Evaluation of dosimetric and spatial accuracy of a virtual cone technique for radiosurgery using linac-integrated CBCT-based polymer gel dosimetry.

PURPOSE: This study evaluates the dosimetric and geometric precision of a virtual cone technique using CBCT-based polymer gel dosimetry, enabling radiation delivery, and imaging readout within an identical spatial coordinate system. METHODS: We created a C# script for a virtual cone technique that generates a treatment plan with 10 gantry arcs at 0°, 36°, 72°, 288°, and 324° couch angles, with 2 arcs per couch angle using 45° and 135° collimator angles. Two verification plans using Eclipse v15.6 (AcurosXB) were created with 20 Gy at the maximum dose for: (1) a cylindrical gel, with an additional calibration region; (2) a 3D printed anthropomorphic skull phantom with a gel insert. The 50% isodose (10 Gy) width through the central axis of the axial and sagittal planes (SPs) were measured for the gel experiment. The distance between the centers-of-masses of the 10 Gy isodose region of the plan and the gel (skull phantom) were calculated for an end-to-end spatial accuracy test. RESULTS: The maximum point dose measured with gel was within 1% of the plan, though the gel measured 50% isodose widths of 5.56  ±  0.02 mm, 5.65  ± 0.04 mm, 4.23  ± 0.01 mm for axial (anterior-posterior), axial (left-right), sagittal (superior-inferior) respectively, which were slightly narrower than Eclipse (1.29 mm maximum difference in the SP due to CBCT slice thickness). The center-of-mass distance was 0.66 mm for the gel experiment, and 0.94 mm for complete end-to-end testing with the anthropomorphic phantom, including CBCT setup (kV-MV isocenter uncertainty). CONCLUSION: The 50% isodose width of the gel measurement was 5.15 mm (mean), which was tighter than our Eclipse v15.6 beam model. The end-to-end spatial accuracy test, only achievable with gel dosimetry using CBCT readout, resulted in sub-millimeter accuracy. This study demonstrates the value of gel dosimetry in verifying the dosimetric and spatial accuracy of this high precision, stereotactic technique.