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Yalvac B, Reulens N, Reniers B. Early results of a remote dosimetry audit program for lung stereotactic body radiation therapy. Phys Imaging Radiat Oncol 2024; 29:100544. [PMID: 38327761 PMCID: PMC10848021 DOI: 10.1016/j.phro.2024.100544] [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: 05/31/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/09/2024] Open
Abstract
Background and purpose A dosimetry audit program based on alanine electron paramagnetic resonance (EPR) and radiochromic film dosimetry, may be a valuable tool for monitoring and improving the quality of lung stereotactic body radiotherapy (SBRT). The aim of this study was to report the initial, independent assessment of the dosimetric accuracy for lung SBRT practice using these dosimeters in combination with a novel phantom design. Materials and Methods The audit service was a remote audit program performed on a commercial lung phantom preloaded with film and alanine detectors. An alanine pellet was placed in the centre of the target simulated using silicone in a 3D-printed mould. Large film detectors were placed coronally through the target and the lung/tissue interface and analysed using gamma analysis. The beam output was always checked on the same day with alanine dosimetry in water. We audited 29 plans from 14 centres up to now. Results For the alanine results 28/29 plans were within 5 % with 19/29 plans being within 3 %. The passing rates were > 95 % for the film through the target for 27/29 plans and 17/29 plans for the film at the lung/tissue interface. For three plans the passing rate was < 90 % for the film on top of the lungs. Conclusions The preliminary results were very satisfactory for both detectors. The high passing rates for the film in the interface region indicate good performance of the treatment planning systems. The phantom design was robust and performed well on several treatment systems.
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Affiliation(s)
- Burak Yalvac
- Universiteit Hasselt, CMK, NuTeC, Diepenbeek, Belgium
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Jornet N, Strojan P, Howlett DC, Brady AP, Hierath M, Clark J, Wadsak W, Giammarile F, Coffey M. The QuADRANT study: Current status and recommendations for improving uptake and implementation of clinical audit of medical radiological procedures in Europe. The radiotherapy perspective. Radiother Oncol 2023; 186:109772. [PMID: 37385381 DOI: 10.1016/j.radonc.2023.109772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND QuADRANT was a research project funded by the European Commission to evaluate clinical audit uptake and implementation across Europe, with an emphasis on clinical audit as mandated within the BSSD (Basic Safety Standards Directive). AIM Focusing on the QuADRANT objectives - to obtain an overview of European clinical audit activity; identify good practices, resources, barriers and challenges; provide guidance and recommendations going forwards; identify the potential for European Union action on quality and safety focusing on the field of radiotherapy. RESULTS A pan-European survey, expert interviews and a literature review conducted within the framework of the QuADRANT project indicated that developments in national clinical audit infrastructure are required. While in radiotherapy, there is a strong tradition and high level of experience of dosimetry audits and well-established practice through the IAEA's QUATRO audits, few countries have a well-established comprehensive clinical audit programme or international/national initiatives on tumour specific clinical audits. Even if sparse, the experience from countries with established system of quality audits can be used as role-models for national professional societies to promote clinical audit implementation. However, resource allocation and national prioritisation of clinical audit are needed in many countries. National and international societies should take the initiative to promote and facilitate training and resources (guidelines, experts, courses) for clinical audits. Enablers used to enhance clinical audit participation are not widely employed. Development of hospital accreditation programmes can facilitate clinical audit uptake. An active and formalised role for patients in clinical audit practice and policy development is recommended. Because there is a persisting variation in European awareness of BSSD clinical audit requirements, work is needed to improve dissemination of information on the legislative requirements relating to clinical audit in the BSSD and in relation to inspection processes. The aim is to ensure these include clinical audit and that they encompass all clinics and specialties involved in medical applications using ionising radiation. CONCLUSION QuADRANT provided an overarching view of clinical audit practice in Europe, with all its related aspects. Unfortunately, it showed that the awareness of the BSSD requirements for clinical audit are highly variable. Therefore, there is an urgent need to dedicate efforts towards ensuring that regulatory inspections also incorporate an assessment of clinical audit program(s), affecting all aspects of clinical work and specialties involved in patient exposure to ionising radiation.
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Affiliation(s)
- Núria Jornet
- Servei de Radiofísica i Radioprotecció, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; European Society for Radiotherapy and Oncology, Brussels, Belgium.
| | - Primoz Strojan
- Dept. of Radiation Oncology, Institute of Oncology Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia; European Society for Radiotherapy and Oncology, Brussels, Belgium
| | - David C Howlett
- Radiology Department, East Sussex Healthcare NHS Trust, Brighton and Sussex Medical School, UK; European Society of Radiology (ESR), Vienna, Austria
| | - Adrian P Brady
- Radiology Department, Mercy University Hospital, Cork, Ireland; Radiology Department, University College Cork, Ireland; European Society of Radiology (ESR), Vienna, Austria
| | | | | | - Wolfgang Wadsak
- European Association of Nuclear Medicine, Vienna, Austria; Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Francesco Giammarile
- European Association of Nuclear Medicine, Vienna, Austria; Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency (IAEA), Vienna, Austria
| | - Mary Coffey
- Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Ireland; European Society for Radiotherapy and Oncology, Brussels, Belgium
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Putu Inten Gayatri IA, Handika AD, Wibowo WE, Fitriandini A, Fadli M, Yudi Putranto AM, Yudhi Prasada DN, Okselia A, Suharsono, Pawiro SA. 2-Dimensional IMRT dose audit: An Indonesian multicenter study. Appl Radiat Isot 2022; 188:110415. [PMID: 36027871 DOI: 10.1016/j.apradiso.2022.110415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 07/27/2022] [Accepted: 08/09/2022] [Indexed: 11/02/2022]
Abstract
Intensity modulated radiation therapy (IMRT) is an advanced technique in radiation therapy delivery. IMRT depends on the accuracy of the multileaf collimator during treatment. Hence, the actual dose distribution can deviate from the treatment planning system's calculation. This study aimed to perform a multicentre planar dosimetry audit of radiotherapy centres in Indonesia, using the structure sets from AAPM TG-119. The gamma index used to evaluate the dose distribution was 3%/3 mm and 3%/2 mm. We observed 100% gamma index passing rates mostly in the 3%/3 mm evaluations. The gamma index passing rates dropped in the 3%/2 mm analysis. Most of the radiotherapy centres participating in this audit satisfied each criterion's tolerance limit of the action level. This study may become a first result for the next multicenter IMRT audit by using a standardized protocol.
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Affiliation(s)
- Ida Ayu Putu Inten Gayatri
- Department of Physics, Faculty of Mathematics and Natural Sciences, Universitas Indonesia, Depok, Indonesia; Department of Radiation Oncology, MRCCC Siloam Hospitals, Jakarta, Indonesia
| | - Andrian Dede Handika
- Department of Radiation Oncology, Persahabatan General Hospital, Jakarta, Indonesia
| | - Wahyu Edy Wibowo
- Department of Radiation Oncology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Aninda Fitriandini
- Department of Radiation Oncology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Muhamad Fadli
- Department of Radiation Oncology, MRCCC Siloam Hospitals, Jakarta, Indonesia
| | | | | | - Anisza Okselia
- Department of Radiation Oncology, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Suharsono
- Department of Radiotherapy, Dharmais National Cancer Center Hospital, Jakarta, Indonesia
| | - Supriyanto Ardjo Pawiro
- Department of Physics, Faculty of Mathematics and Natural Sciences, Universitas Indonesia, Depok, Indonesia.
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Abdullah N, Bradley D, Nisbet A, Kamarul Zaman Z, Deraman S, Mohd Noor N. Dosimetric characteristics of fabricated germanium doped optical fibres for a postal audit of therapy electron beams. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Lee J, Dean C, Patel R, Webster G, Eaton DJ. Multi-center evaluation of dose conformity in stereotactic body radiotherapy. Phys Imaging Radiat Oncol 2019; 11:41-46. [PMID: 33458276 PMCID: PMC7807546 DOI: 10.1016/j.phro.2019.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Stereotactic body radiotherapy (SBRT) is an emerging technique for treating oligometastases, but limited data is available on what plan quality is achievable for a range of modalities and clinical sites. METHODS SBRT plans for lung, spine, bone, adrenal, liver and node sites from 17 participating centers were reviewed. Centers used various delivery techniques including static and rotational intensity-modulation and multiple non-coplanar beams. Plans were split into lung and other body sites and evaluated with different plan quality metrics, including two which are independent of target coverage; "prescription dose spillage" (PDS) and "modified gradient index" (MGI). These were compared to constraints from the ROSEL and RTOG 0813 clinical trials. RESULTS Planning target volume (PTV) coverage was compromised (PTV V100% < 90%) in 29% of patient plans in order to meet organ-at-risk (OAR) tolerances, supporting the use of plan quality metrics which are independent of target coverage. Both lung (n = 48) and other body (n = 99) site PDS values agreed well with ROSEL constraints on dose spillage, but RTOG 0813 values were too high to detect sub-optimal plans. MGI values for lung plans were mis-matched to both sets of previous constraints, with ROSEL values too high and RTOG 0813 values too low. MGI values were lower for other body plans as expected, though this was only statistically significant for PTV volumes <20 cm3. CONCLUSIONS Updated guidance for lung and other body site SBRT plan quality using the PDS and MGI metrics is presented.
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Affiliation(s)
- Jonny Lee
- National Radiotherapy Trials QA Group, Mount Vernon Hospital, London HA6 2RN, UK
| | | | - Rushil Patel
- National Radiotherapy Trials QA Group, Mount Vernon Hospital, London HA6 2RN, UK
| | | | - David J. Eaton
- National Radiotherapy Trials QA Group, Mount Vernon Hospital, London HA6 2RN, UK
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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.
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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
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Affiliation(s)
- Catharine H. Clark
- Medical Physics Department, Royal Surrey County Hospital, Guildford Surrey, UK
- Metrology for Medical Physics, National Physical Laboratory, Teddington, Middx, UK
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