{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T19:58:50Z","timestamp":1791921530049,"version":"4.3.4"},"reference-count":31,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2021,7,30]],"date-time":"2021-07-30T00:00:00Z","timestamp":1627603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To develop a standardized set of representative clinical treatment cases that pose a range of optimization problems for evaluating the plan quality and dosimetric accuracy within the commissioning process for linac\u2010based stereotactic radiosurgery (SRS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Five test cases with increasing complexity were created to validate delivery accuracy in SRS commissioning similar to the approach used by AAPM TG\u2010119 in developing a test suite for IMRT commissioning. Standardized structure sets, planning goals, and delivery requirements were specified for each case including a small sphere target, irregular target, irregular target placed off\u2010axis, multi\u2010target, and abutting organs\u2010at\u2010risk (OARs). Various VMAT field arrangements including a single arc, two coplanar arcs, full arc and vertex half arc, and four noncoplanar arcs were tested to generate clinically appropriate treatment plans.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The small spherical target was 1.0\u00a0cm in diameter. The irregular target was a clinical cavity (2.3\u00a0\u00d7\u00a02.2\u00a0\u00d7\u00a01.4\u00a0cm\u00b3) and was shifted 4.5\u00a0cm for the irregular target off\u2010axis case. The multi\u2010target case used the irregular target and four spherical targets representing metastases ranging 0.9 to 1.6\u00a0cm in diameter, placed up to 7.5\u00a0cm off\u2010axis. The abutting OARs case included an acoustic neuroma and target placed near the optic nerve. All spherical targets received 24\u00a0Gy and the cavity received 18\u00a0Gy. The abutting OAR cases included a 3.74\u00a0cc lesion adjacent to the brainstem receiving 13\u00a0Gy and a 1.11\u00a0cc lesion adjacent to the optic nerve receiving 12\u00a0Gy. All plans used a single\u2010isocenter placed at the target center or geometric center of multiple targets. Planning goals for all cases included constraints for the target and brain minus PTV, along with brainstem and optic nerve where applicable. Deliverability was assessed through ion chamber measurements, in addition to composite and per\u2010field planar measurements on Gafchromic film and small\u2010field diode array. A mean and SD for measured versus planned doses of 101.0%\u00a0\u00b1\u00a02.9% was observed over the 14 ion chamber measurements. Mean and SD for gamma pass rates were 98.5%\u00a0\u00b1\u00a02.2% and 97.1%\u00a0\u00b1\u00a04.9% for film and diode array, respectively, for gamma criteria of 2% and 1\u00a0mm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These cases could provide the preliminary groundwork for a novel benchmark for institutions to evaluate linac\u2010based SRS commissioning and delivery accuracy prior to clinical implementation. The rapid widespread implementation of linac\u2010based SRS, the complexity associated with dosimetry and delivery, and high\u2010profile treatment deviations that have already resulted from its use, highlight the importance of such a benchmark test suite. Comprehensive dosimetric measurements from this standardized set of SRS optimization problems were used to fine\u2010tune and understand the limitations of our SRS planning and delivery system and establish a set of baseline data for comparison with other delivery platforms.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.15087","type":"journal-article","created":{"date-parts":[[2021,7,14]],"date-time":"2021-07-14T08:44:54Z","timestamp":1626252294000},"page":"7568-7579","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Stereotactic radiosurgery commissioning and QA test cases\u2014A TG\u2010119 approach for Stereotactic radiosurgery"],"prefix":"10.1002","volume":"48","author":[{"given":"Rebecca","family":"Culcasi","sequence":"first","affiliation":[{"name":"Karmanos Cancer Institute Detroit MI 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