Evaluation of dynamic accuracy and latency of a surface-guided radiotherapy system

The aim of this study is to evaluate the dynamic accuracy and latency of the surface-guided radiotherapy (SGRT) system using TrueBeam and AlignRT in compliance with SGRT guidelines. Beam characteristics-flatness, symmetry, beam quality, and output-were compared between gated and nongated beams using a two-dimensional ionization chamber array and a Farmer-type chamber. Dynamic accuracy was assessed using a moving platform and breast phantom, with measurements taken for various shift values (5, 10, 30 mm), region-of-interest (ROI) shapes, reference-surface image types (DICOM and capture), surface resolutions, and room illuminations. Latency due to differences in frame rates was evaluated using radiochromic film, calculated from position displacements of profiles at two speeds. Differences in beam characteristics between gated and nongated beams were within 0.1%. Dynamic accuracy showed minimal dependence on settings, with deviations of < 1 mm for a 10-mm shift. A maximum displacement of 1.9 mm was observed with a 30-mm shift at the body ROI. Beam-on latency at 12, 16, 25, and 35 frames per second was 253.2 +/- 21.9, 225.7 +/- 33.7, 177.1 +/- 43.0, and 112.4 +/- 29.2 ms, respectively, with similar trends for beam-off latency. This study is the first to evaluate the dynamic accuracy of the TrueBeam and AlignRT system under SGRT-specific settings. While accuracy was generally maintained (< 1 mm), ROI shape significantly impacted results. Latency results indicate that certain frame rates may not meet guideline limits, underscoring the need for careful SGRT system use in clinical applications.