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Stevens S, Moloney S, Blackmore A, Hart C, Rixham P, Bangiri A, Pooler A, Doolan P. IPEM topical report: guidance for the clinical implementation of online treatment monitoring solutions for IMRT/VMAT. Phys Med Biol 2023; 68:18TR02. [PMID: 37531959 DOI: 10.1088/1361-6560/acecd0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/02/2023] [Indexed: 08/04/2023]
Abstract
This report provides guidance for the implementation of online treatment monitoring (OTM) solutions in radiotherapy (RT), with a focus on modulated treatments. Support is provided covering the implementation process, from identification of an OTM solution to local implementation strategy. Guidance has been developed by a RT special interest group (RTSIG) working party (WP) on behalf of the Institute of Physics and Engineering in Medicine (IPEM). Recommendations within the report are derived from the experience of the WP members (in consultation with manufacturers, vendors and user groups), existing guidance or legislation and a UK survey conducted in 2020 (Stevenset al2021). OTM is an inclusive term representing any system capable of providing a direct or inferred measurement of the delivered dose to a RT patient. Information on each type of OTM is provided but, commensurate with UK demand, guidance is largely influenced byin vivodosimetry methods utilising the electronic portal imager device (EPID). Sections are included on the choice of OTM solutions, acceptance and commissioning methods with recommendations on routine quality control, analytical methods and tolerance setting, clinical introduction and staffing/resource requirements. The guidance aims to give a practical solution to sensitivity and specificity testing. Functionality is provided for the user to introduce known errors into treatment plans for local testing. Receiver operating characteristic analysis is discussed as a tool to performance assess OTM systems. OTM solutions can help verify the correct delivery of radiotherapy treatment. Furthermore, modern systems are increasingly capable of providing clinical decision-making information which can impact the course of a patient's treatment. However, technical limitations persist. It is not within the scope of this guidance to critique each available solution, but the user is encouraged to carefully consider workflow and engage with manufacturers in resolving compatibility issues.
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Affiliation(s)
| | - Stephen Moloney
- University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom
| | | | - Clare Hart
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Philip Rixham
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Anna Bangiri
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Alistair Pooler
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom
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Bossuyt E, Nevens D, Weytjens R, Taieb Mokaddem A, Verellen D. Assessing the impact of adaptations to the clinical workflow in radiotherapy using transit in vivo dosimetry. Phys Imaging Radiat Oncol 2023; 25:100420. [PMID: 36820237 PMCID: PMC9937948 DOI: 10.1016/j.phro.2023.100420] [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: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Background and Purpose Currently in-vivo dosimetry (IVD) is primarily used to identify individual patient errors in radiotherapy. This study investigated possible correlations of observed trends in transit IVD results, with adaptations to the clinical workflow, aiming to demonstrate the possibility of using the bulk data for continuous quality improvement. Materials and methods In total 84,100 transit IVD measurements were analyzed of all patients treated between 2018 and 2022, divided into four yearly periods. Failed measurements (FM) were divided per pathology and into four categories of causes of failure: technical, planning and positioning problems, and anatomic changes. Results The number of FM due to patient related problems gradually decreased from 9.5% to 6.6%, 6.1% and 5.6% over the study period. FM attributed to positioning problems decreased from 10.0% to 4.9% in boost breast cancer patients after introduction of extra imaging, from 9.1% to 3.9% in Head&Neck patients following education of radiation therapists on positioning of patients' shoulders, from 6.1% to 2.8% in breast cancer patients after introduction of ultrahypofractionated breast radiotherapy with daily online pre-treatment imaging and from 11.2% to 4.3% in extremities following introduction of immobilization with calculated couch parameters and a Surface Guided Radiation Therapy solution. FM related to anatomic changes decreased from 10.2% to 4.0% in rectum patients and from 6.7% to 3.3% in prostate patients following more patient education from dieticians. Conclusions Our study suggests that IVD can be a powerful tool to assess the impact of adaptations to the clinical workflow and its use for continuous quality improvement.
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Affiliation(s)
- Evy Bossuyt
- Iridium Netwerk, GZA Hospitals, Radiation Oncology Department, Antwerp, Belgium,Corresponding author.
| | - Daan Nevens
- Iridium Netwerk, GZA Hospitals, Radiation Oncology Department, Antwerp, Belgium,Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
| | - Reinhilde Weytjens
- Iridium Netwerk, GZA Hospitals, Radiation Oncology Department, Antwerp, Belgium
| | | | - Dirk Verellen
- Iridium Netwerk, GZA Hospitals, Radiation Oncology Department, Antwerp, Belgium,Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
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A Large Area Pixelated Silicon Array Detector for Independent Transit In Vivo Dosimetry. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A large area pixelated silicon array detector named “MP987” has been developed for in vivo dosimetry. The detector was developed to overcome the non-water equivalent response of EPID (Electronic Portal Imaging Device) dosimetry systems, due to the shortfalls of the extensive corrections required. The detector, readout system and software have all been custom designed to be operated independently from the linac with the array secured directly above the EPID, to be used in combination with the 6 MV imaging system. Dosimetry characterisation measurements of percentage depth dose (PDD), dose rate dependence, radiation damage, output factors (OF), profile measurements, linearity and uniformity were performed. Additionally, the first pre-clinical tests with this novel detector of a transit dosimetry characterization and a collapsed IMRT (intensity-modulated radiation therapy) study are presented. Both PDD and OF measurements had a percentage difference of less than 2.5% to the reference detector. A maximum change in sensitivity of 4.3 ± 0.3% was observed after 30 kGy of gamma accumulated dose. Transit dosimetry measurements through a homogeneous Solid Water phantom had a measured dose within error of the TPS calculations, for field sizes between 3 × 3 cm2 and 10 × 10 cm2. A four-fraction collapsed IMRT plan on a lung phantom had absolute dose pass fractions between the MP987 and TPS (treatment planning system) from 94.2% to 97.4%, with a 5%/5 mm criteria. The ability to accurately measure dose at a transit level, without the need for correction factors derived from extensive commissioning data collection procedures, makes the MP987 a viable alternative to the EPID for in vivo dosimetry. This MP987 is this first of its kind to be successfully developed specifically for a dual detector application.
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Bossuyt E, Weytjens R, Nevens D, De Vos S, Verellen D. Evaluation of automated pre-treatment and transit in-vivo dosimetry in radiotherapy using empirically determined parameters. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2020; 16:113-129. [PMID: 33458354 PMCID: PMC7807610 DOI: 10.1016/j.phro.2020.09.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/07/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022]
Abstract
Background and purpose First reports on clinical use of commercially automated systems for Electronic Portal Imaging Device (EPID)-based dosimetry in radiotherapy showed the capability to detect important changes in patient setup, anatomy and external device position. For this study, results for more than 3000 patients, for both pre-treatment verification and in-vivo transit dosimetry were analyzed. Materials and methods For all Volumetric Modulated Arc Therapy (VMAT) plans, pre-treatment quality assurance (QA) with EPID images was performed. In-vivo dosimetry using transit EPID images was analyzed, including causes and actions for failed fractions for all patients receiving photon treatment (2018-2019). In total 3136 and 32,632 fractions were analyzed with pre-treatment and transit images respectively. Parameters for gamma analysis were empirically determined, balancing the rate between detection of clinically relevant problems and the number of false positive results. Results Pre-treatment and in-vivo results depended on machine type. Causes for failed in-vivo analysis included deviations in patient positioning (32%) and anatomy change (28%). In addition, errors in planning, imaging, treatment delivery, simulation, breath hold and with immobilization devices were detected. Actions for failed fractions were mostly to repeat the measurement while taking extra care in positioning (54%) and to intensify imaging procedures (14%). Four percent initiated plan adjustments, showing the potential of the system as a basis for adaptive planning. Conclusions EPID-based pre-treatment and in-vivo transit dosimetry using a commercially available automated system efficiently revealed a wide variety of deviations and showed potential to serve as a basis for adaptive planning.
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Affiliation(s)
- Evy Bossuyt
- Iridium Kankernetwerk, Radiation Oncology Department, Antwerp, Belgium
| | | | - Daan Nevens
- Iridium Kankernetwerk, Radiation Oncology Department, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
| | - Sarah De Vos
- Iridium Kankernetwerk, Radiation Oncology Department, Antwerp, Belgium
| | - Dirk Verellen
- Iridium Kankernetwerk, Radiation Oncology Department, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
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Abbasian P, McCowan PM, Rickey DW, Van Uytven E, McCurdy BMC. Modeling the temporal–spatial nature of the readout of an electronic portal imaging device (EPID). Med Phys 2020; 47:5301-5311. [DOI: 10.1002/mp.14440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 07/13/2020] [Accepted: 07/19/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- Parandoush Abbasian
- Department of Physics and Astronomy University of Manitoba Winnipeg ManitobaR3T 2N2 Canada
| | - Peter M. McCowan
- Department of Physics and Astronomy University of Manitoba Winnipeg ManitobaR3T 2N2 Canada
- Medical Physics Department CancerCare Manitoba 675 McDermot Avenue Winnipeg ManitobaR3E 0V9 Canada
| | - Daniel W. Rickey
- Department of Physics and Astronomy University of Manitoba Winnipeg ManitobaR3T 2N2 Canada
- Medical Physics Department CancerCare Manitoba 675 McDermot Avenue Winnipeg ManitobaR3E 0V9 Canada
- Department of Radiology University of Manitoba 820 Sherbrook Street Winnipeg ManitobaR3A 1R9 Canada
| | - Eric Van Uytven
- Medical Physics Department CancerCare Manitoba 675 McDermot Avenue Winnipeg ManitobaR3E 0V9 Canada
- Department of Radiology University of Manitoba 820 Sherbrook Street Winnipeg ManitobaR3A 1R9 Canada
| | - Boyd M. C. McCurdy
- Department of Physics and Astronomy University of Manitoba Winnipeg ManitobaR3T 2N2 Canada
- Medical Physics Department CancerCare Manitoba 675 McDermot Avenue Winnipeg ManitobaR3E 0V9 Canada
- Department of Radiology University of Manitoba 820 Sherbrook Street Winnipeg ManitobaR3A 1R9 Canada
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A novel approach to SBRT patient quality assurance using EPID-based real-time transit dosimetry. Strahlenther Onkol 2020; 196:182-192. [DOI: 10.1007/s00066-019-01549-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/26/2019] [Indexed: 12/25/2022]
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Stevens S, Dvorak P, Spevacek V, Pilarova K, Bray-Parry M, Gesner J, Richmond A. An assessment of a 3D EPID-based dosimetry system using conventional two- and three-dimensional detectors for VMAT. Phys Med 2018; 45:25-34. [DOI: 10.1016/j.ejmp.2017.11.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 10/05/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022] Open
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Abstract
Patient motion can cause misalignment of the tumour and toxicities to the healthy lung tissue during lung stereotactic body radiation therapy (SBRT). Any deviations from the reference setup can miss the target and have acute toxic effects on the patient with consequences onto its quality of life and survival outcomes. Correction for motion, either immediately prior to treatment or intra-treatment, can be realized with image-guided radiation therapy (IGRT) and motion management devices. The use of these techniques has demonstrated the feasibility of integrating complex technology with clinical linear accelerator to provide a higher standard of care for the patients and increase their quality of life.
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Affiliation(s)
- Vincent Caillet
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; School of Physics, University of Sydney, Sydney, Australia.
| | - Jeremy T Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; School of Physics, University of Sydney, Sydney, Australia
| | - Paul Keall
- School of Medicine, University of Sydney, Sydney, Australia
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