Photon caliper to achieve submillimeter positioning accuracy.

The purpose of this study was to demonstrate the feasibility of using a commercial two-dimensional (2D) detector array with an inherent detector spacing of 5 mm to achieve submillimeter accuracy in localizing the radiation isocenter. This was accomplished by delivering the Vernier 'dose' caliper to a 2D detector array where the nominal scale was the 2D detector array and the non-nominal Vernier scale was the radiation dose strips produced by the high-definition (HD) multileaf collimators (MLCs) of the linear accelerator. Because the HD MLC sequence was similar to the picket fence test, we called this procedure the Vernier picket fence (VPF) test. We confirmed the accuracy of the VPF test by offsetting the HD MLC bank by known increments and comparing the known offset with the VPF test result. The VPF test was able to determine the known offset within 0.02 mm. We also cross-validated the accuracy of the VPF test in an evaluation of couch hysteresis. This was done by using both the VPF test and the ExacTrac optical tracking system to evaluate the couch position. We showed that the VPF test was in agreement with the ExacTrac optical tracking system within a root-mean-square value of 0.07 mm for both the lateral and longitudinal directions. In conclusion, we demonstrated the VPF test can determine the offset between a 2D detector array and the radiation isocenter with submillimeter accuracy. Until now, no method to locate the radiation isocenter using a 2D detector array has been able to achieve such accuracy.