Author: Hulya Ozdemir Buss, Jeffrey Geiger, Kim Howard, Julius G. Ojwang, Neelu Soni 👨🔬
Affiliation: Mercy Hospital Springfield 🌍
Purpose: The Radixact Synchrony system integrates real-time motion tracking and compensates to improve treatment accuracy for moving targets. This study presents a streamlined and efficient quality assurance (QA) program aligned with AAPM Task Group 306 (TG-306) guidelines, providing a practical framework for clinics to implement high-quality motion management protocols using widely available QA tools.
Methods: A comprehensive QA program was developed for the Radixact Synchrony system in accordance with TG-306 guidelines and the Accuray Physics Essentials Guide. Acceptance testing was performed using vendor-recommended equipment to verify beam output consistency, mechanical integrity of the dynamic jaws and multileaf collimator (MLC), and alignment between kilovoltage (kV) imaging and megavoltage (MV) treatment beams. A streamlined daily QA workflow was established for Radiation Therapy Technologists (RTTs) using the MapCHECK 2D detector array and CIRS 1D motion platform to assess dosimetric accuracy and motion tracking. Tests included fiducial and non-fiducial target tracking with and without respiratory motion, kV-MV isocenter alignment, imaging quality, and dose output verification. Automated QA procedures evaluated root mean square (RMS) error and tracking accuracy, ensuring system performance within TG-306 thresholds (RMS error < 1 mm). Monthly QA incorporated the ArcCHECK phantom and CIRS 3D motion platform for comprehensive evaluation of one-dimensional (1D) and three-dimensional (3D) motion compensation, ensuring long-term system stability.
Results: The QA program fully met TG-306 requirements, confirming system stability, precise motion tracking, and consistent dose delivery. Routine QA results consistently demonstrated RMS errors below 1 mm, supporting accurate motion compensation and effective clinical integration.
Conclusion: This scalable QA program offers an effective framework for clinics to implement the Radixact Synchrony system using accessible tools like MapCHECK and ArcCHECK, in alignment with TG-306 guidelines. Future work will expand patient-specific QA and treatment outcome analysis to further optimize motion management and improve clinical care.