Comprehensive characterization of ExacTrac stereoscopic image guidance system using Monte Carlo and Spektr simulations

The purpose of this work is to develop accurate computational methods to comprehensively characterize and model the clinical ExacTrac imaging system, which is used as an image guidance system for stereotactic treatment applications. The Spektr toolkit was utilized to simulate the spectral and imaging characterization of the system. Since Spektr only simulates the primary beam (ignoring scatter), a full model of ExacTrac was also developed in Monte Carlo (MC) to characterize the imaging system. To ensure proper performance of both simulation models, Spektr and MC data were compared to the measured spectral and half value layers (HVLs) values. To validate the simulation results, x-ray spectra of the ExacTrac system were measured for various tube potentials using a CdTe spectrometer with multiple added narrow collimators. The raw spectra were calibrated using a ⁵⁷Co source and corrected for the escape peaks and detector efficiency. HVLs in mm of Al for various energies were measured using a calibrated RaySafe detector. Spektr and MC HVLs were calculated and compared to the measured values. The patient surface dose was calculated for different clinical imaging protocols from the measured air kerma and HVL values following the TG-61 methodology. The x-ray focal spot was measured by slanted edge technique using gafchromic films. ExacTrac imaging system beam profiles were simulated for various energies by MC simulation and the results were benchmarked by experimentally acquired beam profiles using gafchromic films. The effect of 6D IGRT treatment couch on beam hardening, dynamic range of the flat panel detector and scatter effect were determined using both Spektr simulation and experimental measurements. The measured and simulated spectra (of both MC and Spektr) for various kVps were compared and agreed within acceptable error. As another validation, the measured HVLs agreed with the Spektr and MC simulated HVLs on average within 1.0% for all kVps. The maximum and minimum patient surface doses were found to be 1.06 mGy for shoulder (high) and 0.051 mGy for cranial (low) imaging protocols, respectively. The MC simulated beam profiles were well matched with experimental results and replicated the penumbral slopes, the heel effect, and out-of-field regions. Dynamic range of detector (in terms of air kerma at detector surface) was found to be in the range of [6.1 × 10^-6, 5.3 × 10^-3] mGy. Accurate MC and Spektr models of the ExacTrac image guidance system were successfully developed and benchmarked via experimental validation. While patient surface dose for available imaging protocols were reported in this study, the established MC model may be used to obtain 3D imaging dose distribution for real patient geometries.