product is found to be defective during the
warranty period, the part(s) and labour required to repair the product will be
provided free of charge. This warranty is subject to the following exceptions and
limitations:
• The customer shall be responsible for proper maintenance and handling of the
product.
• No warranty is extended to any equipment that has been altered or modified in
any way.
• No warranty is extended to any equipment that has been misused, or damaged.
This warranty is in lieu of all other warranties, express or implied, including
warranties of merchantability or fitness for a particular purpose and is the sole and
exclusive remedy for any claim of damages arising from defects in the Modus
product. Modus shall have no liability for consequential damages or personal
injury or for the loss, damage or expense, directly or indirectly arising from the
use of this product. No distributor, dealer or other party is authorized to make any
warranty on behalf of Modus, or to assume for Modus any other liability with
respect to its products.
Customer Support
If you require service or support for this product please contact Modus Medical
Devices Inc. at:
Modus Medical Devices Inc.
781 Richmond Street, Suite 201
London, Ontario
CANADA, N6A 3H4
Phone +1 (519) 438-2409
[Link]
info@[Link]
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