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Diamantopoulos S, Platoni K, Karaiskos P, Kouloulias V, Efstathopoulos E. Isodose surface differences: A novel tool for the comparison of dose distributions. J Appl Clin Med Phys 2023; 24:e14085. [PMID: 37794700 PMCID: PMC10647989 DOI: 10.1002/acm2.14085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/03/2023] [Accepted: 06/05/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Comparing dose distributions is a routine task in radiotherapy, mainly in patient-specific quality assurance (PSQA). Currently, the evaluation of the dose distributions is being performed mainly with statistical methods, which could underestimate the clinical importance of the spotted differences, as per the literature. PURPOSE This paper aims to provide proof-of-concept for a novel dose distribution comparison method based on the difference of the isodose surfaces. The new method connects acceptance tolerance to QA limitations (equipment capabilities) and integrates a clinical approach into the analysis procedure. METHODS The distance of dose points from the isocenter can be used as a function to define the shape of an isodose surface expressed as a histogram. Isodose surface differences (ISD) are defined as the normalized differences of reference and evaluated surface histograms plotted against their corresponding isodose. Acceptance tolerances originate from actual QA tolerances and are presented clinically intuitively. The ISD method was compared to the gamma index using intentionally erroneous VMAT and IMRT plans. RESULTS Results revealed that the ISD method is sensitive to all errors induced in the plans. Discrepancies are presented per isodose, enabling the evaluation of the plan in two regions representing PTV and Normal Tissue. ISD manages to flag errors that would remain undetected under the gamma analysis. CONCLUSION The ISD method is a meaningful, QA-related, registration-free, and clinically oriented technique of dose distribution evaluation. This method can be used either as a standalone or an auxiliary tool to the well-established evaluation procedures, overcoming significant limitations reported in the literature.
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Affiliation(s)
- Stefanos Diamantopoulos
- 2nd Department of RadiologyUniversity General Hospital “Attikon”1 Rimini StreetNational and Kapodistrian University of AthensChaidariGreece
- Joint Department of PhysicsThe Royal Marsden NHS Foundation TrustLondonUK
| | - Kalliopi Platoni
- 2nd Department of RadiologyUniversity General Hospital “Attikon”1 Rimini StreetNational and Kapodistrian University of AthensChaidariGreece
| | - Pantelis Karaiskos
- Medical Physics LaboratoryMedical SchoolNational and Kapodistrian University of AthensAthensGreece
| | - Vassilis Kouloulias
- 2nd Department of RadiologyUniversity General Hospital “Attikon”1 Rimini StreetNational and Kapodistrian University of AthensChaidariGreece
| | - Efstathios Efstathopoulos
- 2nd Department of RadiologyUniversity General Hospital “Attikon”1 Rimini StreetNational and Kapodistrian University of AthensChaidariGreece
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Malatesta T, Scaggion A, Giglioli FR, Belmonte G, Casale M, Colleoni P, Falco MD, Giuliano A, Linsalata S, Marino C, Moretti E, Richetto V, Sardo A, Russo S, Mancosu P. Patient specific quality assurance in SBRT: a systematic review of measurement-based methods. Phys Med Biol 2023; 68:21TR01. [PMID: 37625437 DOI: 10.1088/1361-6560/acf43a] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/25/2023] [Indexed: 08/27/2023]
Abstract
This topical review focuses on Patient-Specific Quality Assurance (PSQA) approaches to stereotactic body radiation therapy (SBRT). SBRT requires stricter accuracy than standard radiation therapy due to the high dose per fraction and the limited number of fractions. The review considered various PSQA methods reported in 36 articles between 01/2010 and 07/2022 for SBRT treatment. In particular comparison among devices and devices designed for SBRT, sensitivity and resolution, verification methodology, gamma analysis were specifically considered. The review identified a list of essential data needed to reproduce the results in other clinics, highlighted the partial miss of data reported in scientific papers, and formulated recommendations for successful implementation of a PSQA protocol.
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Affiliation(s)
- Tiziana Malatesta
- Medical Physics Unit, Department of Radiotherapy and Medical Oncology and Radiology, Fatebenefratelli Isola Tiberina-Gemelli Isola Hospital, Rome, Italy
| | - Alessandro Scaggion
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | | | - Gina Belmonte
- Medical Physics Department, San Luca Hospital, Lucca, Italy
| | - Michelina Casale
- Medical Physics Unit, Azienda Ospedaliera 'Santa Maria', Terni, Italy
| | - Paolo Colleoni
- UOC Medical Physics Unit-ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Daniela Falco
- Department of Radiation Oncology, 'SS. Annunziata' Hospital, 'G. D'Annunzio' University, Chieti, Italy
| | - Alessia Giuliano
- Medical Physics Unit, Pisa University Hospital 'Azienda Ospedaliero-Universitaria Pisana', Pisa, Italy
| | - Stefania Linsalata
- Medical Physics Unit, Pisa University Hospital 'Azienda Ospedaliero-Universitaria Pisana', Pisa, Italy
| | - Carmelo Marino
- Medical Physics and Radioprotection Unit, Humanitas Istituto Clinico Catanese, Misterbianco (CT), Italy
| | - Eugenia Moretti
- Division of Medical Physics, Department of Oncology, ASUFC Udine, Italy
| | - Veronica Richetto
- Medical Physics Unit, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Anna Sardo
- UOSD Medical Physics, ASLCN2, Verduno, Italy
| | - Serenella Russo
- Medical Physics Unit, Azienda USL Toscana Centro, Florence, Italy
| | - Pietro Mancosu
- Medical Physics Unit of Radiotherapy Department, IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
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Baltz GC, Manigold R, Seier R, Kirsner SM. A hybrid method to improve efficiency of patient specific SRS and SBRT QA using 3D secondary dose verification. J Appl Clin Med Phys 2023; 24:e13858. [PMID: 36583305 PMCID: PMC10018667 DOI: 10.1002/acm2.13858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/25/2022] [Accepted: 11/20/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Patient Specific QA (PSQA) by direct phantom measurement for all intensity modulated radiation therapy (IMRT) cases is labor intensive and an inefficient use of the Medical Physicist's time. The purpose of this work was to develop a hybrid quality assurance (QA) technique utilizing 3D dose verification as a screening tool to determine if a measurement is necessary. METHODS This study utilized Sun Nuclear DoseCHECK (DC), a 3D secondary verification software, and Fraction 0, a trajectory log IMRT QA software. Twenty-two Lung stereotactic body radiation therapy (SBRT) and thirty single isocentre multi-lesion SRS (MLSRS) plans were retrospectively analysed in DC. Agreement of DC and the TPS dose for selected dosimetric criteria was recorded. Calculated 95% confidence limits (CL) were used to establish action limits. All cases were delivered and measured using the Sun Nuclear stereotactic radiosurgery (SRS) MapCheck. Trajectory logs of the delivery were used to calculate Fraction 0 results for the same criteria calculated by DC. Correlation of DC and Fraction 0 results were calculated. Phantom measured QA was compared to Fraction 0 QA results for the cases which had DC criteria action limits exceeded. RESULTS Correlation of DC and Fraction 0 results were excellent, demonstrating the same action limits could be used for both and DC can predict Fraction 0 results. Based on the calculated action limits, zero lung SBRT cases and six MLSRS cases were identified as requiring a measurement. All plans that passed the DC screening had a passing measurement based PSQA and agreed with Fraction 0 results. CONCLUSION Using 95% CL action limits of dosimetric criteria, a 3D secondary dose verification can be used to determine if a measurement is required for PSQA. This method is efficient for it is part of the normal clinical workflow when verifying any clinical treatment. In addition, it can drastically reduce the number of measurements needed for PSQA.
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Affiliation(s)
- Garrett C Baltz
- Scripps MD Anderson Cancer Center, San Diego, California, USA
| | - Remy Manigold
- Scripps MD Anderson Cancer Center, San Diego, California, USA
| | - Richard Seier
- Scripps MD Anderson Cancer Center, San Diego, California, USA
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Verification of an optimizer algorithm by the beam delivery evaluation of intensity-modulated arc therapy plans. Radiol Oncol 2021; 55:508-515. [PMID: 34821138 PMCID: PMC8647790 DOI: 10.2478/raon-2021-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background In the case of dynamic radiotherapy plans, the fractionation schemes can have dosimetric effects. Our goal was to define the effect of the fraction dose on the plan quality and the beam delivery. Materials and methods Treatment plans were created for 5 early-stage lung cancer patients with different dose schedules. The planned total dose was 60 Gy, fraction dose was 2 Gy, 3 Gy, 5 Gy, 12 Gy and 20 Gy. Additionally renormalized plans were created by changing the prescribed fraction dose after optimization. The dosimetric parameters and the beam delivery parameters were collected to define the plan quality and the complexity of the treatment plans. The accuracy of dose delivery was verified with dose measurements using electronic portal imaging device (EPID). Results The plan quality was independent from the used fractionation scheme. The fraction dose could be changed safely after the optimization, the delivery accuracy of the treatment plans with changed prescribed dose was not lower. According to EPID based measurements, the high fraction dose and dose rate caused the saturation of the detector, which lowered the gamma passing rate. The aperture complexity score, the gantry speed and the dose rate changes were not predicting factors for the gamma passing rate values. Conclusions The plan quality and the delivery accuracy are independent from the fraction dose, moreover the fraction dose can be changed safely after the dose optimization. The saturation effect of the EPID has to be considered when the action limits of the quality assurance system are defined.
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Alharthi T, Vial P, Holloway L, Thwaites D. Intrinsic detector sensitivity analysis as a tool to characterize ArcCHECK and EPID sensitivity to variations in delivery for lung SBRT VMAT plans. J Appl Clin Med Phys 2021; 22:229-240. [PMID: 33949087 PMCID: PMC8200424 DOI: 10.1002/acm2.13221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/08/2021] [Accepted: 02/12/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To investigate intrinsic sensitivity of an electronic portal imaging device (EPID) and the ArcCHECK detector and to use this in assessing their performance in detecting delivery variations for lung SBRT VMAT. The effect of detector spatial resolution and dose matrix interpolation on the gamma pass rate was also considered. MATERIALS AND METHODS Fifteen patients' lung SBRT VMAT plans were used. Delivery variations (errors) were introduced by modifying collimator angles, multi-leaf collimator (MLC) field sizes and MLC field shifts by ±5, ±2, and ±1 degrees or mm (investigating 103 plans in total). EPID and ArcCHECK measured signals with introduced variations were compared to measured signals without variations (baseline), using OmniPro-I'mRT software and gamma criteria of 3%/3 mm, 2%/2 mm, 2%/1 mm, and 1%/1 mm, to test each system's basic performance. The measurement sampling resolution for each was also changed to 1 mm and results compared to those with the default detector system resolution. RESULTS Intrinsic detector sensitivity analysis, that is, comparing measurement to baseline measurement, rather than measurement to plan, demonstrated the intrinsic constraints of each detector and indicated the limiting performance that users might expect. Changes in the gamma pass rates for ArcCHECK, for a given introduced error, were affected only by dose difference (DD %) criteria. However, the EPID showed only slight changes when changing DD%, but greater effects when changing distance-to-agreement criteria. This is pertinent for lung SBRT where the minimum dose to the target will drop dramatically with geometric errors. Detector resolution and dose matrix interpolation have an impact on the gamma results for these SBRT plans and can lead to false positives or negatives in error detection if not understood. CONCLUSION The intrinsic sensitivity approach may help in the selection of more meaningful gamma criteria and the choice of optimal QA device for site-specific dose verification.
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Affiliation(s)
- Thahabah Alharthi
- Institute of Medical Physics, School of Physics, The University of Sydney, Sydney, NSW, Australia.,School of Medicine, Taif University, Taif, Saudi Arabia.,Liverpool and Macarthur Cancer Therapy Centers, Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Phil Vial
- Liverpool and Macarthur Cancer Therapy Centers, Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Lois Holloway
- Institute of Medical Physics, School of Physics, The University of Sydney, Sydney, NSW, Australia.,Liverpool and Macarthur Cancer Therapy Centers, Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - David Thwaites
- Institute of Medical Physics, School of Physics, The University of Sydney, Sydney, NSW, Australia
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Chendi A, Botti A, Orlandi M, Sghedoni R, Iori M, Cagni E. EPID-based 3D dosimetry for pre-treatment FFF VMAT stereotactic body radiotherapy plan verification using dosimetry Check TM. Phys Med 2021; 81:227-236. [PMID: 33485140 DOI: 10.1016/j.ejmp.2020.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The software Dosimetry Check (DC) reconstructs the 3D dose distribution on CT images data set by using EPID measured signal. This study aimed to evaluate DC for stereotactic body radiotherapy (SBRT) with unflattened photon beams (FFF) for dosimetric independent plan verification in pre-treatment modality. METHODS DC v.4.1 was configured for Varian TrueBeam STx FFF beams equipped with EPID aS-1200. The DC FFF models were tested using arc open fields (from 1×1 cm2 to 15×15 cm2) and VMAT (Volumetric Modulated Arc Therapy) SBRT plans on phantom and patient CTs. DC dose distributions (DDC) were compared with that calculated by Eclipse with Acuros XB algorithm (DAXB) and one measured by Octavius 1000 SRS detector (DOCT). All differences were quantified in terms of the local 3D gamma passing rate (%GP), DVH and point dose differences. RESULTS DC was configured for FFF VMAT using an appropriate correction procedure. %GP2%2mm (mean±standard deviation) of DOCT-DDC was 96.3±2.7% for open fields whereas it was 90.1±5.9% for plans on homogeneous phantom CT. However, average %GP3%3mm of DAXB-DDC was 95.0±4.1 for treatments on patient CT. The fraction of plans passing the %GP3%3mm DQA tolerance level [10% (50%) of maximum dose threshold] were 20/20 (14/20) and 18/20 (16/20) for OCT on phantom CT and DC on patient CT, respectively. CONCLUSIONS DC characterization for FFF beams was performed. For stereotactic VMAT plan verifications DC showed good agreement with TPS whereas underlined discrepancies with Octavius in the high dose regions. A customized tolerance level is required for EPID-based VMAT FFF pre-treatment verification when DC system is applied.
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Affiliation(s)
- Agnese Chendi
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Postgraduate School in Medical Physics, University of Bologna, Bologna, Italy.
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Matteo Orlandi
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Roberto Sghedoni
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mauro Iori
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisabetta Cagni
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; School of Engineering, Cardiff University, Cardiff, UK
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Diamantopoulos S, Platoni K, Patatoukas G, Karaiskos P, Kouloulias V, Efstathopoulos E. Treatment plan verification: A review on the comparison of dose distributions. Phys Med 2019; 67:107-115. [PMID: 31706146 DOI: 10.1016/j.ejmp.2019.10.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/10/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE The aim of this review article is to provide a useful reference for dose comparison techniques within the frame of treatment plan verification. Each technique is presented with a general description given along with advantages and disadvantage and the rationale for its development. METHODS The review was conducted in PubMed from 1993 to 2019 including articles referring to the methodology of dose comparison for treatment plan verification. RESULTS The search identified thirty-one dose comparison methods that were categorized according to the number of physical parameters that take into account for dose comparison. CONCLUSIONS Among the available methods for the comparison of two dose distributions, the γ-analysis (gamma analysis) has been widely adopted as the gold standard in verification procedures. However, due to various intrinsic limitations of gamma index, the development of a better metric taking into account both statistical and in clinical parameters is required.
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Affiliation(s)
- Stefanos Diamantopoulos
- 2nd Department of Radiology, University General Hospital "Attikon", National and Kapodistrian, University of Athens, Greece.
| | - Kalliopi Platoni
- 2nd Department of Radiology, University General Hospital "Attikon", National and Kapodistrian, University of Athens, Greece
| | - Georgios Patatoukas
- 2nd Department of Radiology, University General Hospital "Attikon", National and Kapodistrian, University of Athens, Greece
| | - Pantelis Karaiskos
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Greece
| | - Vassilis Kouloulias
- 2nd Department of Radiology, University General Hospital "Attikon", National and Kapodistrian, University of Athens, Greece
| | - Efstathios Efstathopoulos
- 2nd Department of Radiology, University General Hospital "Attikon", National and Kapodistrian, University of Athens, Greece
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