An affordable custom phantom for measurement of linac time delay in gated treatments with irregular breathing

Respiratory gated treatments are now common in order to reduce tumour motion uncertainties due to breathing. One issue associated with gated treatments is the time delay between the gating system and the linear accelerator. In this study we develop and characterise an affordable phantom to be used in routine and patient specific quality assurance (QA) of the Varian Real-Time Position Management (TM) (RPM) system. A photodiode has been incorporated into the phantom in order to estimate the time delay. A commercial Quasar phantom was customised to incorporate two stepper motors which independently control an anterior-posterior abdomen/thorax moving plate, and an inferior-superior moving lung insert. A photodiode placed in the path of the radiation is used to measure when beam on/off occurs. Two Arduino microcontroller boards have been utilised to control the motors, read the photodiode and write to an SD card. The measured beam on/off, correlated to the known positions of the phantom is compared to the gate window for RPM. The time delay was measured for sinusoidal movements with a period of 7.50 s and 3.75 s, and for three patient breathing traces. For the sinusoidal movements, time delays of 150 +/- 34 ms and 39 +/- 34 ms were measured, for 7.50 s and 3.75 s periods, respectively. In the case of the patients' breathing traces time delays of 135 +/- 26 ms, 137 +/- 34 ms and 129 +/- 28 ms were measured. An affordable motion phantom has been developed for routine and patient specific QA of respiratory gating systems. It is capable of reproducing a patient's breathing waveform and performing time delay measurements with a photodiode. Results indicate a time delay of the order of 0.1-0.2 s for the RPM system.