Implementation and preliminary evaluation of a practical digital workflow for routine laser-radiation field coincidence quality assurance on the CyberKnife M6.
- 1National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Shenzhen China.
- 2School of Computer Science and Artificial Intelligence Wuhan University of Technology Wuhan China.
Abstract
Purpose
To implement and preliminarily evaluate a practical digital acquisition-and-analysis workflow for routine laser-radiation field coincidence quality assurance (QA) on the CyberKnife M6 by integrating multileaf collimator (MLC) QA tool-based laser reference definition, QA StereoChecker (QASC)-based external digital image acquisition, and automated analysis with CKQA, an in-house CyberKnife QA software, and to compare this workflow with clinically realistic film-based alternatives.Methods
Methods a and b were film-based measurements performed at the perch position. Method a used manual laser marking on film, whereas method b used the central metal marker of the MLC QA tool to define the laser reference. Method c used QASC as an external digital image-acquisition platform in combination with the MLC QA tool, and method d used film on the same QASC-based setup as a control. All methods were tested with 10 fixed collimators (5-40 mm). Images were analyzed using ImageJ and CKQA. Mean deviation, standard deviation, root mean square error (RMSE), and pairwise two-sided exact Wilcoxon signed-rank tests were used for exploratory comparisons.Results
All evaluated workflows achieved submillimeter mean deviations. Across both analysis approaches, the mean deviation ranked consistently in descending order: method a > method b > method d > method c. Under the present experimental conditions, method c yielded the lowest mean deviation and RMSE (0.116 mm and 0.155 mm with CKQA), whereas method a showed the largest deviations. Dataset-level exact Wilcoxon signed-rank tests showed that several comparisons involving method a were statistically significant, but statistically significant differences were not uniform across both ImageJ- and CKQA-based comparisons. For comparisons between analysis methods within each workflow, CKQA and ImageJ were not significantly different for methods a and b, whereas CKQA yielded significantly lower deviations than ImageJ for methods c and d (p < 0.05).Conclusions
Laser-radiation field coincidence testing is an established CyberKnife QA procedure. The present study implemented and preliminarily evaluated a practical digital acquisition-and-analysis workflow for this routine task. The workflow combining MLC QA tool-based laser reference definition, QASC-based external digital image acquisition, and automated CKQA analysis provided a standardized and less operator-dependent procedure under the present experimental conditions. Its main value lies in reducing manual marking, film handling, scanning, and subjective image-analysis steps rather than in introducing a new physical measurement principle. In centers where QASC is not available, the film-based workflow using the MLC QA tool (method b) may serve as a practical alternative.
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BibTeX
@article{hu2026implementation,
title = {{Implementation and preliminary evaluation of a practical digital workflow for routine laser-radiation field coincidence quality assurance on the CyberKnife M6.}},
author = {Linzheng Hu and Yongkang Zhao and Chunling Zheng and Jiajun Cai and Yajun Jia and Yi Tao and Yikun Liu and Yin Zhang and Zhitao Dai},
journal = {Precision radiation oncology},
year = {2026},
month = oct,
doi = {10.1002/pro6.70103},
url = {https://europepmc.org/article/MED/42927071},
note = {CC BY},
}
RIS
TY - JOUR
TI - Implementation and preliminary evaluation of a practical digital workflow for routine laser-radiation field coincidence quality assurance on the CyberKnife M6.
AU - Linzheng Hu
AU - Yongkang Zhao
AU - Chunling Zheng
AU - Jiajun Cai
AU - Yajun Jia
AU - Yi Tao
AU - Yikun Liu
AU - Yin Zhang
AU - Zhitao Dai
PY - 2026
DA - 2026/10/24
JO - Precision radiation oncology
DO - 10.1002/pro6.70103
UR - https://europepmc.org/article/MED/42927071
AB - Purpose To implement and preliminarily evaluate a practical digital acquisition-and-analysis workflow for routine laser-radiation field coincidence quality assurance (QA) on the CyberKnife M6 by integrating multileaf collimator (MLC) QA tool-based laser reference definition, QA StereoChecker (QASC)-based external digital image acquisition, and automated analysis with CKQA, an in-house CyberKnife QA software, and to compare this workflow with clinically realistic film-based alternatives.Methods Methods a and b were film-based measurements performed at the perch position. Method a used manual laser marking on film, whereas method b used the central metal marker of the MLC QA tool to define the laser reference. Method c used QASC as an external digital image-acquisition platform in combination with the MLC QA tool, and method d used film on the same QASC-based setup as a control. All methods were tested with 10 fixed collimators (5-40 mm). Images were analyzed using ImageJ and CKQA. Mean deviation, standard deviation, root mean square error (RMSE), and pairwise two-sided exact Wilcoxon signed-rank tests were used for exploratory comparisons.Results All evaluated workflows achieved submillimeter mean deviations. Across both analysis approaches, the mean deviation ranked consistently in descending order: method a > method b > method d > method c. Under the present experimental conditions, method c yielded the lowest mean deviation and RMSE (0.116 mm and 0.155 mm with CKQA), whereas method a showed the largest deviations. Dataset-level exact Wilcoxon signed-rank tests showed that several comparisons involving method a were statistically significant, but statistically significant differences were not uniform across both ImageJ- and CKQA-based comparisons. For comparisons between analysis methods within each workflow, CKQA and ImageJ were not significantly different for methods a and b, whereas CKQA yielded significantly lower deviations than ImageJ for methods c and d (p < 0.05).Conclusions Laser-radiation field coincidence testing is an established CyberKnife QA procedure. The present study implemented and preliminarily evaluated a practical digital acquisition-and-analysis workflow for this routine task. The workflow combining MLC QA tool-based laser reference definition, QASC-based external digital image acquisition, and automated CKQA analysis provided a standardized and less operator-dependent procedure under the present experimental conditions. Its main value lies in reducing manual marking, film handling, scanning, and subjective image-analysis steps rather than in introducing a new physical measurement principle. In centers where QASC is not available, the film-based workflow using the MLC QA tool (method b) may serve as a practical alternative.
SN - 2398-7324
ER -