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Dunn L, Tamborriello A, Subramanian B, Xu X, Ruruku TT. Assessing the sensitivity and suitability of a range of detectors for SIMT PSQA. J Appl Clin Med Phys 2024; 25:e14343. [PMID: 38569013 PMCID: PMC11087180 DOI: 10.1002/acm2.14343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/07/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024] Open
Abstract
PURPOSE Single-isocenter multi-target intracranial stereotactic radiotherapy (SIMT) is an effective treatment for brain metastases with complex treatment plans and delivery optimization necessitating rigorous quality assurance. This work aims to assess five methods for quality assurance of SIMT treatment plans in terms of their suitability and sensitivity to delivery errors. METHODS Sun Nuclear ArcCHECK and SRS MapCHECK, GafChromic EBT Radiochromic Film, machine log files, and Varian Portal Dosimetry were all used to measure 15 variations of a single SIMT plan. Variations of the original plan were created with Python. They comprised various degrees of systematic MLC offsets per leaf up to 2 mm, random per-leaf variations with differing minimum and maximum magnitudes, simulated collimator, and dose miscalibrations (MU scaling). The erroneous plans were re-imported into Eclipse and plan-quality degradation was assessed by comparing each plan variation to the original clinical plan in terms of the percentage of clinical goals passing relative to the original plan. Each erroneous plan could be then ranked by the plan-quality degradation percentage following recalculation in the TPS so that the effects of each variation could be correlated with γ pass rates and detector suitability. RESULTS & CONCLUSIONS It was found that 2%/1 mm is a good starting point for the ArcCHECK, Portal Dosimetry, and the SRS MapCHECK methods, respectively, and provides clinically relevant error detection sensitivity. Looser dose criteria of 5%/1 mm or 5%/1.5 mm are suitable for film dosimetry and log-file-based methods. The statistical methods explored can be expanded to other areas of patient-specific QA and detector assessment.
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Affiliation(s)
- Leon Dunn
- GenesisCare BerwickSt John of God Berwick Specialist CentreBerwickVictoriaAustralia
| | | | | | - Xiaolei Xu
- GenesisCare RingwoodRingwood Private HospitalRingwood EastVictoriaAustralia
| | - Tyrone Te Ruruku
- GenesisCare BerwickSt John of God Berwick Specialist CentreBerwickVictoriaAustralia
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Xiao Q, Li G. Application and Challenges of Statistical Process Control in Radiation Therapy Quality Assurance. Int J Radiat Oncol Biol Phys 2024; 118:295-305. [PMID: 37604239 DOI: 10.1016/j.ijrobp.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/21/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
Quality assurance (QA) is important for ensuring precision in radiation therapy. The complexity and resource-intensive nature of QA has increased with the continual evolution of equipment and techniques. An effective approach is to improve the process control technology and resource optimization. Statistical process control is an economical and efficient tool that has been widely used to monitor, control, and improve quality management processes and is now being increasingly used for radiation therapy QA. This article reviews the development and methodology of statistical process control technology, evaluates its suitability in radiation therapy QA practices, and assesses its importance and challenges in optimizing radiation therapy QA processes.
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Affiliation(s)
- Qing Xiao
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Radiotherapy Physics & Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guangjun Li
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Radiotherapy Physics & Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Lin J, Chen M, Lai Y, Trivedi Z, Wu J, Foo T, Gonzalez Y, Reynolds R, Park C, Yan Y, Godley A, Jiang S, Jia X, Lin MH, Pompos A, Lu W. ART2Dose: A comprehensive dose verification platform for online adaptive radiotherapy. Med Phys 2024; 51:18-30. [PMID: 37856190 DOI: 10.1002/mp.16806] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/09/2023] [Accepted: 10/07/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Online adaptive radiotherapy (ART) involves the development of adaptable treatment plans that consider patient anatomical data obtained right prior to treatment administration, facilitated by cone-beam computed tomography guided adaptive radiotherapy (CTgART) and magnetic resonance image-guided adaptive radiotherapy (MRgART). To ensure accuracy of these adaptive plans, it is crucial to conduct calculation-based checks and independent verification of volumetric dose distribution, as measurement-based checks are not practical within online workflows. However, the absence of comprehensive, efficient, and highly integrated commercial software for secondary dose verification can impede the time-sensitive nature of online ART procedures. PURPOSE The main aim of this study is to introduce an efficient online quality assurance (QA) platform for online ART, and subsequently evaluate it on Ethos and Unity treatment delivery systems in our clinic. METHODS To enhance efficiency and ensure compliance with safety standards in online ART, ART2Dose, a secondary dose verification software, has been developed and integrated into our online QA workflow. This implementation spans all online ART treatments at our institution. The ART2Dose infrastructure comprises four key components: an SQLite database, a dose calculation server, a report generator, and a web portal. Through this infrastructure, file transfer, dose calculation, report generation, and report approval/archival are seamlessly managed, minimizing the need for user input when exporting RT DICOM files and approving the generated QA report. ART2Dose was compared with Mobius3D in pre-clinical evaluations on secondary dose verification for 40 adaptive plans. Additionally, a retrospective investigation was conducted utilizing 1302 CTgART fractions from ten treatment sites and 1278 MRgART fractions from seven treatment sites to evaluate the practical accuracy and efficiency of ART2Dose in routine clinical use. RESULTS With dedicated infrastructure and an integrated workflow, ART2Dose achieved gamma passing rates that were comparable to or higher than those of Mobius3D. Additionally, it significantly reduced the time required to complete pre-treatment checks by 3-4 min for each plan. In the retrospective analysis of clinical CTgART and MRgART fractions, ART2Dose demonstrated average gamma passing rates of 99.61 ± 0.83% and 97.75 ± 2.54%, respectively, using the 3%/2 mm criteria for region greater than 10% of prescription dose. The average calculation times for CTgART and MRgART were approximately 1 and 2 min, respectively. CONCLUSION Overall, the streamlined implementation of ART2Dose notably enhances the online ART workflow, offering reliable and efficient online QA while reducing time pressure in the clinic and minimizing labor-intensive work.
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Affiliation(s)
- Jingying Lin
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mingli Chen
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Youfang Lai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Zipalkumar Trivedi
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Junjie Wu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tim Foo
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yesenia Gonzalez
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert Reynolds
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Chunjoo Park
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yulong Yan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Andrew Godley
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Steve Jiang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Xun Jia
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mu-Han Lin
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Arnold Pompos
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Weiguo Lu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Byrne M, Archibald-Heeren B, Hu Y, Greer P, Luo S, Aland T. Assessment of semi-automated stereotactic treatment planning for online adaptive radiotherapy in ethos. Med Dosim 2022; 47:342-347. [PMID: 36127189 DOI: 10.1016/j.meddos.2022.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/04/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The Ethos treatment planning system allows for the rapid generation of online adaptive treatment plans while the patient is on the treatment couch. One promising application of online adaptive radiotherapy is its use in stereotactic radiotherapy. The purpose of this study was to ensure the Ethos treatment planning system (TPS) can produce clinically acceptable stereotactic plans, that are non-inferior to those from the Eclipse TPS. METHOD Forty patients that received previous stereotactic radiotherapy treatment on a Halcyon, 20 of which were lung cases, and 20 that were brain cases, were replanned using the Ethos TPS. The generated IMRT and VMAT plans were compared to the clinical Eclipse VMAT plan. RESULTS This study found that the Ethos TPS can produce VMAT plans of equivalent quality (target coverage, conformity and OAR doses) to those from the Eclipse TPS for lung SBRT and brain SRT. The IMRT plans produced by the Ethos planning system were marginally inferior to Eclipse VMAT plans, with the differences likely primarily due to beam geometry rather than the optimization system. Ethos plans were generally more modulated than Eclipse plans. With careful selection of optimization structures and reduction in the body contour, VMAT plan generation time could be reduced by 87%. CONCLUSION Ethos can generate stereotactic VMAT plans that are equivalent to those from Eclipse in the timeframe required for online adaptive radiotherapy.
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Affiliation(s)
- Mikel Byrne
- Strategic Investment & Clinical Care, Icon Group, South Brisbane, QLD, Australia; University of Newcastle, Newcastle, NSW, Australia.
| | - Ben Archibald-Heeren
- Strategic Investment & Clinical Care, Icon Group, South Brisbane, QLD, Australia
| | - Yunfei Hu
- Strategic Investment & Clinical Care, Icon Group, South Brisbane, QLD, Australia
| | - Peter Greer
- University of Newcastle, Newcastle, NSW, Australia; Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia
| | - Suhuai Luo
- University of Newcastle, Newcastle, NSW, Australia
| | - Trent Aland
- Strategic Investment & Clinical Care, Icon Group, South Brisbane, QLD, Australia
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Song L, Li Q, Shi H, Zhang P. Treatment of Cancer Gene Changes in Chronic Myeloid Leukemia by Big Data Analysis Platform-Based Dasatinib. Appl Bionics Biomech 2022; 2022:9294634. [PMID: 35721237 PMCID: PMC9205743 DOI: 10.1155/2022/9294634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/17/2022] [Accepted: 05/03/2022] [Indexed: 01/09/2023] Open
Abstract
Based on data mining, an innovative big data analysis platform was utilized to discuss the treatment of cancer in chronic myeloid leukemia (CML) by dasatinib, aiming to offer help to the diagnosis and treatment of cancer. An integrated gene expression analysis system (IEAS) was firstly constructed to automatically classify data in the online human Mendelian genetic database using clustering algorithms. At the same time, the gene expression profile was analyzed by principal component analysis (PCA) in the analysis system. In addition, the efficacy of dasatinib in the treatment of patients with advanced CML was then retrospectively analyzed. The results showed that the IEAS system could incorporate the gene expression analysis vectors it contained by JAVA-related technologies, and the generated clustering genes showed similar functions. The clustering algorithm could homogenize data and generate visual clustering heat maps. The analysis results of major elements were diverse under different experimental conditions. The characteristic value of the first major element was the largest. Messenger ribonucleic acid (mRNA) datasets of CML patients were selected from cancer genomic map, including 120 samples and 20,614 mRNA in total. In micro-RNA (miRNA) datasets, there were 202 samples including 1,406 miRNAs. Data were screened by miRNA-mRNA regulation template, and 20 differentially expressed mRNAs were obtained. In conclusion, the proposed IEAS system could mine and analyze the gene expression data. Dasatinib showed good efficacy in the treatment of patients with advanced CML. Besides, it could improve visual queries, and data mining had a broad application prospect in clinical application. Dasatinib was considered to be a good option for patients with advanced CML.
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Affiliation(s)
- Linlin Song
- School of Basic Medicine, Jiamusi University, Jiamusi, 154007 Heilongjiang, China
| | - Qi Li
- Department of Biochemistry, Mudanjiang Medical School, Mudanjiang, 157011 Heilongjiang, China
| | - Hui Shi
- Department of Pharmacy, First Affiliated Hospital of Jiamusi University, Jiamusi, 154007 Heilongjiang, China
| | - Pengxia Zhang
- School of Basic Medicine, Jiamusi University, Jiamusi, 154007 Heilongjiang, China
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Hasse K, Scholey J, Ziemer BP, Natsuaki Y, Morin O, Solberg TD, Hirata E, Valdes G, Witztum A. Use of Receiver Operating Curve Analysis and Machine Learning With an Independent Dose Calculation System Reduces the Number of Physical Dose Measurements Required for Patient-Specific Quality Assurance. Int J Radiat Oncol Biol Phys 2021; 109:1086-1095. [PMID: 33197530 DOI: 10.1016/j.ijrobp.2020.10.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE Our purpose was to assess the use of machine learning methods and Mobius 3D (M3D) dose calculation software to reduce the number of physical ion chamber (IC) dose measurements required for patient-specific quality assurance during corona virus disease 2019. METHODS AND MATERIALS In this study, 1464 inversely planned treatments using Pinnacle or Raystation treatment planning software (TPS) were delivered using Elekta Versa HD and Varian Truebeam and Truebeam STx linear accelerators between June 2018 and November 2019. For each plan, an independent dose calculation was performed using M3D, and an absolute dose measurement was taken using a Pinpoint IC inside the Mobius phantom. The point dose differences between the TPS and M3D calculation and between TPS and IC measurements were calculated. Agreement between the TPS and IC was used to define the ground truth plan failure. To reduce the on-site personnel during the pandemic, 2 methods of receiver operating characteristic analysis (n = 1464) and machine learning (n = 603) were used to identify patient plans that would require physical dose measurements. RESULTS In the receiver operating characteristic analysis, a predelivery M3D difference threshold of 3% identified plans that failed an IC measurement at a 4% threshold with 100% sensitivity and 76.3% specificity. This indicates that fewer than 25% of plans required a physical dose measurement. A threshold of 1% on a machine learning model was able to identify plans that failed an IC measurement at a 3% threshold with 100% sensitivity and 54.3% specificity, leading to fewer than 50% of plans that required a physical dose measurement. CONCLUSIONS It is possible to identify plans that are more likely to fail IC patient-specific quality assurance measurements before delivery. This possibly allows for a reduction of physical measurements taken, freeing up significant clinical resources and reducing the required amount of on-site personnel while maintaining patient safety.
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Affiliation(s)
- K Hasse
- Department of Radiation Oncology, University of California, San Francisco, California.
| | - J Scholey
- Department of Radiation Oncology, University of California, San Francisco, California
| | - B P Ziemer
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Y Natsuaki
- Department of Radiation Oncology, University of California, San Francisco, California
| | - O Morin
- Department of Radiation Oncology, University of California, San Francisco, California
| | | | - E Hirata
- Department of Radiation Oncology, University of California, San Francisco, California
| | - G Valdes
- Department of Radiation Oncology, University of California, San Francisco, California
| | - A Witztum
- Department of Radiation Oncology, University of California, San Francisco, California
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