1
|
Ono T, Hirashima H, Adachi T, Iramina H, Fujimoto T, Uto M, Nakamura M, Mizowaki T. Influence of dose calculation algorithms on the helical diode array using volumetric-modulated arc therapy for small targets. J Appl Clin Med Phys 2024; 25:e14307. [PMID: 38363044 PMCID: PMC11244667 DOI: 10.1002/acm2.14307] [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: 11/10/2023] [Revised: 12/26/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND For patient-specific quality assurance (PSQA) for small targets, the dose resolution can change depending on the characteristics of the dose calculation algorithms. PURPOSE This study aimed to evaluate the influence of the dose calculation algorithms Acuros XB (AXB), anisotropic analytical algorithm (AAA), photon Monte Carlo (pMC), and collapsed cone (CC) on a helical diode array using volumetric-modulated arc therapy (VMAT) for small targets. MATERIALS AND METHODS ArcCHECK detectors were inserted with a physical depth of 2.9 cm from the surface. To evaluate the influence of the dose calculation algorithms for small targets, rectangular fields of 2×100, 5×100, 10×100, 20×100, 50×100, and 100×100 mm2 were irradiated and measured using ArcCHECK with TrueBeam STx. A total of 20 VMAT plans for small targets, including the clinical sites of 19 brain metastases and one spine, were also evaluated. The gamma passing rates (GPRs) were evaluated for the rectangular fields and the 20 VMAT plans using AXB, AAA, pMC, and CC. RESULTS For rectangular fields of 2×100 and 5×100 mm2, the GPR at 3%/2 mm of AXB was < 50% because AXB resulted in a coarser dose resolution with narrow beams. For field sizes > 10×100 mm2, the GPR at 3%/2 mm was > 88.1% and comparable for all dose calculation algorithms. For the 20 VMAT plans, the GPRs at 3%/2 mm were 79.1 ± 15.7%, 93.2 ± 5.8%, 94.9 ± 4.1%, and 94.5 ± 4.1% for AXB, AAA, pMC, and CC, respectively. CONCLUSION The behavior of the dose distribution on the helical diode array differed depending on the dose calculation algorithm for small targets. Measurements using ArcCHECK for VMAT with small targets can have lower GPRs owing to the coarse dose resolution of AXB around the detector area.
Collapse
Affiliation(s)
- Tomohiro Ono
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hideaki Hirashima
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takanori Adachi
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiraku Iramina
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takahiro Fujimoto
- Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto, Japan
| | - Megumi Uto
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mitsuhiro Nakamura
- Department of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|
2
|
Hajare R, K K S, Kumar A, Kalita R, Kaginelli S, Mahantshetty U. Commissioning and dosimetric verification of volumetric modulated arc therapy for multiple modalities using electronic portal imaging device-based 3D dosimetry system: a novel approach. Radiol Phys Technol 2024; 17:412-424. [PMID: 38492203 DOI: 10.1007/s12194-024-00792-z] [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: 12/04/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
The purpose of this study was to validate an electronic portal imaging device (EPID) based 3-dimensional (3D) dosimetry system for the commissioning of volumetric modulated arc therapy (VMAT) delivery for flattening filter (FF) and flattening filter free (FFF) modalities based on test suites developed according to American Association of Physicists in Medicine Task Group 119 (AAPM TG 119) and pre-treatment patient specific quality assurance (PSQA).With ionisation chamber, multiple-point measurement in various planes becomes extremely difficult and time-consuming, necessitating repeated exposure of the plan. The average agreement between measured and planned doses for TG plans is recommended to be within 3%, and both the ionisation chamber and PerFRACTION™ measurement were well within this prescribed limit. Both point dose differences with the planned dose and gamma passing rates are comparable with TG reported multi-institution results. From our study, we found that no significant differences were found between FF and FFF beams for measurements using PerFRACTION™ and ion chamber. Overall, PerFRACTION™ produces acceptable results to be used for commissioning and validating VMAT and for performing PSQA. The findings support the feasibility of integrating PerFRACTION™ into routine quality assurance procedures for VMAT delivery. Further multi-institutional studies are recommended to establish global baseline values and enhance the understanding of PerFRACTION™'s capabilities in diverse clinical settings.
Collapse
Affiliation(s)
- Raghavendra Hajare
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital & Research Centre, Visakhapatnam, India.
- Division of Medical Physics, JSS Academy of Higher Education and Research, Mysuru, India.
| | - Sreelakshmi K K
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital & Research Centre, Visakhapatnam, India
| | - Anil Kumar
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital & Research Centre, Visakhapatnam, India
| | - Rituraj Kalita
- Department of Radiation Oncology, Tezpur Cancer Centre, Bihuguri, India
| | - Shanmukhappa Kaginelli
- Division of Medical Physics, JSS Academy of Higher Education and Research, Mysuru, India
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital & Research Centre, Visakhapatnam, India
| |
Collapse
|
3
|
Kaidar-Person O, Meattini I, Boersma LJ, Becherini C, Cortes J, Curigliano G, de Azambuja E, Harbeck N, Rugo HS, Del Mastro L, Gennari A, Isacke CM, Vestmø Maraldo M, Marangoni E, Nader Marta G, Mjaaland I, Salvestrini V, Spanic T, Visani L, Morandi A, Lambertini M, Livi L, Coles CE, Poortmans P, Offersen BV. Essential requirements for reporting radiation therapy in breast cancer clinical trials: An international multi-disciplinary consensus endorsed by the European Society for Radiotherapy and Oncology (ESTRO). Radiother Oncol 2024; 195:110060. [PMID: 38122852 DOI: 10.1016/j.radonc.2023.110060] [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: 10/07/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
The European Society for Radiotherapy and Oncology (ESTRO) has advocated the establishment of guidelines to optimise precision radiotherapy (RT) in conjunction with contemporary therapeutics for cancer care. Quality assurance in RT (QART) plays a pivotal role in influencing treatment outcomes. Clinical trials incorporating QART protocols have demonstrated improved survival rates with minimal associated toxicity. Nonetheless, in routine clinical practice, there can be variability in the indications for RT, dosage, fractionation, and treatment planning, leading to uncertainty. In pivotal trials reporting outcomes of systemic therapy for breast cancer, there is limited information available regarding RT, and the potential interaction between modern systemic therapy and RT remains largely uncharted. This article is grounded in a consensus recommendation endorsed by ESTRO, formulated by international breast cancer experts. The consensus was reached through a modified Delphi process and was presented at an international meeting convened in Florence, Italy, in June 2023. These recommendations are regarded as both optimal and essential standards, with the latter aiming to define the minimum requirements. A template for a case report form (CRF) has been devised, which can be utilised by all clinical breast cancer trials involving RT. Optimal requirements include adherence to predefined RT planning protocols and centralised QART. Essential requirements aim to reduce variations and deviations from the guidelines in RT, even when RT is not the primary focus of the trial. These recommendations underscore the significance of implementing these practices in both clinical trials and daily clinical routines to generate high-quality data.
Collapse
Affiliation(s)
- Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, Sheba Medical Center, Ramat Gan, Israel; The School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; GROW-School for Oncology and Reproduction (Maastro), Maastricht University, Maastricht, the Netherlands
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Liesbeth J Boersma
- GROW-School for Oncology and Reproduction (Maastro), Maastricht University, Maastricht, the Netherlands
| | - Carlotta Becherini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Javier Cortes
- International Breast Cancer Center (IBCC), Pangaea Oncology, Quironsalud Group & Medical Scientia Innovation Research (MedSIR), Barcelona, Spain; Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Giuseppe Curigliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato - Oncology (DIPO), University of Milan, Milan, Italy
| | - Evandro de Azambuja
- Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - Nadia Harbeck
- Department of Gynecology and Obstetrics and CCCMunich, Breast Center, LMU University Hospital, Munich, Germany
| | - Hope S Rugo
- Medicine and Winterhof Family Professor of Breast Oncology, University of California San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy; Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alessandra Gennari
- Department of Translational Medicine, University Piemonte Orientale, Novara, Italy
| | - Clare M Isacke
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK
| | - Maja Vestmø Maraldo
- Department of Clinical Oncology, Center of Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Elisabetta Marangoni
- Laboratory of Preclinical Investigation, Translational Research Department, Institut Curie, Paris, France
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil; Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Ingvil Mjaaland
- Department of Oncology and Hematology, Stavanger University Hospital, Stavanger, Norway
| | - Viola Salvestrini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Tanja Spanic
- Europa Donna - The European Breast Cancer Coalition, Milan, Italy; Europa Donna Slovenia, Ljubljana, Slovenia
| | - Luca Visani
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Andrea Morandi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy; Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Philip Poortmans
- Department of radiation oncology, Iridium Netwerk, Wilrijk-Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk-Antwerp, Belgium
| | - Birgitte V Offersen
- Department of Experimental Clinical Oncology, Danish Centre for Particle Therapy, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
4
|
Mohyedin MZ, Zin HM, Abubakar A, Rahman ATA. Study of PRESAGE® dosimeter for end-to-end 3D radiotherapy verification using an anthropomorphic phantom with bespoke dosimeter insert. Phys Eng Sci Med 2024:10.1007/s13246-024-01418-9. [PMID: 38634981 DOI: 10.1007/s13246-024-01418-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 02/26/2024] [Indexed: 04/19/2024]
Abstract
Modern radiotherapy techniques have advanced and become more sophisticated. End-to-end 3D verification of the complex radiotherapy dose distribution in an anthropomorphic phantom can ensure the accuracy of the treatment delivery. The phantoms commonly used for dosimetry are homogeneous solid water phantom which lacks the capability to measure the 3D dose distribution for heterogeneous tissues necessary for advanced radiotherapy techniques. Therefore, we developed an end-to-end 3D radiotherapy dose verification system based on MAX-HD anthropomorphic phantom (Integrated Medical Technologies Inc., Troy, New York) with bespoke intracranial insert for PRESAGE® dosimeter. In this study, several advanced radiotherapy treatment techniques of various levels of complexity; 3D-CRT, IMRT and VMAT treatment, were planned for a 20 mm diameter of a spherical target in the brain region and delivered to the phantom. The dosimeters were read out using an in-house developed optical computed tomography (OCT) imaging system known as 3DmicroHD-OCT. It was found that the measured dose distribution of the PRESAGE® when compared with the measured dose distribution of EBT film and Monaco TPS has a maximum difference of less than 3% for 3D-CRT, IMRT and VMAT treatment plans. The gamma analysis results of PRESAGE® in comparison to EBT film and Monaco TPS show pass rates of more than 95% for the criteria of 3% dose difference and 3 mm distance-to-agreement. This study proves the capability of PRESAGE® and bespoke MAX-HD phantom in conjunction with the 3DmicroHD-OCT system to measure 3D dose distribution for end-to-end dosimetry verification.
Collapse
Affiliation(s)
- Muhammad Zamir Mohyedin
- School of Physics and Material Studies, Faculty of Applied Sciences, Universiti Teknologi MARA, 40450, Shah Alam, Selangor, Malaysia
- Centre of Astrophysics and Applied Radiation, Institute of Science, Universiti Teknologi MARA, 40450, Shah Alam, Selangor, Malaysia
| | - Hafiz Mohd Zin
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, 13700, Kepala Batas, Penang, Malaysia.
| | - Auwal Abubakar
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, 13700, Kepala Batas, Penang, Malaysia
- Department of Medical Radiography, Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
- Department of Clinical Oncology, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Ahmad Taufek Abdul Rahman
- School of Physics and Material Studies, Faculty of Applied Sciences, Universiti Teknologi MARA, 40450, Shah Alam, Selangor, Malaysia.
- Centre of Astrophysics and Applied Radiation, Institute of Science, Universiti Teknologi MARA, 40450, Shah Alam, Selangor, Malaysia.
| |
Collapse
|
5
|
Liu L, Shen L, Yang Y, Schüler E, Zhao W, Wetzstein G, Xing L. Modeling linear accelerator (Linac) beam data by implicit neural representation learning for commissioning and quality assurance applications. Med Phys 2023; 50:3137-3147. [PMID: 36621812 PMCID: PMC10175132 DOI: 10.1002/mp.16212] [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: 09/24/2022] [Revised: 12/21/2022] [Accepted: 01/01/2023] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Linear accelerator (Linac) beam data commissioning and quality assurance (QA) play a vital role in accurate radiation treatment delivery and entail a large number of measurements using a variety of field sizes. How to optimize the effort in data acquisition while maintaining high quality of medical physics practice has been sought after. PURPOSE We propose to model Linac beam data through implicit neural representation (NeRP) learning. The potential of the beam model in predicting beam data from sparse measurements and detecting data collection errors was evaluated, with the goal of using the beam model to verify beam data collection accuracy and simplify the commissioning and QA process. MATERIALS AND METHODS NeRP models with continuous and differentiable functions parameterized by multilayer perceptrons (MLPs) were used to represent various beam data including percentage depth dose (PDD) and profiles of 6 MV beams with and without flattening filter. Prior knowledge of the beam data was embedded into the MLP network by learning the NeRP of a vendor-provided "golden" beam dataset. The prior-embedded network was then trained to fit clinical beam data collected at one field size and used to predict beam data at other field sizes. We evaluated the prediction accuracy by comparing network-predicted beam data to water tank measurements collected from 14 clinical Linacs. Beam datasets with intentionally introduced errors were used to investigate the potential use of the NeRP model for beam data verification, by evaluating the model performance when trained with erroneous beam data samples. RESULTS Linac beam data predicted by the model agreed well with water tank measurements, with averaged Gamma passing rates (1%/1 mm passing criteria) higher than 95% and averaged mean absolute errors less than 0.6%. Beam data samples with measurement errors were revealed by inconsistent beam predictions between networks trained with correct versus erroneous data samples, characterized by a Gamma passing rate lower than 90%. CONCLUSION A NeRP beam data modeling technique has been established for predicting beam characteristics from sparse measurements. The model provides a valuable tool to verify beam data collection accuracy and promises to simplify commissioning/QA processes by reducing the number of measurements without compromising the quality of medical physics service.
Collapse
Affiliation(s)
- Lianli Liu
- Department of Radiation Oncology, Stanford University, Palo Alto, California, USA
| | - Liyue Shen
- Department of Electrical Engineering, Stanford University, Palo Alto, California, USA
| | - Yong Yang
- Department of Radiation Oncology, Stanford University, Palo Alto, California, USA
| | - Emil Schüler
- Department of Radiation Oncology, Stanford University, Palo Alto, California, USA
| | - Wei Zhao
- Department of Radiation Oncology, Stanford University, Palo Alto, California, USA
| | - Gordon Wetzstein
- Department of Electrical Engineering, Stanford University, Palo Alto, California, USA
| | - Lei Xing
- Department of Radiation Oncology, Stanford University, Palo Alto, California, USA
- Department of Electrical Engineering, Stanford University, Palo Alto, California, USA
| |
Collapse
|
6
|
Smith K, Ulin K, Knopp M, Kry S, Xiao Y, Rosen M, Michalski J, Iandoli M, Laurie F, Quigley J, Reifler H, Santiago J, Briggs K, Kirby S, Schmitter K, Prior F, Saltz J, Sharma A, Bishop-Jodoin M, Moni J, Cicchetti MG, FitzGerald TJ. Quality improvements in radiation oncology clinical trials. Front Oncol 2023; 13:1015596. [PMID: 36776318 PMCID: PMC9911211 DOI: 10.3389/fonc.2023.1015596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
Clinical trials have become the primary mechanism to validate process improvements in oncology clinical practice. Over the past two decades there have been considerable process improvements in the practice of radiation oncology within the structure of a modern department using advanced technology for patient care. Treatment planning is accomplished with volume definition including fusion of multiple series of diagnostic images into volumetric planning studies to optimize the definition of tumor and define the relationship of tumor to normal tissue. Daily treatment is validated by multiple tools of image guidance. Computer planning has been optimized and supported by the increasing use of artificial intelligence in treatment planning. Informatics technology has improved, and departments have become geographically transparent integrated through informatics bridges creating an economy of scale for the planning and execution of advanced technology radiation therapy. This serves to provide consistency in department habits and improve quality of patient care. Improvements in normal tissue sparing have further improved tolerance of treatment and allowed radiation oncologists to increase both daily and total dose to target. Radiation oncologists need to define a priori dose volume constraints to normal tissue as well as define how image guidance will be applied to each radiation treatment. These process improvements have enhanced the utility of radiation therapy in patient care and have made radiation therapy an attractive option for care in multiple primary disease settings. In this chapter we review how these changes have been applied to clinical practice and incorporated into clinical trials. We will discuss how the changes in clinical practice have improved the quality of clinical trials in radiation therapy. We will also identify what gaps remain and need to be addressed to offer further improvements in radiation oncology clinical trials and patient care.
Collapse
Affiliation(s)
- Koren Smith
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Kenneth Ulin
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Michael Knopp
- Imaging and Radiation Oncology Core-Ohio, Department of Radiology, The Ohio State University, Columbus, OH, United States
| | - Stephan Kry
- Imaging and Radiation Oncology Core-Houston, Division of Radiation Oncology, University of Texas, MD Anderson, Houston, TX, United States
| | - Ying Xiao
- Imaging and Radiation Oncology Core Philadelphia, Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Mark Rosen
- Imaging and Radiation Oncology Core Philadelphia, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University, St Louis, MO, United States
| | - Matthew Iandoli
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Fran Laurie
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Jean Quigley
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Heather Reifler
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Juan Santiago
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Kathleen Briggs
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Shawn Kirby
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Kate Schmitter
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Fred Prior
- Department of Biomedical Informatics, University of Arkansas, Little Rock, AR, United States
| | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, United States
| | - Ashish Sharma
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States
| | - Maryann Bishop-Jodoin
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Janaki Moni
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - M. Giulia Cicchetti
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Thomas J. FitzGerald
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| |
Collapse
|
7
|
Intang A, Oonsiri P, Kingkaew S, Chatchumnan N, Oonsiri S. Validation of the Fabricated Cast Nylon Head Phantom for Stereotactic Radiosurgery End-to-End Test using Alanine Dosimeter. J Med Phys 2023; 48:74-79. [PMID: 37342600 PMCID: PMC10277300 DOI: 10.4103/jmp.jmp_98_22] [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: 10/24/2022] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 06/23/2023] Open
Abstract
Background Stereotactic radiosurgery (SRS) is an alternative to surgery as it precisely delivers single-large doses to small tumors. Cast nylon is used in phantom due to its computed tomography (CT) number of about 56-95 HU, which is close to that of the soft tissue. Moreover, cast nylon is also more budget-friendly than the commercial phantoms. Aims The aim of this study is to design and validate the fabricated cast nylon head phantom for SRS end-to-end test using an alanine dosimeter. Materials and Methods The phantom was designed using cast nylon. It was initially created by a computer numerical control three-axis vertical machining center. Then, the cast nylon phantom was scanned using a CT simulator. Finally, the validation of the fabricated phantom using alanine dosimeter proficiency with four Varian LINAC machines was performed. Results The fabricated phantom presented a CT number of 85-90 HU. The outcomes of VMAT SRS plans showed percentage dose differences from 0.24 to 1.55, whereas the percentage dose differences in organ at risk (OAR) were 0.09-10.80 due to the low-dose region. The distance between the target (position 2) and the brainstem (position 3) was 0.88 cm. Conclusions Variation in dose for OAR is higher, which might be due to a high-dose gradient in the area where measurement was being conducted. The fabricated cast nylon end-to-end test head phantom had been suitably designed to image and irradiate during an end-to-end test for SRS using an alanine dosimeter.
Collapse
Affiliation(s)
- Aungsumalin Intang
- Department of Radiology, Medical Physics Program, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Office of Atoms for Peace, Division of Radiation Oncology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Puntiwa Oonsiri
- Department of Radiology, Division of Radiation Oncology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sakda Kingkaew
- Department of Radiology, Division of Radiation Oncology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nichakan Chatchumnan
- Department of Radiology, Division of Radiation Oncology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sornjarod Oonsiri
- Department of Radiology, Division of Radiation Oncology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| |
Collapse
|
8
|
Avelino SR, Dias JR, Peron TM, Vidal GS. Evaluation of an EPID in vivo monitoring system using local and external independent audit measurements. J Appl Clin Med Phys 2022; 23:e13822. [PMID: 36356260 PMCID: PMC9797176 DOI: 10.1002/acm2.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2003] [Revised: 08/26/2022] [Accepted: 09/18/2022] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The aim of this work was to evaluate the SunCHECK PerFRACTION, the software for in vivo monitoring using EPID images. MATERIALS/METHODS First, the PerFRACTION ability to detect errors was investigated simulating two situations: (1) variation of LINAC output and (2) variation of the phantom thickness. An ionization chamber was used as reference to measure the introduced dose variations. Both tests used EPID in integrated mode (absolute dose). Second, EPID measurements in integrated mode were carried out during an independent Brazilian governmental audit that provided four phantoms and TLDs. PerFRACTION calculated the absolute dose on EPID plane, and it compared with predicted calculated dose for every delivered plan. The dose deviations reported using PerFRACTION were compared with dose deviations reported by the independent audit. Third, an end-to-end test using a heterogeneous phantom was performed. A VMAT plan with EPID in cine mode was delivered. PerFRACTION calculated the mean dose on CBCT using EPID information and log files. The calculated doses at four different points were compared with ionization chambers measurements. RESULTS About the first test, the largest difference found was 1.2%. Considering the audit results, the variations detected by TLD measurements and by PerFRACTION dose calculation on EPID plane were close: 12 points had variations less than 2%, 2 points with variation between 2% and 3%, and 2 points with deviations greater than 3% (max 3.7%). The end-to-end tests using a heterogeneous phantom achieved dose deviation less than 1.0% in the water-equivalent region. In the mimicking lung region, the deviations were higher (max 7.3%), but in accordance with what is expected for complex situations. CONCLUSION The tests results indicate that PerFRACTION dose calculations in different situations have good agreement with standard measurements. Action levels were suggested for absolute dose on EPID plane as well as 3D dose calculation on CBCT using PerFRACTION.
Collapse
Affiliation(s)
| | | | | | - Gabriel Souza Vidal
- VITTA Radiotherapy CenterBrasília‐DFBrazil,Department of Radiation OncologyStephenson Cancer CenterUniversity of OklahomaOklahoma CityUnited States
| |
Collapse
|
9
|
Kaplan LP, Placidi L, Bäck A, Canters R, Hussein M, Vaniqui A, Fusella M, Piotrowski T, Hernandez V, Jornet N, Hansen CR, Widesott L. Plan quality assessment in clinical practice: Results of the 2020 ESTRO survey on plan complexity and robustness. Radiother Oncol 2022; 173:254-261. [PMID: 35714808 DOI: 10.1016/j.radonc.2022.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/24/2022] [Accepted: 06/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Plan complexity and robustness are two essential aspects of treatment plan quality but there is a great variability in their management in clinical practice. This study reports the results of the 2020 ESTRO survey on plan complexity and robustness to identify needs and guide future discussions and consensus. METHODS A survey was distributed online to ESTRO members. Plan complexity was defined as the modulation of machine parameters and increased uncertainty in dose calculation and delivery. Robustness was defined as a dose distribution's sensitivity towards errors stemming from treatment uncertainties, patient setup, or anatomical changes. RESULTS A total of 126 radiotherapy centres from 33 countries participated, 95 of them (75%) from Europe and Central Asia. The majority controlled and evaluated plan complexity using monitor units (56 centres) and aperture shapes (38 centres). To control robustness, 98 (97% of question responses) photon and 5 (50%) proton centres used PTV margins for plan optimization while 75 (94%) and 5 (50%), respectively, used margins for plan evaluation. Seventeen (21%) photon and 8 (80%) proton centres used robust optimisation, while 10 (13%) and 8 (80%), respectively, used robust evaluation. Primary uncertainties considered were patient setup (photons and protons) and range calculation uncertainties (protons). Participants expressed the need for improved commercial tools to control and evaluate plan complexity and robustness. CONCLUSION Clinical implementation of methods to control and evaluate plan complexity and robustness is very heterogeneous. Better tools are needed to manage complexity and robustness in treatment planning systems. International guidelines may promote harmonization.
Collapse
Affiliation(s)
- Laura Patricia Kaplan
- Department of Oncology, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy.
| | - Anna Bäck
- Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Medical Radiation Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Richard Canters
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, the Netherlands
| | - Mohammad Hussein
- Metrology for Med Phys Centre, National Physical Laboratory, Teddington, United Kingdom
| | - Ana Vaniqui
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, the Netherlands
| | - Marco Fusella
- Department of Med Phys, Veneto Institute of Oncology - IOV IRCCS, Padua, Italy
| | - Tomasz Piotrowski
- Department of Electroradiology, Poznan University of Medical Sciences and Department of Med Phys, Greater Poland Cancer Centre, Poznan, Poland
| | - Victor Hernandez
- Department of Med Phys, Hospital Sant Joan de Reus, IISPV, Spain
| | - Nuria Jornet
- Servei de Radiofísica i Radioprotecció, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Christian Rønn Hansen
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Denmark; Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | |
Collapse
|
10
|
Lehmann J, Hussein M, Barry M, Siva S, Moore A, Chu M, Díez P, Eaton DJ, Harwood J, Lonski P, Claridge Mackonis E, Meehan C, Patel R, Ray X, Shaw M, Shepherd J, Smyth G, Standen TS, Subramanian B, Greer P, Clark CH. SEAFARER – A new concept for validating radiotherapy patient specific QA for clinical trials and clinical practice. Radiother Oncol 2022; 171:121-128. [DOI: 10.1016/j.radonc.2022.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/22/2022] [Accepted: 04/14/2022] [Indexed: 01/12/2023]
|
11
|
Corrigan KL, Kry S, Howell RM, Kouzy R, Jaoude JA, Patel RR, Jhingran A, Taniguchi C, Koong AC, McAleer MF, Nitsch P, Rödel C, Fokas E, Minsky BD, Das P, Fuller CD, Ludmir EB. The radiotherapy quality assurance gap among phase III cancer clinical trials. Radiother Oncol 2022; 166:51-57. [PMID: 34838891 PMCID: PMC8900671 DOI: 10.1016/j.radonc.2021.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Quality assurance (QA) practices improve the quality level of oncology trials by ensuring that the protocol is followed and the results are valid and reproducible. This study investigated the utilization of QA among randomized controlled trials that involve radiotherapy (RT). METHODS AND MATERIALS We searched ClinicalTrials.gov in February 2020 for all phase III oncology randomized clinical trials (RCTs). These trials were screened for RT-specific RCTs that had published primary trial results. Information regarding QA in each trial was collected from the study publications and trial protocol if available. Two individuals independently performed trial screening and data collection. Pearson's Chi-square tests analyses were used to assess factors that were associated with QA inclusion in RT trials. RESULTS Forty-two RCTs with RT as the primary intervention or as a mandatory component of the protocol were analyzed; the earliest was started in 1994 and one trial was still active though not recruiting. Twenty-nine (69%) trials mandated RT quality assurance (RTQA) practices as part of the trial protocol, with 19 (45%) trials requiring institutional credentialing. Twenty-one (50%) trials published protocol deviation outcomes. Clinical trials involving advanced radiation techniques (IMRT, VMAT, SRS, SBRT) did not include more RTQA than trials without these advanced techniques (73% vs. 65%, p = 0.55). Trials that reported protocol deviation outcomes were associated with mandating RTQA in their protocols as compared to trials that did not report these outcomes (100% vs. 38%, p < 0.001). CONCLUSIONS There is a lack of RTQA utilization and transparency in RT clinical trials. It is imperative for RT trials to include increased QA for safe, consistent, and high-quality RT planning and delivery.
Collapse
Affiliation(s)
- Kelsey L. Corrigan
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030,
| | - Stephen Kry
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Rebecca M. Howell
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Ramez Kouzy
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Joseph Abi Jaoude
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Roshal R. Patel
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Anuja Jhingran
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Cullen Taniguchi
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Albert C. Koong
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Mary Fran McAleer
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Paige Nitsch
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Claus Rödel
- University of Frankfurt, 60323 Frankfurt am Main, Frankfurt, Germany,German Cancer Research Center, 69120 Im Neuenheimer Feld 280, Heidelberg, Germany,German Cancer Consortium, 60590 Frankfurt am Main, Frankfurt, Germany,Frankfurt Cancer Institute, 60596 Frankfurt am Main, Frankfurt, Germany
| | - Emmanouil Fokas
- University of Frankfurt, 60323 Frankfurt am Main, Frankfurt, Germany,German Cancer Research Center, 69120 Im Neuenheimer Feld 280, Heidelberg, Germany,German Cancer Consortium, 60590 Frankfurt am Main, Frankfurt, Germany,Frankfurt Cancer Institute, 60596 Frankfurt am Main, Frankfurt, Germany
| | - Bruce D. Minsky
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Prajnan Das
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - C. David Fuller
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030
| | - Ethan B. Ludmir
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA, 77030,Corresponding Author: Ethan B. Ludmir, M.D., 1400 Pressler St., Unit 1422, Houston TX, USA 77030, Phone: 832-729-0998,
| |
Collapse
|
12
|
Kumar L, Bhushan M, Kishore V, Yadav G, Gurjar OP. Dosimetric validation of Acuros® XB algorithm for RapidArc™ treatment technique: A post software upgrade analysis. J Cancer Res Ther 2021; 17:1491-1498. [PMID: 34916383 DOI: 10.4103/jcrt.jcrt_1154_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aim To validate the Acuros® XB (AXB) algorithm in Eclipse treatment planning system (TPS) for RapidArc™ (RA) technique following the software upgrades. Materials and Methods A Clinac-iX (2300CD) linear accelerator and Eclipse TPS (Varian Medical System, Inc., Palo Alto, USA) was used for commissioning of AXB algorithm using a 6 megavolts photon beam. Percentage depth dose (PDD) and profiles for field size 2 cm × 2 cm, 4 cm × 4 cm, 6 cm × 6 cm, 10 cm × 10 cm, 20 cm × 20 cm, 30 cm × 30 cm to 40 cm × 40 cm were taken. AXB calculated PDDs and profiles were evaluated against the measured and analytical anisotropic algorithm (AAA)-calculated PDDs and profiles. Test sites recommended by American Association of Physicists in Medicine task group (AAPM TG)-119 recommendation were used for RA planning and delivery verification using AXB algorithm. Results Dosimetric analysis of AXB calculated data showed that difference between calculated and measured data for PDD curves were maximum <1% beyond the depth of dose maximum and computed profiles in central region matches with maximum <1% for all considered field sizes. Ion-chamber measurements showed that the average confidence limit (CLs) was 0.034 and 0.020 in high-gradient and 0.047 and 0.042 in low-gradient regions, respectively, for AAA and AXB calculated RA plans. Portal measurements show the average CLs were 2.48 and 2.58 for AAA and AXB-calculated RA plans, with gamma passing criteria of 3%/3 mm. Conclusions AXB shows excellent agreement with measurements and AAA calculated data. The CLs were consistent with the baseline values published by TG-119. AXB algorithm has the potential to perform photon dose calculation with comparable fast calculation speed without negotiating the accuracy. AAPM TG-119 was successfully implemented to access the proper configuration of AXB algorithm following the TPS upgrade.
Collapse
Affiliation(s)
- Lalit Kumar
- Department of Applied Science and Humanities, Dr. A.P.J Abdul Kalam Technical University, Lucknow, Uttar Pradesh; Department of Radiation Oncology, Division of Medical Physics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Manindra Bhushan
- Department of Radiation Oncology, Division of Medical Physics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Vimal Kishore
- Department of Applied Science and Humanities, Bundelkhand Institute of Engineering and Technology, Jhansi, Uttar Pradesh, India
| | - Girigesh Yadav
- Department of Radiation Oncology, Division of Medical Physics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Om Prakash Gurjar
- Department of Radiotherapy, Mahatma Gandhi Memorial Medical College, Indore, Madhya Pradesh, India
| |
Collapse
|
13
|
Glenn MC, Brooks F, Peterson CB, Howell RM, Followill DS, Pollard-Larkin JM, Kry SF. Photon beam modeling variations predict errors in IMRT dosimetry audits. Radiother Oncol 2021; 166:8-14. [PMID: 34748857 PMCID: PMC8863621 DOI: 10.1016/j.radonc.2021.10.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022]
Abstract
Background & purpose: To evaluate treatment planning system (TPS) beam modeling parameters as contributing factors to IMRT audit performance. Materials & methods: We retrospectively analyzed IROC Houston phantom audit performance and concurrent beam modeling survey responses from 337 irradiations performed between August 2017 and November 2019. Irradiation results were grouped based on the reporting of typical or atypical beam modeling parameter survey responses (<10th or >90th percentile values), and compared for passing versus failing (>7% error) or “poor” (>5% error) irradiation status. Additionally, we assessed the impact on the planned dose distribution from variations in modeling parameter value. Finally, we estimated the overall impact of beam modeling parameter variance on dose calculations, based on reported community variations. Results: Use of atypical modeling parameters were more frequently seen with failing phantom audit results (p = 0.01). Most pronounced was for Eclipse AAA users, where phantom irradiations with atypical values of dosimetric leaf gap (DLG) showed a greater incidence of both poor-performing (p = 0.048) and failing phantom audits (p = 0.014); and in general, DLG value was correlated with dose calculation accuracy (r = 0.397, p < 0.001). Manipulating TPS parameters induced systematic changes in planned dose distributions which were consistent with prior observations of how failures manifest. Dose change estimations based on these dose calculations agreed well with true dosimetric errors identified. Conclusion: Atypical TPS beam modeling parameters are associated with failing phantom audits. This is identified as an important factor contributing to the observed failing phantom results, and highlights the need for accurate beam modeling.
Collapse
Affiliation(s)
- Mallory C Glenn
- Department of Radiation Oncology, University of Washington, Seattle, United States
| | - Fre'Etta Brooks
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, United States; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, United States
| | - Christine B Peterson
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, United States; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Rebecca M Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, United States; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, United States
| | - David S Followill
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, United States; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, United States
| | - Julianne M Pollard-Larkin
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, United States; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, United States
| | - Stephen F Kry
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, United States; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, United States.
| |
Collapse
|
14
|
Roncali E, Capala J, Benedict SH, Akabani G, Bednarz B, Bhadrasain V, Bolch WE, Buchsbaum JC, Coleman NC, Dewaraja YK, Frey E, Ghaly M, Grudzinski J, Hobbs RF, Howell RW, Humm JL, Kunos CA, Larson S, Lin FI, Madsen M, Mirzadeh S, Morse D, Pryma D, Sgouros G, St James S, Wahl RL, Xiao Y, Zanzonico P, Zukotynski K. Overview of the First NRG Oncology-National Cancer Institute Workshop on Dosimetry of Systemic Radiopharmaceutical Therapy. J Nucl Med 2021; 62:1133-1139. [PMID: 33277396 PMCID: PMC8833877 DOI: 10.2967/jnumed.120.255547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/20/2021] [Indexed: 11/16/2022] Open
Abstract
In 2018, the National Cancer Institute and NRG Oncology partnered for the first time to host a joint workshop on systemic radiopharmaceutical therapy (RPT) to specifically address dosimetry issues and strategies for future clinical trials. The workshop focused on current dosimetric approaches for clinical trials, strategies under development that would optimize dose reporting, and future desired or optimized approaches for novel emerging radionuclides and carriers in development. In this article, we review the main approaches that are applied clinically to calculate the absorbed dose. These include absorbed doses calculated over a variety of spatial scales, including whole body, organ, suborgan, and voxel, the last 3 of which are achievable within the MIRD schema (S value) and can be calculated with analytic methods or Monte Carlo methods, the latter in most circumstances. This article will also contrast currently available methods and tools with those used in the past, to propose a pathway whereby dosimetry helps the field by optimizing the biologic effect of the treatment and trial design in the drug approval process to reduce financial and logistical costs. We also briefly discuss the dosimetric equivalent of biomarkers to help bring a precision medicine approach to RPT implementation when merited by evidence collected during early-phase trial investigations. Advances in the methodology and related tools have made dosimetry the optimum biomarker for RPT.
Collapse
Affiliation(s)
| | | | | | | | - Bryan Bednarz
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Wesley E Bolch
- Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | | | | | | | - Eric Frey
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland
| | - Michael Ghaly
- Radiopharmaceutical Imaging and Dosimetry LLC (Rapid), Baltimore, Maryland
| | | | - Robert F Hobbs
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Roger W Howell
- Department of Radiology, Rutgers University, Newark, New Jersey
| | - John L Humm
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Steve Larson
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | | | - Daniel Pryma
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - George Sgouros
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland
| | - Sara St James
- University of California San Francisco, San Francisco, California
| | - Richard L Wahl
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Ying Xiao
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pat Zanzonico
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | |
Collapse
|
15
|
Pang T, Yang B, Liu X, Castle JR, Yu L, Liu N, Li W, Dong T, Qiu J, Chen Q. Investigation of absolute dose calibration accuracy for TomoTherapy using real water. J Appl Clin Med Phys 2021; 22:139-145. [PMID: 34060222 PMCID: PMC8200510 DOI: 10.1002/acm2.13311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/23/2021] [Accepted: 05/10/2021] [Indexed: 12/03/2022] Open
Abstract
A systematic bias in TomoTherapy output calibration was reported by the Imaging and Radiation Oncology Core Houston (IROC‐H) after analyzing intensity‐modulated radiation therapy (IMRT) credentialing results from hundreds of TomoTherapy units. Multiple theories were developed to explain this observation. One theory was that the use of a solid water “cheese” phantom instead of real water in the calibration measurement was the culprit. A phantom filled with distilled water was built to investigate whether our TomoTherapy was miscalibrated due to the use of a solid water phantom. A miscalibration of −1.47% was detected on our TomoTherapy unit. It is found that despite following the vendor's updated recommendation on computed tomography (CT) number to density calibration, the cheese phantom was still mapped to a density of 1.028 g/cm3, rather than the 1.01 g/cm3 value reported in literature. When the density of the cheese phantom was modified to 1.01 g/cm3 in the treatment planning system, the measurement also indicated that our TomoTherapy machine was miscalibrated by −1.52%, agreeing with the real water phantom findings. Our single‐institution finding showed that the cheese phantom density assignment can introduce greater than 1% errors in the TomoTherapy absolute dose calibration. It is recommended that the absolute dose calibration for TomoTherapy be performed either in real water or in the cheese phantom with the density in TPS overridden as 1.01 g/cm3.
Collapse
Affiliation(s)
- Tingtian Pang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Beijing, China
| | - Bo Yang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Beijing, China
| | - Xia Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Beijing, China
| | - James R Castle
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Lang Yu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Beijing, China
| | - Nan Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Beijing, China
| | - Wenbo Li
- Department of Radiation Oncology, Peking Union Medical College Hospital, Beijing, China
| | - Tingting Dong
- Department of Radiation Oncology, Peking Union Medical College Hospital, Beijing, China
| | - Jie Qiu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Beijing, China
| | - Quan Chen
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
16
|
Carlino A, Palmans H, Gouldstone C, Trnkova P, Noerrevang O, Vestergaard A, Freixas GV, Bosmans G, Lorentini S, Schwarz M, Koska B, Wulff J, Vatnitsky S, Stock M. Results of an independent dosimetry audit for scanned proton beam therapy facilities. Z Med Phys 2021; 31:145-153. [PMID: 33712295 DOI: 10.1016/j.zemedi.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/13/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE An independent dosimetry audit based on end-to-end testing of the entire chain of radiation therapy delivery is highly recommended to ensure consistent treatments among proton therapy centers. This study presents an auditing methodology developed by the MedAustron Ion Beam Therapy Center (Austria) in collaboration with the National Physical Laboratory (UK) and audit results for five scanned proton beam therapy facilities in Europe. METHODS The audit procedure used a homogeneous and an anthropomorphic head phantom. The phantoms were loaded either with an ionization chamber or with alanine pellets and radiochromic films. Homogeneously planned doses of 10Gy were delivered to a box-like target volume in the homogeneous phantom and to two clinical scenarios with increasing complexity in the head phantom. RESULTS For all tests the mean of the local differences of the absolute dose to water determined with the alanine pellets compared to the predicted dose from the treatment planning system installed at the audited institution was determined. The mean value taken over all tests performed was -0.1±1.0%. The measurements carried out with the ionization chamber were consistent with the dose determined by the alanine pellets with a mean deviation of -0.5±0.6%. CONCLUSION The developed dosimetry audit method was successfully applied at five proton centers including various "turn-key" Cyclotron solutions by IBA, Varian and Mevion. This independent audit with extension to other tumour sites and use of the correspondent anthropomorphic phantoms may be proposed as part of a credentialing procedure for future clinical trials in proton beam therapy.
Collapse
Affiliation(s)
- Antonio Carlino
- MedAustron Ion Therapy Center, Medical Physics, Wiener Neustadt, Austria.
| | - Hugo Palmans
- MedAustron Ion Therapy Center, Medical Physics, Wiener Neustadt, Austria; National Physical Laboratory, Teddington, United Kingdom
| | | | - Petra Trnkova
- HollandPTC, Huismansingel 4, Delft, The Netherlands; Erasmus MC, Department of Radiation Oncology, Rotterdam, The Netherlands
| | - Ole Noerrevang
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Vestergaard
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Gloria Vilches Freixas
- Maastro Proton Therapy, Department of Radiation Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Geert Bosmans
- Maastro Proton Therapy, Department of Radiation Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Stefano Lorentini
- Centro di Protonterapia, APSS, Via al Desert 14, 38122 Trento, Italy
| | - Marco Schwarz
- Centro di Protonterapia, APSS, Via al Desert 14, 38122 Trento, Italy; TIFPA-INFN, Trento, Italy
| | - Benjamin Koska
- West German Proton Therapy Centre Essen, Hufelandstr. 55, Essen, Germany; University Hospital Essen, Hufelandstr. 55, Essen, Germany
| | - Jörg Wulff
- West German Proton Therapy Centre Essen, Hufelandstr. 55, Essen, Germany; University Hospital Essen, Hufelandstr. 55, Essen, Germany
| | | | - Markus Stock
- MedAustron Ion Therapy Center, Medical Physics, Wiener Neustadt, Austria
| |
Collapse
|
17
|
Bouchard H. Reference dosimetry of modulated and dynamic photon beams. Phys Med Biol 2021; 65:24TR05. [PMID: 33438582 DOI: 10.1088/1361-6560/abc3fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In the late 1980s, a new technique was proposed that would revolutionize radiotherapy. Now referred to as intensity-modulated radiotherapy, it is at the core of state-of-the-art photon beam delivery techniques, such as helical tomotherapy and volumetric modulated arc therapy. Despite over two decades of clinical application, there are still no established guidelines on the calibration of dynamic modulated photon beams. In 2008, the IAEA-AAPM work group on nonstandard photon beam dosimetry published a formalism to support the development of a new generation of protocols applicable to nonstandard beam reference dosimetry (Alfonso et al 2008 Med. Phys. 35 5179-86). The recent IAEA Code of Practice TRS-483 was published as a result of this initiative and addresses exclusively small static beams. But the plan-class specific reference calibration route proposed by Alfonso et al (2008 Med. Phys. 35 5179-86) is a change of paradigm that is yet to be implemented in radiotherapy clinics. The main goals of this paper are to provide a literature review on the dosimetry of nonstandard photon beams, including dynamic deliveries, and to discuss anticipated benefits and challenges in a future implementation of the IAEA-AAPM formalism on dynamic photon beams.
Collapse
Affiliation(s)
- Hugo Bouchard
- Département de physique, Université de Montréal, Complexe des sciences, 1375 Avenue Thérèse-Lavoie-Roux, Montréal, Québec H2V 0B3, Canada. Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 Rue Saint-Denis, Montréal, Québec H2X 0A9, Canada. Département de radio-oncologie, Centre hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montréal, Québec H2X 3E4, Canada
| |
Collapse
|
18
|
Wortman BG, Astreinidou E, Laman MS, van der Steen-Banasik EM, Lutgens LCHW, Westerveld H, Koppe F, Slot A, van den Berg HA, Nowee ME, Bijmolt S, Stam TC, Zwanenburg AG, Mens JWM, Jürgenliemk-Schulz IM, Snyers A, Gillham CM, Weidner N, Kommoss S, Vandecasteele K, Tomancova V, Creutzberg CL, Nout RA. Brachytherapy quality assurance in the PORTEC-4a trial for molecular-integrated risk profile guided adjuvant treatment of endometrial cancer. Radiother Oncol 2020; 155:160-166. [PMID: 33159971 DOI: 10.1016/j.radonc.2020.10.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The PORTEC-4a trial investigates molecular-integrated risk profile guided adjuvant treatment for endometrial cancer. The quality assurance programme included a dummy run for vaginal brachytherapy prior to site activation, and annual quality assurance to verify protocol adherence. Aims of this study were to evaluate vaginal brachytherapy quality and protocol adherence. METHODS For the dummy run, institutes were invited to create a brachytherapy plan on a provided CT-scan with the applicator in situ. For annual quality assurance, institutes provided data of one randomly selected brachytherapy case. A brachytherapy panel reviewed and scored the brachytherapy plans according to a checklist. RESULTS At the dummy run, 15 out of 21 (71.4%) institutes needed adjustments of delineation or planning. After adjustments, the mean dose at the vaginal apex (protocol: 100%; 7 Gy) decreased from 100.7% to 99.9% and range and standard deviation (SD) narrowed from 83.6-135.1 to 96.4-101.4 and 8.8 to 1.1, respectively. At annual quality assurance, 22 out of 27 (81.5%) cases had no or minor and 5 out of 27 (18.5%) major deviations. Most deviations were related to delineation, mean dose at the vaginal apex (98.0%, 74.7-114.2, SD 7.6) or reference volume length. CONCLUSIONS Most feedback during the brachytherapy quality assurance procedure of the PORTEC-4a trial was related to delineation, dose at the vaginal apex and the reference volume length. Annual quality assurance is essential to promote protocol compliance, ensuring high quality vaginal brachytherapy in all participating institutes.
Collapse
Affiliation(s)
- B G Wortman
- Department of Radiation Oncology, Leiden University Medical Centre, The Netherlands.
| | - E Astreinidou
- Department of Radiation Oncology, Leiden University Medical Centre, The Netherlands
| | - M S Laman
- Department of Radiation Oncology, Leiden University Medical Centre, The Netherlands
| | | | | | - H Westerveld
- Department of Radiation Oncology, Amsterdam University Medical Centres, University of Amsterdam, The Netherlands
| | - F Koppe
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands
| | - A Slot
- Radiotherapy Institute Friesland, Leeuwarden, The Netherlands
| | - H A van den Berg
- Department of Radiation Oncology, Catharina Hospital Eindhoven, The Netherlands
| | - M E Nowee
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Bijmolt
- Department of Radiation Oncology, University Medical Centre Groningen, The Netherlands
| | - T C Stam
- Department of Radiation Oncology, Haaglanden Medical Centre, Leidschendam, The Netherlands
| | - A G Zwanenburg
- Department of Radiation Oncology, Zwolle, The Netherlands
| | - J W M Mens
- Department of Radiation Oncology, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands
| | | | - A Snyers
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C M Gillham
- Department of Radiation Oncology, St Luke's Radiation Oncology Network, Dublin 6, Ireland
| | - N Weidner
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University, Germany
| | - S Kommoss
- Department of Women's Health, Tübingen University Hospital, Germany
| | - K Vandecasteele
- Department of Radiation Oncology, Ghent University Hospital, Belgium
| | - V Tomancova
- Department of Clinical Oncology, General Teaching Hospital, First Medical School, Charles University, Prague, Czech Republic
| | - C L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Centre, The Netherlands
| | - R A Nout
- Department of Radiation Oncology, Leiden University Medical Centre, The Netherlands
| | | |
Collapse
|
19
|
Zhao W, Patil I, Han B, Yang Y, Xing L, Schüler E. Beam data modeling of linear accelerators (linacs) through machine learning and its potential applications in fast and robust linac commissioning and quality assurance. Radiother Oncol 2020; 153:122-129. [PMID: 33039427 DOI: 10.1016/j.radonc.2020.09.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE To propose a novel machine learning-based method for reliable and accurate modeling of linac beam data applicable to the processes of linac commissioning and QA. MATERIALS AND METHODS We hypothesize that the beam data is a function of inherent linac features and percentage depth doses (PDDs) and profiles of different field sizes are correlated with each other. The correlation is formulated as a multivariable regression problem using a machine learning framework. Varian TrueBeam beam data sets (n = 43) acquired from multiple institutions were used to evaluate the framework. The data sets included PDDs and profiles across different energies and field sizes. A multivariate regression model was trained for prediction of beam specific PDDs and profiles of different field sizes using a 10 × 10 cm2 field as input. RESULTS Predictions of PDDs were achieved with a mean absolute percent relative error (%RE) of 0.19-0.35% across the different beam energies investigated. The maximum mean absolute %RE was 0.93%. For profile prediction, the mean absolute %RE was 0.66-0.93% with a maximum absolute %RE of 3.76%. The largest uncertainties in the PDD and profile predictions were found at the build-up region and at the field penumbra, respectively. The prediction accuracy increased with the number of training sets up to around 20 training sets. CONCLUSIONS Through this novel machine learning-based method we have shown accurate and reproducible generation of beam data for linac commissioning for routine radiation therapy. This method has the potential to simplify the linac commissioning procedure, save time and manpower while increasing the accuracy of the commissioning process.
Collapse
Affiliation(s)
- Wei Zhao
- Stanford University, Department of Radiation Oncology, Stanford, CA 94305, USA.
| | - Ishan Patil
- Stanford University, Department of Radiation Oncology, Stanford, CA 94305, USA
| | - Bin Han
- Stanford University, Department of Radiation Oncology, Stanford, CA 94305, USA.
| | - Yong Yang
- Stanford University, Department of Radiation Oncology, Stanford, CA 94305, USA.
| | - Lei Xing
- Stanford University, Department of Radiation Oncology, Stanford, CA 94305, USA.
| | - Emil Schüler
- Stanford University, Department of Radiation Oncology, Stanford, CA 94305, USA; The University of Texas MD Anderson Cancer Center, Department of Radiation Physics, Houston, TX 77030, USA.
| |
Collapse
|
20
|
Tamura M, Monzen H, Matsumoto K, Otsuka M, Nishimura Y, Okumura M. Design of commissioning process for Halcyon™ linac with a new rigid board: A clinical experience. Phys Med 2020; 77:121-126. [DOI: 10.1016/j.ejmp.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/15/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022] Open
|
21
|
Knutson NC, Schmidt MC, Reynoso FJ, Hao Y, Mazur TR, Laugeman E, Hugo G, Mutic S, Li HH, Ngwa W, Cai B, Sajo E. Automated and robust beam data validation of a preconfigured ring gantry linear accelerator using a 1D tank with synchronized beam delivery and couch motions. J Appl Clin Med Phys 2020; 21:200-207. [PMID: 32614511 PMCID: PMC7484825 DOI: 10.1002/acm2.12946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/25/2020] [Accepted: 05/12/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To develop an efficient and automated methodology for beam data validation for a preconfigured ring gantry linear accelerator using scripting and a one-dimensional (1D) tank with automated couch motions. MATERIALS AND METHODS Using an application programming interface, a program was developed to allow the user to choose a set of beam data to validate with measurement. Once selected the program generates a set of instructions for radiation delivery with synchronized couch motions for the linear accelerator in the form of an extensible markup language (XML) file to be delivered on the ring gantry linear accelerator. The user then delivers these beams while measuring with the 1D tank and data logging electrometer. The program also automatically calculates this set of beams on the measurement geometry within the treatment planning system (TPS) and extracts the corresponding calculated dosimetric data for comparison to measurement. Once completed the program then returns a comparison of the measurement to the predicted result from the TPS to the user and prints a report. In this work lateral, longitudinal, and diagonal profiles were taken for fields sizes of 6 × 6, 8 × 8, 10 × 10, 20 × 20, and 28 × 28 cm2 at depths of 1.3, 5, 10, 20, and 30 cm. Depth dose profiles were taken for all field sizes. RESULTS Using this methodology, the TPS was validated to agree with measurement. All compared points yielded a gamma value less than 1 for a 1.5%/1.5 mm criteria (100% passing rate). Off axis profiles had >98.5% of data points producing a gamma value <1 with a 1%/1 mm criteria. All depth profiles produced 100% of data points with a gamma value <1 with a 1%/1 mm criteria. All data points measured were within 1.5% or 2 mm distance to agreement. CONCLUSIONS This methodology allows for an increase in automation in the beam data validation process. Leveraging the application program interface allows the user to use a single system to create the measurement files, predict the result, and then compare to actual measurement increasing efficiency and reducing the chance for user input errors.
Collapse
Affiliation(s)
- Nels C Knutson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Physics, University of Massachusetts Lowell, Lowell, MA, USA
| | - Matthew C Schmidt
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Physics, University of Massachusetts Lowell, Lowell, MA, USA
| | - Francisco J Reynoso
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Yao Hao
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Thomas R Mazur
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric Laugeman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Geoffrey Hugo
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - H Harold Li
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Wilfred Ngwa
- Department of Physics, University of Massachusetts Lowell, Lowell, MA, USA
| | - Bin Cai
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Erno Sajo
- Department of Physics, University of Massachusetts Lowell, Lowell, MA, USA
| |
Collapse
|
22
|
Wright JL, Terezakis SA, Ford E. Safety First: Developing and Deploying a System to Promote Safety and Quality in Your Clinic. Pract Radiat Oncol 2020; 11:92-100. [PMID: 32450366 DOI: 10.1016/j.prro.2020.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/02/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Abstract
The terms "safety and quality" (SAQ) have become inextricably linked, highly used terms that together encompass a wide range of parameters within medical departments. Safety has always been a priority in radiation oncology; quality assurance has been foundational to our practice. Despite this increased focus and attention on SAQ, the "what" of SAQ remains ill-defined, largely because of the vast number of indicators that fall under this umbrella. Similarly, the "how" of developing and maintaining the highest standards of SAQ is not formulaic and varies based on the unique setting of individual practices. There are several excellent resources available to inform SAQ in radiation oncology, including the American Society for Radiation Oncology's "Safety Is No Accident," which provides an overview of safety and quality standards and resources. This review is intended as a brief summary of key considerations, with the goal of providing a practical framework and context for improving or developing a SAQ program in radiation oncology practices. We believe that the following 10 key elements, drawn from numerous reports that have appeared over the last decade examining this topic, should be considered when conceptualizing a practice-based approach to SAQ: establishing a strong safety culture; establishing a structured program for safety and quality; establishing up-to-date, relevant, and accessible policies and procedures; a system for peer review; systems to assess and reduce risk; an educational program focused on safety and quality; development and review of meaningful quality metrics; utilization of a physics quality control system; well-defined models for staffing, training, and professional development; and finally, validation from external bodies via accreditations and audits. These 10 items are addressed herein.
Collapse
Affiliation(s)
- Jean L Wright
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland.
| | | | - Eric Ford
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| |
Collapse
|
23
|
Edward SS, Alvarez PE, Taylor PA, Molineu HA, Peterson CB, Followill DS, Kry SF. Differences in the Patterns of Failure Between IROC Lung and Spine Phantom Irradiations. Pract Radiat Oncol 2020; 10:372-381. [PMID: 32413413 DOI: 10.1016/j.prro.2020.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/16/2020] [Accepted: 04/17/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Our purpose was to investigate and classify the reasons why institutions fail the Imaging and Radiation Oncology Core (IROC) stereotactic body radiation therapy (SBRT) spine and moving lung phantoms, which are used to credential institutions for clinical trial participation. METHODS AND MATERIALS All IROC moving lung and SBRT spine phantom irradiation failures recorded from January 2012 to December 2018 were evaluated in this study. A failure was a case where the institution did not meet the established IROC criteria for agreement between planned and delivered dose. We analyzed the reports for all failing irradiations, including point dose disagreement, dose profiles, and gamma analyses. Classes of failure patterns were created and used to categorize each instance. RESULTS There were 158 failing cases analyzed: 116 of 1052 total lung irradiations and 42 of 263 total spine irradiations. Seven categories were required to describe the lung phantom failures, whereas 4 were required for the spine. Types of errors present in both phantom groups included systematic dose and localization errors. Fifty percent of lung failures were due to a superior-inferior localization error, that is, error in the direction of major motion. Systematic dose errors, however, contributed to only 22% of lung failures. In contrast, the majority (60%) of spine phantom failures were due to systematic dose errors, with localization errors (in any direction) accounting for only 14% of failures. CONCLUSIONS There were 2 distinct patterns of failure between the IROC moving lung and SBRT spine phantoms. The majority of the lung phantom failures were due to localization errors, whereas the spine phantom failures were largely attributed to systematic dose errors. Both of these errors are clinically relevant and could manifest as errors in patient cases. These findings highlight the value of independent end-to-end dosimetry audits and can help guide the community in improving the quality of radiation therapy by focusing attention on where errors manifest in the community.
Collapse
Affiliation(s)
- Sharbacha S Edward
- UT Health Graduate School of Biomedical Sciences, Houston, Texas; IROC Houston Quality Assurance Center, Houston, Texas; Department of Radiation Physics, Houston, Texas
| | - Paola E Alvarez
- IROC Houston Quality Assurance Center, Houston, Texas; Department of Radiation Physics, Houston, Texas
| | - Paige A Taylor
- UT Health Graduate School of Biomedical Sciences, Houston, Texas; IROC Houston Quality Assurance Center, Houston, Texas; Department of Radiation Physics, Houston, Texas
| | - H Andrea Molineu
- IROC Houston Quality Assurance Center, Houston, Texas; Department of Radiation Physics, Houston, Texas
| | - Christine B Peterson
- UT Health Graduate School of Biomedical Sciences, Houston, Texas; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David S Followill
- UT Health Graduate School of Biomedical Sciences, Houston, Texas; IROC Houston Quality Assurance Center, Houston, Texas; Department of Radiation Physics, Houston, Texas
| | - Stephen F Kry
- UT Health Graduate School of Biomedical Sciences, Houston, Texas; IROC Houston Quality Assurance Center, Houston, Texas; Department of Radiation Physics, Houston, Texas.
| |
Collapse
|
24
|
Kry SF, Alvarez P, Cygler JE, DeWerd LA, Howell RM, Meeks S, O'Daniel J, Reft C, Sawakuchi G, Yukihara EG, Mihailidis D. AAPM TG 191: Clinical use of luminescent dosimeters: TLDs and OSLDs. Med Phys 2019; 47:e19-e51. [DOI: 10.1002/mp.13839] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Stephen F. Kry
- The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Paola Alvarez
- The University of Texas MD Anderson Cancer Center Houston TX USA
| | | | | | | | - Sanford Meeks
- University of Florida Health Cancer Center Orlando FL USA
| | | | | | | | | | | |
Collapse
|
25
|
Dosimetric Multicenter Planning Comparison Studies for Stereotactic Body Radiation Therapy: Methodology and Future Perspectives. Int J Radiat Oncol Biol Phys 2019; 106:403-412. [PMID: 31707124 DOI: 10.1016/j.ijrobp.2019.10.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/03/2019] [Accepted: 10/25/2019] [Indexed: 12/22/2022]
Abstract
In this review a summary of the published literature pertaining to the stereotactic body radiation therapy multiplanning comparison, data sharing strategies, and implementation of benchmark planning cases to improve the skills and knowledge of the participating centers was investigated. A total of 30 full-text articles were included. The studies were subdivided in 3 categories: multiplanning studies on dosimetric variability, planning harmonization before clinical trials, and technical and methodologic studies. The methodology used in the studies were critically analyzed to find common and original elements with the pros and cons. Multicenter planning studies have played a key role in improving treatment plan harmonization, treatment plan compliance, and even clinical practices. This review has highlighted that some fundamental steps should be taken to transform a simple treatment planning comparison study into a potential credentialing method for stereotactic body radiation therapy accreditation. In particular, prescription and general requirements should always be well defined; data analysis should be performed with independent dose volume histogram or dose calculations; quality score indices should be constructed; feedback and correction strategies should be provided; and a simple web-based collaboration platform should be used. The results reported clearly showed that a crowd-based replanning approach is a viable method for achieving harmonization and standardization of treatment planning among centers using different technologies.
Collapse
|
26
|
Kumar L, Yadav G, Kishore V, Bhushan M, Gairola M, Tripathi D. Validation of the RapidArc Delivery System Using a Volumetric Phantom as Per Task Group Report 119 of the American Association of Physicists in Medicine. J Med Phys 2019; 44:126-134. [PMID: 31359931 PMCID: PMC6580814 DOI: 10.4103/jmp.jmp_118_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aim This study validated the RapidArc (RA) delivery using a volumetric ArcCHECK phantom as per the guidelines proposed in Task Group Report 119 from the American Association of Physicists in Medicine Task group 119 (AAPM TG 119). This study also investigated the impact of the Acuros XB (AXB) algorithm in comparison to analytical anisotropic algorithm (AAA) on the RA dose calculations in the homogeneous medium of the ArcCHECK phantom. Materials and Methods A volumetric ArcCHECK phantom along with AAPM TG 119 tests was used to evaluate the RA plans and verify the dose delivery for photon beam of 6 MV energy. Results The RA planning results were comparable and satisfied the planning criteria stated in the TG 119 report for all test cases. The average percentage gamma passing rates for the AAA-calculated plans were 98.5 (standard deviation [SD]: 0.6), 98.5 (SD: 1.3), and 98.1 (SD: 2.0) and for the AXB-calculated plans were 95.1 (SD: 1.8), 96.1 (SD: 1.3), and 94.0 (SD: 0.9) for the Clinac-iX (6 MV) and TrueBeam (TB)-STx (6 MV_filtered beam [FB] and 6 MV_flattening filter-free beam [FFFB]), respectively. For ion chamber measurements, the average percentage dose differences for the AAA-calculated plans were 1.5 (SD: 2.5), 2.7 (SD: 1.4), and 1.4(SD: 2.7) and for AXB-calculated plans were 2.3 (SD: 1.6), 3.2 (SD: 1.5), and 2.3 (SD: 2.0) for Clinac-iX (6 MV) and TB-STx (6 MV_FB and 6 MV_FFFB), respectively. Conclusion Thus, the ArcCHECK can successfully be utilized for the validation of the RA delivery. The AXB has potential to perform dose calculations comparable to those of the AAA for RA plans in the homogeneous medium of the ArcCHECK phantom.
Collapse
Affiliation(s)
- Lalit Kumar
- Department of Radiation Oncology, Division of Medical Physics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.,Department of Applied Science and Humanities, Dr. A.P.J Abdul Kalam Technical University, Lucknow, Uttar Pradesh, India
| | - Girigesh Yadav
- Department of Radiation Oncology, Division of Medical Physics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Vimal Kishore
- Department of Applied Science and Humanities, Bundelkhand Institute of Engineering and Technology, Jhansi, Uttar Pradesh, India
| | - Manindra Bhushan
- Department of Radiation Oncology, Division of Medical Physics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.,Department of Applied Science, Amity School of Applied Sciences, Amity University, Noida, Uttar Pradesh, India
| | - Munish Gairola
- Department of Radiation Oncology, Division of Medical Physics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Deepak Tripathi
- Department of Applied Science, Amity School of Applied Sciences, Amity University, Noida, Uttar Pradesh, India
| |
Collapse
|
27
|
Pan Y, Yang R, Zhang S, Li J, Dai J, Wang J, Cai J. National survey of patient specific IMRT quality assurance in China. Radiat Oncol 2019; 14:69. [PMID: 31023348 PMCID: PMC6482589 DOI: 10.1186/s13014-019-1273-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 04/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To analyze and present the China's national survey on patient-specific IMRT quality assurance (QA). METHODS A national survey was conducted in all radiotherapy centers in China to collect comprehensive information on status of IMRT QA practice, including machine, technique, equipment, issues and suggestions. RESULTS Four hundred and three centers responded to this survey, accounting for 56.92% of all the centers implementing IMRT in China. The total number of medical physicists and the total number of patients treated with IMRT annually in these centers was 1599 and 305,000 respectively. All centers implemented measurement-based verification. Point dose verification and 2D dose verification was implemented in 331 and 399 centers, respectively. Three hundred forty-eight centers had 2D arrays, and 52 centers had detector devices designed to measure VMAT beams. EPID and film were used in 78 and 70 centers, respectively. Seventeen and 20 centers used log file and 3D DVH analysis, respectively. One hundred sixty-eight centers performed measurement-based verification not for each patient based on different selection criteria. The techniques and methods varied significantly in both point dose and dose distribution verification, from evaluation metrics, criteria, tolerance limit, and steps to check failed IMRT QA plans. Major issues identified in this survey were the limited resources of physicists, QA devices, and linacs. CONCLUSIONS IMRT QA was implemented in all the surveyed centers. The practice of IMRT QA varied significantly between centers. An increase in personnel, QA devices and linacs is highly desired. National standard, guideline, regulation and training programs are urgently needed in China for consistent and effective implementation of IMRT QA.
Collapse
Affiliation(s)
- Yuxi Pan
- Department of Radiation Oncology, Peking University Third Hospital, 49th North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Ruijie Yang
- Department of Radiation Oncology, Peking University Third Hospital, 49th North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
| | - Shuming Zhang
- Department of Radiation Oncology, Peking University Third Hospital, 49th North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Jiaqi Li
- Department of Radiation Oncology, Peking University Third Hospital, 49th North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Jianrong Dai
- Department of Radiation Oncology, Chinese Academy of Medical Science Cancer Institute, 17 Panjiayuan Nanli, Beijing, People's Republic of China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, 49th North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Jing Cai
- Department of Health Technology and Informatics, The Hongkong Polytechnic University, Hongkong, People's Republic of China
| |
Collapse
|
28
|
Kron T, Hardcastle N. SABR in clinical trials: what quality assurance (QA) is required and how can it be done? ACTA ACUST UNITED AC 2019. [DOI: 10.1088/1742-6596/1154/1/012014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
29
|
Johnson JE, Beltran C, Wan Chan Tseung H, Mundy DW, Kruse JJ, Whitaker TJ, Herman MG, Furutani KM. Highly efficient and sensitive patient-specific quality assurance for spot-scanned proton therapy. PLoS One 2019; 14:e0212412. [PMID: 30763390 PMCID: PMC6375645 DOI: 10.1371/journal.pone.0212412] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/02/2019] [Indexed: 12/02/2022] Open
Abstract
The purpose of this work was to develop an end-to-end patient-specific quality assurance (QA) technique for spot-scanned proton therapy that is more sensitive and efficient than traditional approaches. The patient-specific methodology relies on independently verifying the accuracy of the delivered proton fluence and the dose calculation in the heterogeneous patient volume. A Monte Carlo dose calculation engine, which was developed in-house, recalculates a planned dose distribution on the patient CT data set to verify the dose distribution represented by the treatment planning system. The plan is then delivered in a pre-treatment setting and logs of spot position and dose monitors, which are integrated into the treatment nozzle, are recorded. A computational routine compares the delivery log to the DICOM spot map used by the Monte Carlo calculation to ensure that the delivered parameters at the machine match the calculated plan. Measurements of dose planes using independent detector arrays, which historically are the standard approach to patient-specific QA, are not performed for every patient. The nozzle-integrated detectors are rigorously validated using independent detectors in regular QA intervals. The measured data are compared to the expected delivery patterns. The dose monitor reading deviations are reported in a histogram, while the spot position discrepancies are plotted vs. spot number to facilitate independent analysis of both random and systematic deviations. Action thresholds are linked to accuracy of the commissioned delivery system. Even when plan delivery is acceptable, the Monte Carlo second check system has identified dose calculation issues which would not have been illuminated using traditional, phantom-based measurement techniques. The efficiency and sensitivity of our patient-specific QA program has been improved by implementing a procedure which independently verifies patient dose calculation accuracy and plan delivery fidelity. Such an approach to QA requires holistic integration and maintenance of patient-specific and patient-independent QA.
Collapse
Affiliation(s)
- J. E. Johnson
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - C. Beltran
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - H. Wan Chan Tseung
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - D. W. Mundy
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - J. J. Kruse
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - T. J. Whitaker
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - M. G. Herman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - K. M. Furutani
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States of America
| |
Collapse
|
30
|
Tanaka Y, Mizuno H, Akino Y, Isono M, Masai N, Yamamoto T. Do the representative beam data for TrueBeam ™ linear accelerators represent average data? J Appl Clin Med Phys 2019; 20:51-62. [PMID: 30636358 PMCID: PMC6370991 DOI: 10.1002/acm2.12518] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/05/2018] [Accepted: 11/26/2018] [Indexed: 11/11/2022] Open
Abstract
If the vendor's representative beam data (RBD) for TrueBeam linear accelerators are to be valid for use in clinical practice, the variations in the beam data used for beam modeling must be small. Although a few studies have reported the variation of the beam data of the TrueBeam machines, the numbers of machines analyzed in those studies were small. In this study, we investigated the variation in the beam data for 21 TrueBeam machines collected from 17 institutions with their agreement. In the exponential regions, the percent depth dose (PDD) values showed very small variation, <1% for all the photon energies analyzed. Similarly, the off‐center ratio (OCR) values also showed small variation for all energies. In the field regions, the standard deviations of the values of dose difference (DD) between the data for each machine and the study average were <1% for field sizes ≥100 × 100 mm2. The maximum distance‐to‐agreement from the average data was <0.5 mm in the penumbra regions. The output factor (OPF) values also showed very small variation (<1%) for all energies and field sizes. Both the PDD and OCR of the average study data showed good agreement with the vendor's RBD for field sizes ≥100 × 100 mm2. The OPF of the average study data also showed good agreement with the vendor's RBD for all field sizes. However, although all the institutions used ionization chambers with similar cavity volumes, the 30 × 30 mm2 field size showed large DD variations (≥2%) in OCR in the field regions. We conclude that the intermachine variability of TrueBeam linear accelerators was very small except for small field dosimetry, supporting the validity of the use of the RBD for clinical applications. The use of the vendor's RBD might greatly facilitate the quick installation of a new linear accelerator.
Collapse
Affiliation(s)
- Yoshihiro Tanaka
- Department of Radiation Therapy, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto-shi, Kyoto, Japan
| | - Hirokazu Mizuno
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita-shi, Osaka, Japan
| | - Yuichi Akino
- Oncology Center, Osaka University Hospital, Suita-shi, Osaka, Japan
| | - Masaru Isono
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka-shi, Osaka, Japan
| | | | - Toshijiro Yamamoto
- Department of Radiology, Saiseikai Noe Hospital, Osaka-shi, Osaka, Japan
| |
Collapse
|
31
|
Mizuno H, Fukumura A, Kanematsu N, Yonai S, Shirai T, Yusa K, Yanou T, Suga M, Mizota M, Minohara S, Kanai T, Kamada T. External dosimetry audit for quality assurance of carbon-ion radiation therapy clinical trials. J Appl Clin Med Phys 2019; 20:31-36. [PMID: 30387294 PMCID: PMC6333139 DOI: 10.1002/acm2.12465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/16/2018] [Accepted: 08/28/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The QA team of the Japan carbon-ion radiation oncology study group (J-CROS) was organized in 2015 to enhance confidence in the accuracy of clinical dosimetry and ensure that the facility QA procedures are adequate. The team conducted onsite dosimetry audits in all the carbon-ion radiation therapy centers in Japan. MATERIALS AND METHODS A special phantom was fabricated for the onsite dosimetry audit. Target volumes such as the GTV, CTV, and PTV were contoured to the obtained CT images, and two plans with different isocenter depths were created. The dose at the isocenter was measured by an ionization chamber, in the onsite audit and compared with the calculated dose. RESULTS For all the centers, the average of the percentage ratio between the measured and calculated doses (measured/calculated) was 0.5% (-2.7% to +2.6%) and the standard deviation, 1.7%. In all the centers, the beams were within the set tolerance level of 3%. CONCLUSIONS The audit demonstrated that the dose at a single point in the water phantom was within tolerance, but it is a big step to say that all doses are correct. In addition, this external dosimetry audit encouraged centers to improve the quality of their dosimetry systems.
Collapse
Affiliation(s)
| | | | | | - Shunsuke Yonai
- National Institute of Radiological Sciences, QSTChibaJapan
| | | | - Ken Yusa
- Gunma University Heavy Ion Medical CenterGunmaJapan
| | | | - Masaki Suga
- Hyogo Ion Beam Medical CenterTatsunoHyōgoJapan
| | - Manabu Mizota
- Ion Beam Therapy CenterSAGA HIMAT FoundationSagaJapan
| | | | - Tatsuaki Kanai
- Gunma University Heavy Ion Medical CenterGunmaJapan
- Present address:
Tatsuaki KanaiOsaka Heavy Ion Therapy CenterOsakaJapan
| | - Tadashi Kamada
- National Institute of Radiological Sciences, QSTChibaJapan
| |
Collapse
|
32
|
De Roover R, Crijns W, Poels K, Michiels S, Nulens A, Vanstraelen B, Petillion S, De Brabandere M, Haustermans K, Depuydt T. Validation and IMRT/VMAT delivery quality of a preconfigured fast‐rotating O‐ring linac system. Med Phys 2018; 46:328-339. [DOI: 10.1002/mp.13282] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Robin De Roover
- Department of Oncology Laboratory of Experimental Radiotherapy KU Leuven – University of Leuven Herestraat 49 B‐3000 Leuven Belgium
| | - Wouter Crijns
- Department of Oncology Laboratory of Experimental Radiotherapy KU Leuven – University of Leuven Herestraat 49 B‐3000 Leuven Belgium
- Department of Radiation Oncology University Hospitals Leuven Herestraat 49 B‐3000 Leuven Belgium
| | - Kenneth Poels
- Department of Radiation Oncology University Hospitals Leuven Herestraat 49 B‐3000 Leuven Belgium
| | - Steven Michiels
- Department of Oncology Laboratory of Experimental Radiotherapy KU Leuven – University of Leuven Herestraat 49 B‐3000 Leuven Belgium
| | - An Nulens
- Department of Radiation Oncology University Hospitals Leuven Herestraat 49 B‐3000 Leuven Belgium
| | - Bianca Vanstraelen
- Department of Radiation Oncology University Hospitals Leuven Herestraat 49 B‐3000 Leuven Belgium
| | - Saskia Petillion
- Department of Radiation Oncology University Hospitals Leuven Herestraat 49 B‐3000 Leuven Belgium
| | - Marisol De Brabandere
- Department of Radiation Oncology University Hospitals Leuven Herestraat 49 B‐3000 Leuven Belgium
| | - Karin Haustermans
- Department of Oncology Laboratory of Experimental Radiotherapy KU Leuven – University of Leuven Herestraat 49 B‐3000 Leuven Belgium
- Department of Radiation Oncology University Hospitals Leuven Herestraat 49 B‐3000 Leuven Belgium
| | - Tom Depuydt
- Department of Oncology Laboratory of Experimental Radiotherapy KU Leuven – University of Leuven Herestraat 49 B‐3000 Leuven Belgium
- Department of Radiation Oncology University Hospitals Leuven Herestraat 49 B‐3000 Leuven Belgium
| |
Collapse
|
33
|
Quality assurance of volumetric-modulated arc therapy head and neck cancer treatment using PRESAGE ® dosimeter. JOURNAL OF RADIOTHERAPY IN PRACTICE 2018. [DOI: 10.1017/s146039691800016x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackgroundAccurate three-dimensional dosimetry is essential in modern radiotherapy techniques such as volumetric-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT). In this research work, the PRESAGE® dosimeter was used as quality assurance (QA) tool for VMAT planning for head and neck (H&N) cancer.Material and methodComputer tomography (CT) scans of an Image Radiation Oncology Core (IROC) H&N anthropomorphic phantom with both IROC standard insert and PRESAGE® insert were acquired separately. Both CT scans were imported into the Pinnacle (9.4 version) TPS for treatment planning, where the structures [planning target volume (PTV), organs at risk) and thermoluminescent detectors (TLDs) were manually contoured and used to optimise a VMAT plan. Treatment planning was done using VMAT (dual arc: 182°–178°, 178°–182°). Beam profile comparisons and gamma analysis were used to quantify agreement with film, PRESAGE® measurement and treatment planning system (TPS) calculated dose distribution.ResultsThe average ratio of TLD measured to calculated doses at the four PTV locations in the H&N phantom were between 0·95 to 0·99 for all three VMAT deliveries. Dose profiles were taken along the left–right, the anterior–posterior and superior–inferior axes, and good agreement was found between the PRESAGE® and Pinnacle profile. The mean value of gamma results for three VMAT deliveries in axial and sagittal planes were found to be 94·24 and 93·16% when compared with film and Pinnacle, respectively. The average values comparing the PRESAGE® results and dose values calculated on Pinnacle were observed to be 95·29 and 94·38% in the said planes, respectively, using a 5%/3 mm gamma criteria.ConclusionThe PRESAGE® dose measurements and calculated dose of pinnacle show reasonable agreement in both axial and sagittal planes for complex dual arc VMAT treatment plans. In general, the PRESAGE® dosimeter is found to be a feasible QA tool of VMAT plan for H&N cancer treatment.
Collapse
|
34
|
Knutson NC, Schmidt MC, Belley MD, Nguyen N, Price M, Mutic S, Sajo E, Li HH. Equivalency of beam scan data collection using a 1D tank and automated couch movements to traditional 3D tank measurements. J Appl Clin Med Phys 2018; 19:60-67. [PMID: 30188009 PMCID: PMC6236829 DOI: 10.1002/acm2.12444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 07/16/2018] [Accepted: 08/04/2018] [Indexed: 12/18/2022] Open
Abstract
This work shows the feasibility of collecting linear accelerator beam data using just a 1‐D water tank and automated couch movements with the goal to maximize the cost effectiveness in resource‐limited clinical settings. Two commissioning datasets were acquired: (a) using a standard of practice 3D water tank scanning system (3DS) and (b) using a novel technique to translate a commercial TG‐51 complaint 1D water tank via automated couch movements (1DS). The Extensible Markup Language (XML) was used to dynamically move the linear accelerator couch position (and thus the 1D tank) during radiation delivery for the acquisition of inline, crossline, and diagonal profiles. Both the 1DS and 3DS datasets were used to generate beam models (BM1DS and BM3DS) in a commercial treatment planning system (TPS). 98.7% of 1DS measured points had a gamma value (2%/2 mm) < 1 when compared with the 3DS. Static jaw defined field and dynamic MLC field dose distribution comparisons for the TPS beam models BM1DS and BM3DS had 3D gamma values (2%/2 mm) < 1 for all 24,900,000 data points tested and >99.5% pass rate with gamma value (1%/1 mm) < 1. In conclusion, automated couch motions and a 1D scanning tank were used to collect commissioning beam data with accuracy comparable to traditionally acquired data using a 3D scanning system. TPS beam models generated directly from 1DS measured data were clinically equivalent to a model derived from 3DS data.
Collapse
Affiliation(s)
- Nels C Knutson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA.,Medical Physics Program, University of Massachusetts Lowell, Lowell, MA, 01852, USA.,Department of Radiation Oncology, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Matthew C Schmidt
- Medical Physics Program, University of Massachusetts Lowell, Lowell, MA, 01852, USA.,Department of Radiation Oncology, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI, 02903, USA.,Education Department, Varian Medical Systems, Las Vegas, NV, 89119, USA
| | - Matthew D Belley
- Department of Radiation Oncology, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI, 02903, USA.,Department of Physics, University of Rhode Island, Kingston, RI, 02881, USA
| | - Ngoc Nguyen
- Department of Radiation Oncology, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI, 02903, USA.,Department of Physics, University of Rhode Island, Kingston, RI, 02881, USA
| | - Michael Price
- Department of Radiation Oncology, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI, 02903, USA.,Department of Physics, University of Rhode Island, Kingston, RI, 02881, USA
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Erno Sajo
- Medical Physics Program, University of Massachusetts Lowell, Lowell, MA, 01852, USA
| | - H Harold Li
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| |
Collapse
|
35
|
Okamoto H, Minemura T, Nakamura M, Mizuno H, Tohyama N, Nishio T, Wakita A, Nakamura S, Nishioka S, Iijima K, Fujiyama D, Itami J, Nishimura Y. Establishment of postal audit system in intensity-modulated radiotherapy by radiophotoluminescent glass dosimeters and a radiochromic film. Phys Med 2018; 48:119-126. [DOI: 10.1016/j.ejmp.2018.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/24/2018] [Accepted: 03/23/2018] [Indexed: 10/17/2022] Open
|
36
|
Lehmann J, Alves A, Dunn L, Shaw M, Kenny J, Keehan S, Supple J, Gibbons F, Manktelow S, Oliver C, Kron T, Williams I, Lye J. Dosimetric end-to-end tests in a national audit of 3D conformal radiotherapy. Phys Imaging Radiat Oncol 2018; 6:5-11. [PMID: 33458381 PMCID: PMC7807562 DOI: 10.1016/j.phro.2018.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Independent dosimetry audits improve quality and safety of radiation therapy. This work reports on design and findings of a comprehensive 3D conformal radiotherapy (3D-CRT) Level III audit. MATERIALS AND METHODS The audit was conducted as onsite audit using an anthropomorphic thorax phantom in an end-to-end test by the Australian Clinical Dosimetry Service (ACDS). Absolute dose point measurements were performed with Farmer-type ionization chambers. The audited treatment plans included open and half blocked fields, wedges and lung inhomogeneities. Audit results were determined as Pass Optimal Level (deviations within 3.3%), Pass Action Level (greater than 3.3% but within 5%) and Out of Tolerance (beyond 5%), as well as Reported Not Scored (RNS). The audit has been performed between July 2012 and January 2018 on 94 occasions, covering approximately 90% of all Australian facilities. RESULTS The audit pass rate was 87% (53% optimal). Fifty recommendations were given, mainly related to planning system commissioning. Dose overestimation behind low density inhomogeneities by the analytical anisotropic algorithm (AAA) was identified across facilities and found to extend to beam setups which resemble a typical breast cancer treatment beam placement. RNS measurements inside lung showed a variation in the opposite direction: AAA under-dosed a target beyond lung and over-dosed the lung upstream and downstream of the target. Results also highlighted shortcomings of some superposition and convolution algorithms in modelling large angle wedges. CONCLUSIONS This audit showed that 3D-CRT dosimetry audits remain relevant and can identify fundamental global and local problems that also affect advanced treatments.
Collapse
Affiliation(s)
- Joerg Lehmann
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
- Institute of Medical Physics, School of Physics A28, University of Sydney NSW 2006, Australia
- School of Mathematical and Physical Sciences, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- School of Science, Royal Melbourne Institute of Technology (RMIT) University, 124 La Trobe Street, Melbourne, VIC 3000, Australia
| | - Andrew Alves
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| | - Leon Dunn
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| | - Maddison Shaw
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
- School of Science, Royal Melbourne Institute of Technology (RMIT) University, 124 La Trobe Street, Melbourne, VIC 3000, Australia
| | - John Kenny
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| | - Stephanie Keehan
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
- School of Science, Royal Melbourne Institute of Technology (RMIT) University, 124 La Trobe Street, Melbourne, VIC 3000, Australia
| | - Jeremy Supple
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| | - Francis Gibbons
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| | - Sophie Manktelow
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| | - Chris Oliver
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| | - Tomas Kron
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
- School of Science, Royal Melbourne Institute of Technology (RMIT) University, 124 La Trobe Street, Melbourne, VIC 3000, Australia
- Department of Radiation Oncology, Peter MacCallum Cancer Center, 305 Grattan Street, Melbourne, VIC 3000, Australia
| | - Ivan Williams
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| | - Jessica Lye
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| |
Collapse
|
37
|
Cho B. Intensity-modulated radiation therapy: a review with a physics perspective. Radiat Oncol J 2018; 36:1-10. [PMID: 29621869 PMCID: PMC5903356 DOI: 10.3857/roj.2018.00122] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 03/15/2018] [Accepted: 03/20/2018] [Indexed: 01/08/2023] Open
Abstract
Intensity-modulated radiation therapy (IMRT) has been considered the most successful development in radiation oncology since the introduction of computed tomography into treatment planning that enabled three-dimensional conformal radiotherapy in 1980s. More than three decades have passed since the concept of inverse planning was first introduced in 1982, and IMRT has become the most important and common modality in radiation therapy. This review will present developments in inverse IMRT treatment planning and IMRT delivery using multileaf collimators, along with the associated key concepts. Other relevant issues and future perspectives are also presented.
Collapse
Affiliation(s)
- Byungchul Cho
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
38
|
Miften M, Olch A, Mihailidis D, Moran J, Pawlicki T, Molineu A, Li H, Wijesooriya K, Shi J, Xia P, Papanikolaou N, Low DA. Tolerance limits and methodologies for IMRT measurement-based verification QA: Recommendations of AAPM Task Group No. 218. Med Phys 2018; 45:e53-e83. [DOI: 10.1002/mp.12810] [Citation(s) in RCA: 373] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 12/10/2017] [Accepted: 01/11/2018] [Indexed: 11/07/2022] Open
Affiliation(s)
- Moyed Miften
- Department of Radiation Oncology; University of Colorado School of Medicine; Aurora CO USA
| | - Arthur Olch
- Department of Radiation Oncology; University of Southern California and Radiation Oncology Program; Childrens Hospital of Los Angeles; Los Angeles CA USA
| | - Dimitris Mihailidis
- Department of Radiation Oncology; University of Pennsylvania; Perelman Center for Advanced Medicine; Philadelphia PA USA
| | - Jean Moran
- Department of Radiation Oncology; University of Michigan; Ann Arbor MI USA
| | - Todd Pawlicki
- Department of Radiation Oncology; University of California San Diego; La Jolla CA USA
| | - Andrea Molineu
- Radiological Physics Center; UT MD Anderson Cancer Center; Houston TX USA
| | - Harold Li
- Department of Radiation Oncology; Washington University; St. Louis MO USA
| | - Krishni Wijesooriya
- Department of Radiation Oncology; University of Virginia; Charlottesville VA USA
| | - Jie Shi
- Sun Nuclear Corporation; Melbourne FL USA
| | - Ping Xia
- Department of Radiation Oncology; The Cleveland Clinic; Cleveland OH USA
| | - Nikos Papanikolaou
- Department of Medical Physics; University of Texas Health Sciences Center; San Antonio TX USA
| | - Daniel A. Low
- Department of Radiation Oncology; University of California Los Angeles; Los Angeles CA USA
| |
Collapse
|
39
|
Kron T, Chesson B, Hardcastle N, Crain M, Clements N, Burns M, Ball D. Credentialing of radiotherapy centres in Australasia for TROG 09.02 (Chisel), a Phase III clinical trial on stereotactic ablative body radiotherapy of early stage lung cancer. Br J Radiol 2018; 91:20170737. [PMID: 29446317 DOI: 10.1259/bjr.20170737] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE A randomised clinical trial comparing stereotactic ablative body radiotherapy (SABR) with conventional radiotherapy for early stage lung cancer has been conducted in Australia and New Zealand under the auspices of the TransTasman Radiation Oncology Group (NCT01014130). We report on the technical credentialing program as prerequisite for centres joining the trial. METHODS Participating centres were asked to develop treatment plans for two test cases to assess their ability to create plans according to protocol. Dose delivery in the presence of inhomogeneity and motion was assessed during a site visit using a phantom with moving inserts. RESULTS Site visits for the trial were conducted in 16 Australian and 3 New Zealand radiotherapy facilities. The tests with low density inhomogeneities confirmed shortcomings of the AAA algorithm for dose calculation. Dose was assessed for a typical treatment delivery including at least one non-coplanar beam in a stationary and moving phantom. This end-to-end test confirmed that all participating centres were able to deliver stereotactic ablative body radiotherapy with the required accuracy while the planning study demonstrated that they were able to produce acceptable plans for both test cases. CONCLUSION The credentialing process documented that participating centres were able to deliver dose as required in the trial protocol. It also gave an opportunity to provide education about the trial and discuss technical issues such as four-dimensional CT, small field dosimetry and patient immobilisation with staff in participating centres. Advances in knowledge: Credentialing is an important quality assurance tool for radiotherapy trials using advanced technology. In addition to confirming technical competence, it provides an opportunity for education and discussion about the trial.
Collapse
Affiliation(s)
- Tomas Kron
- 1 Department of Physical Sciences, Peter MacCallum Cancer Centre , Melbourne, VIC , Australia.,2 Sir Peter MacCallum Department of Oncology, University of Melbourne , Parkville, VIC , Australia
| | - Brent Chesson
- 3 Department of Radiation Therapy Services, Peter MacCallum Cancer Centre , Melbourne, VIC , Australia
| | - Nicholas Hardcastle
- 1 Department of Physical Sciences, Peter MacCallum Cancer Centre , Melbourne, VIC , Australia
| | - Melissa Crain
- 4 Trans Tasman Radiation Oncology Group (TROG) , Newcastle, NSW , Australia
| | | | - Mark Burns
- 3 Department of Radiation Therapy Services, Peter MacCallum Cancer Centre , Melbourne, VIC , Australia
| | - David Ball
- 2 Sir Peter MacCallum Department of Oncology, University of Melbourne , Parkville, VIC , Australia.,6 Department of Radiation Oncology, Peter MacCallum Cancer Centre , Melbourne, VIC , Australia
| |
Collapse
|
40
|
Carlino A, Gouldstone C, Kragl G, Traneus E, Marrale M, Vatnitsky S, Stock M, Palmans H. End-to-end tests using alanine dosimetry in scanned proton beams. ACTA ACUST UNITED AC 2018; 63:055001. [DOI: 10.1088/1361-6560/aaac23] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
41
|
Hernandez V, Saez J, Pasler M, Jurado-Bruggeman D, Jornet N. Comparison of complexity metrics for multi-institutional evaluations of treatment plans in radiotherapy. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2018; 5:37-43. [PMID: 33458367 PMCID: PMC7807588 DOI: 10.1016/j.phro.2018.02.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 11/17/2022]
Abstract
Several complexity metrics were highly correlated and can be considered equivalent. Other metrics produced different results, especially for plans from different TPSs. Different TPSs prioritise modulation of different plan parameters. The ranking of plan complexity can greatly depend on the metric used. This must be carefully considered in multi-institutional plan comparisons.
Background and purpose It is known that intensity-modulated radiotherapy plans that are highly complex might be less accurate in dose calculation and treatment delivery. Multiple complexity metrics have been proposed, but the relationships between them have not been thoroughly investigated. This study investigated these relationships in multi-institutional comparisons of treatment plans, where plans from multiple treatment planning systems (TPSs) are typically evaluated. Materials and methods A program was developed to compute several complexity indices and provide analysis of dynamic plan parameters. This in-house software was used to analyse plans from a recent multi-institutional audit. Additionally, 100 clinical volumetric modulated arc therapy (VMAT) plans from two institutions using different TPSs were analysed. Results All plans produced satisfactory pre-treatment verification results and, hence, complexity metrics could not be used to predict plans failing QA. Regarding the relationship among complexity indices, some very strong correlations were found (r > 0.9 with p < 0.01). However, some relevant discrepancies between complexity indices were obtained, even with negative correlation coefficients (r ∼ −0.6) which were expected to be positive. These discrepancies could be explained because each complexity index focused on different features of the plan and different TPSs prioritised modulation of different plan parameters. Conclusions Some complexity indices provided similar information and can be considered equivalent. However, indices that focused on different plan parameters yielded different results and it was unclear which complexity index should be used. Careful consideration should be given to the use of complexity metrics in multi-institutional studies.
Collapse
Affiliation(s)
- Victor Hernandez
- Department of Medical Physics, Hospital Universitari Sant Joan de Reus, IISPV, Tarragona, Spain
| | - Jordi Saez
- Department of Radiation Oncology, Hospital Clínic de Barcelona, Spain
| | - Marlies Pasler
- Lake Constance Radiation Oncology Center Singen-Friedrichshafen, Germany
| | - Diego Jurado-Bruggeman
- Medical Physics and Radiation Protection Department, Institut Català d'Oncologia, Girona, Spain
| | - Nuria Jornet
- Servei de Radiofísica i Radioprotecció, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| |
Collapse
|
42
|
A multi-centre dosimetry audit on advanced radiotherapy in lung as part of the Isotoxic IMRT study. Phys Imaging Radiat Oncol 2017. [DOI: 10.1016/j.phro.2017.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|
43
|
Multidisciplinary quality assurance and control in oncological trials: Perspectives from European Organisation for Research and Treatment of Cancer (EORTC). Eur J Cancer 2017; 86:91-100. [PMID: 28964907 DOI: 10.1016/j.ejca.2017.07.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 07/25/2017] [Indexed: 02/06/2023]
Abstract
Quality assurance (QA) programmes are one of the mainstays of clinical research and constitute the pillars on which European Organisation for Research Treatment of Cancer (EORTC) delivers multidisciplinary therapeutic progress. Changing practice treatments require solid evidence-based data, which can only be achieved if integral QA is part of the infrastructure sustaining research projects. Cancer treatment is a multimodality approach, which is often applied either in sequence and/or in combination. Each modality plays a key role in cancer control. The modalities by which QA is applied varies substantially within and across the disciplines. In addition, translational and diagnostic disciplines take an increasing role in the era of precision medicine. Building on the structuring effect of clinical research with fully integrated multidisciplinary QA programmes associated with the solutions addressing the chain of custody for biological material and data integrity as well as compliance ensure at the same time validity of clinical research output but also have a training effect on health care providers, who are more likely to apply such principles as routine. The principles of QA are therefore critical to be embedded in multidisciplinary infrastructure to guarantee therapeutic progress. These principles also provide the basis for the functioning of multidisciplinary tumour board. However, technical, operational and economic challenges which go with the implementation of such programmes require optimal know-how and the coordination of the multiple expertise and such efforts are best achieved through centralised infrastructure.
Collapse
|
44
|
Craft DF, Howell RM. Preparation and fabrication of a full-scale, sagittal-sliced, 3D-printed, patient-specific radiotherapy phantom. J Appl Clin Med Phys 2017; 18:285-292. [PMID: 28857407 PMCID: PMC5874860 DOI: 10.1002/acm2.12162] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/29/2017] [Accepted: 07/11/2017] [Indexed: 01/17/2023] Open
Abstract
Purpose Patient‐specific 3D‐printed phantoms have many potential applications, both research and clinical. However, they have been limited in size and complexity because of the small size of most commercially available 3D printers as well as material warping concerns. We aimed to overcome these limitations by developing and testing an effective 3D printing workflow to fabricate a large patient‐specific radiotherapy phantom with minimal warping errors. In doing so, we produced a full‐scale phantom of a real postmastectomy patient. Methods We converted a patient's clinical CT DICOM data into a 3D model and then sliced the model into eleven 2.5‐cm‐thick sagittal slices. The slices were printed with a readily available thermoplastic material representing all body tissues at 100% infill, but with air cavities left open. Each slice was printed on an inexpensive and commercially available 3D printer. Once the printing was completed, the slices were placed together for imaging and verification. The original patient CT scan and the assembled phantom CT scan were registered together to assess overall accuracy. Results The materials for the completed phantom cost $524. The printed phantom agreed well with both its design and the actual patient. Individual slices differed from their designs by approximately 2%. Registered CT images of the assembled phantom and original patient showed excellent agreement. Conclusions Three‐dimensional printing the patient‐specific phantom in sagittal slices allowed a large phantom to be fabricated with high accuracy. Our results demonstrate that our 3D printing workflow can be used to make large, accurate, patient‐specific phantoms at 100% infill with minimal material warping error.
Collapse
Affiliation(s)
- Daniel F Craft
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Medical Physics Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA
| | - Rebecca M Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Medical Physics Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA
| |
Collapse
|
45
|
Carson ME, Molineu A, Taylor PA, Followill DS, Stingo FC, Kry SF. Examining credentialing criteria and poor performance indicators for IROC Houston's anthropomorphic head and neck phantom. Med Phys 2017; 43:6491. [PMID: 27908168 DOI: 10.1118/1.4967344] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To analyze the most recent results of the Imaging and Radiation Oncology Core Houston Quality Assurance Center's (IROC-H) anthropomorphic head and neck (H&N) phantom to determine the nature of failing irradiations and the feasibility of altering credentialing criteria. METHODS IROC-H's H&N phantom, used for intensity-modulated radiation therapy credentialing for National Cancer Institute-sponsored clinical trials, requires that an institution's treatment plan agrees within ±7% of measured thermoluminescent dosimeter (TLD) doses; it also requires that ≥85% of pixels pass ±4 mm distance to agreement (7%/4 mm gamma analysis for film). The authors re-evaluated 156 phantom irradiations (November 1, 2014-October 31, 2015) according to the following tighter criteria: (1) 5% TLD and 5%/4 mm, (2) 5% TLD and 5%/3 mm, (3) 4% TLD and 4%/4 mm, and (4) 3% TLD and 3%/3 mm. Failure rates were evaluated with respect to individual film and TLD performance by location in the phantom. Overall poor phantom results were characterized qualitatively as systematic errors (correct shape and position but wrong magnitude of dose), setup errors/positional shifts, global but nonsystematic errors, and errors affecting only a local region. RESULTS The pass rate for these phantoms using current criteria was 90%. Substituting criteria 1-4 reduced the overall pass rate to 77%, 70%, 63%, and 37%, respectively. Statistical analyses indicated that the probability of noise-induced TLD failure, even at the 5% criterion, was <0.5%. Phantom failures were generally identified by TLD (≥66% failed TLD, whereas ≥55% failed film), with most failures occurring in the primary planning target volume (≥77% of cases). Results failing current criteria or criteria 1 were primarily diagnosed as systematic >58% of the time (11/16 and 21/36 cases, respectively), with a greater extent due to underdosing. Setup/positioning errors were seen in 11%-13% of all failing cases (2/16 and 4/36 cases, respectively). Local errors (8/36 cases) could only be demonstrated at criteria 1. Only three cases of global errors were identified in these analyses. For current criteria and criteria 1, irradiations that failed from film only were overwhelmingly associated with phantom shifts/setup errors (≥80% of cases). CONCLUSIONS This study highlighted that the majority of phantom failures are the result of systematic dosimetric discrepancies between the treatment planning system and the delivered dose. Further work is necessary to diagnose and resolve such dosimetric inaccuracy. In addition, the authors found that 5% TLD and 5%/4 mm gamma criteria may be both practically and theoretically achievable as an alternative to current criteria.
Collapse
Affiliation(s)
- Mallory E Carson
- Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston, Houston, Texas 77030
| | - Andrea Molineu
- IROC Houston Quality Assurance Center, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - Paige A Taylor
- IROC Houston Quality Assurance Center, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - David S Followill
- IROC Houston Quality Assurance Center, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - Francesco C Stingo
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - Stephen F Kry
- IROC Houston Quality Assurance Center, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| |
Collapse
|
46
|
Miri N, Lehmann J, Legge K, Vial P, Greer PB. Virtual EPID standard phantom audit (VESPA) for remote IMRT and VMAT credentialing. Phys Med Biol 2017; 62:4293-4299. [PMID: 28248642 DOI: 10.1088/1361-6560/aa63df] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A virtual EPID standard phantom audit (VESPA) has been implemented for remote auditing in support of facility credentialing for clinical trials using IMRT and VMAT. VESPA is based on published methods and a clinically established IMRT QA procedure, here extended to multi-vendor equipment. Facilities are provided with comprehensive instructions and CT datasets to create treatment plans. They deliver the treatment directly to their EPID without any phantom or couch in the beam. In addition, they deliver a set of simple calibration fields per instructions. Collected EPID images are uploaded electronically. In the analysis, the dose is projected back into a virtual cylindrical phantom. 3D gamma analysis is performed. 2D dose planes and linear dose profiles are provided and can be considered when needed for clarification. In addition, using a virtual flat-phantom, 2D field-by-field or arc-by-arc gamma analyses are performed. Pilot facilities covering a range of planning and delivery systems have performed data acquisition and upload successfully. Advantages of VESPA are (1) fast turnaround mainly driven by the facility's capability of providing the requested EPID images, (2) the possibility for facilities performing the audit in parallel, as there is no need to wait for a phantom, (3) simple and efficient credentialing for international facilities, (4) a large set of data points, and (5) a reduced impact on resources and environment as there is no need to transport heavy phantoms or audit staff. Limitations of the current implementation of VESPA for trials credentialing are that it does not provide absolute dosimetry, therefore a Level I audit is still required, and that it relies on correctly delivered open calibration fields, which are used for system calibration. The implemented EPID based IMRT and VMAT audit system promises to dramatically improve credentialing efficiency for clinical trials and wider applications.
Collapse
Affiliation(s)
- Narges Miri
- School of Mathematical and Physical Sciences, The University of Newcastle, Newcastle, Australia
| | | | | | | | | |
Collapse
|
47
|
Nakamura M, Minemura T, Ishikura S, Nishio T, Narita Y, Nishimura Y. An on-site audit system for dosimetry credentialing of intensity-modulated radiotherapy in Japanese Clinical Oncology Group (JCOG) clinical trials. Phys Med 2016; 32:987-91. [PMID: 27402255 DOI: 10.1016/j.ejmp.2016.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 06/21/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE This study was undertaken to analyze the results of intensity-modulated radiotherapy (IMRT) dosimetry credentialing using a phantom in the Japanese Clinical Oncology Group clinical trials. METHODS All measurements were performed on-site. The IMRT phantom consisted of a phantom shell and a module. Two types of structures, including a C-shaped planning target volume (PTV) around a column-shaped organ at risk (OAR), were included in the module. Each participating institution was asked to image, plan, and treat the phantom. A prescription dose of 2Gy should cover 95% of the PTV. The plan should limit the maximum doses to the PTV and OAR to less than 110% and 60%, respectively. The pass criteria were ±3% in terms of chamber dosimetry and a difference in profile position ⩽2mm in the high-dose gradient area of film dosimetry. The positional difference was defined as the largest distance between the measured and calculated positions at doses of 60% or 80%. These tolerances were based on the Japanese Society for Radiation Oncology IMRT guidelines. RESULTS Credentialing was performed on a total of 44 treatment machines in 32 institutions from 2009 to 2015. All differences between measured and planned doses at the measurement points of the PTV were within 3%. The means±standard deviations of the positional differences were 1.0±0.4mm and 0.9±0.3mm without and with the phantom shell, respectively. CONCLUSIONS The dose differences and positional differences met the desired criteria in all institutions.
Collapse
Affiliation(s)
- Mitsuhiro Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan.
| | - Toshiyuki Minemura
- Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Satoshi Ishikura
- Department of Radiology, Koshigaya Municipal Hospital, Saitama, Japan
| | - Teiji Nishio
- Department of Radiation Oncology, Graduate School of Medicine, Hiroshima University, Japan
| | - Yuichiro Narita
- Department of Oncological Radiation, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Japan
| |
Collapse
|
48
|
Izewska J, Wesolowska P, Azangwe G, Followill DS, Thwaites DI, Arib M, Stefanic A, Viegas C, Suming L, Ekendahl D, Bulski W, Georg D. Testing the methodology for dosimetry audit of heterogeneity corrections and small MLC-shaped fields: Results of IAEA multi-center studies. Acta Oncol 2016; 55:909-16. [PMID: 26934916 PMCID: PMC4926790 DOI: 10.3109/0284186x.2016.1139180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The International Atomic Energy Agency (IAEA) has a long tradition of supporting development of methodologies for national networks providing quality audits in radiotherapy. A series of co-ordinated research projects (CRPs) has been conducted by the IAEA since 1995 assisting national external audit groups developing national audit programs. The CRP ‘Development of Quality Audits for Radiotherapy Dosimetry for Complex Treatment Techniques’ was conducted in 2009–2012 as an extension of previously developed audit programs. Material and methods. The CRP work described in this paper focused on developing and testing two steps of dosimetry audit: verification of heterogeneity corrections, and treatment planning system (TPS) modeling of small MLC fields, which are important for the initial stages of complex radiation treatments, such as IMRT. The project involved development of a new solid slab phantom with heterogeneities containing special measurement inserts for thermoluminescent dosimeters (TLD) and radiochromic films. The phantom and the audit methodology has been developed at the IAEA and tested in multi-center studies involving the CRP participants. Results. The results of multi-center testing of methodology for two steps of dosimetry audit show that the design of audit procedures is adequate and the methodology is feasible for meeting the audit objectives. A total of 97% TLD results in heterogeneity situations obtained in the study were within 3% and all results within 5% agreement with the TPS predicted doses. In contrast, only 64% small beam profiles were within 3 mm agreement between the TPS calculated and film measured doses. Film dosimetry results have highlighted some limitations in TPS modeling of small beam profiles in the direction of MLC leave movements. Discussion. Through multi-center testing, any challenges or difficulties in the proposed audit methodology were identified, and the methodology improved. Using the experience of these studies, the participants could incorporate the auditing procedures in their national programs.
Collapse
Affiliation(s)
| | | | | | | | | | - Mehenna Arib
- Centre De Recherche Nucleaire D’alger, Alger Gare, Algeria
| | | | | | - Luo Suming
- Chinese Centre for Disease Control and Prevention, Beijing, China
| | | | - Wojciech Bulski
- Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Dietmar Georg
- Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Vienna, Austria
| |
Collapse
|
49
|
Kron T, Lehmann J, Greer PB. Dosimetry of ionising radiation in modern radiation oncology. Phys Med Biol 2016; 61:R167-205. [DOI: 10.1088/0031-9155/61/14/r167] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
50
|
Rehman J, Iqbal T, Tailor R. Dosimetric comparison among different head and neck radiotherapy techniques using PRESAGE® dosimeter. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2015. [DOI: 10.14319/ijcto.34.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|