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Stevens S, Moloney S, Blackmore A, Hart C, Rixham P, Bangiri A, Pooler A, Doolan P. IPEM topical report: guidance for the clinical implementation of online treatment monitoring solutions for IMRT/VMAT. Phys Med Biol 2023; 68:18TR02. [PMID: 37531959 DOI: 10.1088/1361-6560/acecd0] [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: 03/24/2023] [Accepted: 08/02/2023] [Indexed: 08/04/2023]
Abstract
This report provides guidance for the implementation of online treatment monitoring (OTM) solutions in radiotherapy (RT), with a focus on modulated treatments. Support is provided covering the implementation process, from identification of an OTM solution to local implementation strategy. Guidance has been developed by a RT special interest group (RTSIG) working party (WP) on behalf of the Institute of Physics and Engineering in Medicine (IPEM). Recommendations within the report are derived from the experience of the WP members (in consultation with manufacturers, vendors and user groups), existing guidance or legislation and a UK survey conducted in 2020 (Stevenset al2021). OTM is an inclusive term representing any system capable of providing a direct or inferred measurement of the delivered dose to a RT patient. Information on each type of OTM is provided but, commensurate with UK demand, guidance is largely influenced byin vivodosimetry methods utilising the electronic portal imager device (EPID). Sections are included on the choice of OTM solutions, acceptance and commissioning methods with recommendations on routine quality control, analytical methods and tolerance setting, clinical introduction and staffing/resource requirements. The guidance aims to give a practical solution to sensitivity and specificity testing. Functionality is provided for the user to introduce known errors into treatment plans for local testing. Receiver operating characteristic analysis is discussed as a tool to performance assess OTM systems. OTM solutions can help verify the correct delivery of radiotherapy treatment. Furthermore, modern systems are increasingly capable of providing clinical decision-making information which can impact the course of a patient's treatment. However, technical limitations persist. It is not within the scope of this guidance to critique each available solution, but the user is encouraged to carefully consider workflow and engage with manufacturers in resolving compatibility issues.
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Affiliation(s)
| | - Stephen Moloney
- University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom
| | | | - Clare Hart
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Philip Rixham
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Anna Bangiri
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Alistair Pooler
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom
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Hanušová T, Linhart V, Vrba T. PLASTIC SCINTILLATOR BASED 2D DETECTOR FOR PHOTON RADIOTHERAPY: PRELIMINARY RESULTS. RADIATION PROTECTION DOSIMETRY 2022; 198:566-572. [PMID: 36005955 DOI: 10.1093/rpd/ncac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/07/2022] [Accepted: 02/22/2022] [Indexed: 06/15/2023]
Abstract
A proof-of-concept study of a new detector based on a thin plastic scintillator monitored by a Charge-Coupled Device (CCD) camera designed for monitoring and characterisation of Linac photon beams is presented. The response of the detector is compared with radiochromic film using 6 and 18 MV radiotherapeutic beams. We have observed: (i) all instruments survived the secondary radiation fields during Linac operation, (ii) it was possible to process the measured data using statistical techniques and (iii) the processed data from the CCD camera qualitatively correspond to film dosimetry results. A statistical technique based on the selection of minimal values provides the clearest results. Quantitatively, CCD and film results can only be compared as 6 to 18 MV response rates. We have observed that the rates from the CCD data are systematically higher than the rates from film dosimetry. Differences are not too high, namely 1.9-2.4 times the combined standard deviation.
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Affiliation(s)
- Tereza Hanušová
- Department of Dosimetry and Application of Ionizing Radiation, Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Břehová 7, 115 19 Prague 1, Czech Republic
- Department of Medical Physics, Thomayer University Hospital, Vídeňská 800, 140 59 Prague 4, Czech Republic
| | - Vladimír Linhart
- Department of Dosimetry and Application of Ionizing Radiation, Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Břehová 7, 115 19 Prague 1, Czech Republic
| | - Tomáš Vrba
- Department of Dosimetry and Application of Ionizing Radiation, Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Břehová 7, 115 19 Prague 1, Czech Republic
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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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Leste J, Younes T, Chauvin M, Franceries X, Delbaere A, Vieillevigne L, Ferrand R, Bardies M, Simon L. Technical note: GAMMORA, a free, open-source, and validated GATE-based model for Monte-Carlo simulations of the Varian TrueBeam. Phys Med 2021; 89:211-218. [PMID: 34416389 DOI: 10.1016/j.ejmp.2021.07.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Monte Carlo (MC) is the reference computation method for medical physics. In radiotherapy, MC computations are necessary for some issues (such as assessing figures of merit, double checks, and dose conversions). A tool based on GATE is proposed to easily create full MC simulations of the Varian TrueBeam STx. METHODS GAMMORA is a package that contains photon phase spaces as a pre-trained generative adversarial network (GAN) and the TrueBeam's full geometry. It allows users to easily create MC simulations for simple or complex radiotherapy plans such as VMAT. To validate the model, the characteristics of generated photons are first compared to those provided by Varian (IAEA format). Simulated data are also compared to measurements in water and heterogeneous media. Simulations of 8 SBRT plans are compared to measurements (in a phantom). Two examples of applications (a second check and interplay effect assessment) are presented. RESULTS The simulated photons generated by the GAN have the same characteristics (energy, position, and direction) as the IAEA data. Computed dose distributions of simple cases (in water) and complex plans delivered in a phantom are compared to measurements, and the Gamma index (3%/3mm) was always superior to 98%. The feasibility of both clinical applications is shown. CONCLUSIONS This model is now shared as a free and open-source tool that generates radiotherapy MC simulations. It has been validated and used for five years. Several applications can be envisaged for research and clinical purposes.
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Affiliation(s)
- Jeremy Leste
- Centre de Recherches en Cancerologie de Toulouse (CRCT), Universite de Toulouse, UPS, INSERM, Toulouse, France
| | - Tony Younes
- Centre de Recherches en Cancerologie de Toulouse (CRCT), Universite de Toulouse, UPS, INSERM, Toulouse, France
| | - Maxime Chauvin
- Centre de Recherches en Cancerologie de Toulouse (CRCT), Universite de Toulouse, UPS, INSERM, Toulouse, France
| | - Xavier Franceries
- Centre de Recherches en Cancerologie de Toulouse (CRCT), Universite de Toulouse, UPS, INSERM, Toulouse, France
| | - Alexia Delbaere
- Centre de Recherches en Cancerologie de Toulouse (CRCT), Universite de Toulouse, UPS, INSERM, Toulouse, France
| | - Laure Vieillevigne
- Centre de Recherches en Cancerologie de Toulouse (CRCT), Universite de Toulouse, UPS, INSERM, Toulouse, France; Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Departement Ingenierie Physique Medicale, Toulouse, France
| | | | - Manuel Bardies
- Cancer Research Institute of Montpellier, U1194 INSERM/ICM/Montpellier University, and Cancer Institute of Montpellier, Montpellier, France
| | - Luc Simon
- Centre de Recherches en Cancerologie de Toulouse (CRCT), Universite de Toulouse, UPS, INSERM, Toulouse, France; Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Departement Ingenierie Physique Medicale, Toulouse, France.
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