Assessment of Spatial Uncertainties in the Radiotherapy Process With the Novalis System

Purpose: The purpose of this study was to evaluate the accuracy of a new version of the ExacTrac X-ray (ETX) system with statistical analysis retrospectively in order to determine the tolerance of systematic components of spatial uncertainties with the Novalis system. Methods and Materials: Three factors of geometrical accuracy related to the ETX system were evaluated by phantom studies. First, location dependency of the detection ability of the infrared system was evaluated. Second, accuracy of the automated calculation by the image fusion algorithm in the patient registration software was evaluated. Third, deviation of the coordinate scale between the ETX isocenter and the mechanical isocenter was evaluated. From the values of these examinations and clinical experiences, the total spatial uncertainty with the Novalis system was evaluated. Results: As to the location dependency of the detection ability of the infrared system, the detection errors between the actual position and the detected position were 1% in translation shift and 0.1° in rotational angle, respectively. As to the accuracy of patient verification software, the repeatability and the coincidence of the calculation value by image fusion were good when the contrast of the X-ray image was high. The deviation of coordinates between the ETX isocenter and the mechanical isocenter was 0.313 ± 0.024 mm, in a suitable procedure. Conclusions: The spatial uncertainty will be less than 2 mm when suitable treatment planning, optimal patient setup, and daily quality assurance for the Novalis system are achieved in the routine workload.