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Nakamura M, Zhou D, Minemura T, Kito S, Okamoto H, Tohyama N, Kurooka M, Kumazaki Y, Ishikawa M, Clark CH, Miles E, Lehmann J, Andratschke N, Kry S, Ishikura S, Mizowaki T, Nishio T. A virtual audit system for intensity-modulated radiation therapy credentialing in Japan Clinical Oncology Group clinical trials: A pilot study. J Appl Clin Med Phys 2023:e14040. [PMID: 37191875 DOI: 10.1002/acm2.14040] [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: 11/20/2022] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/17/2023] Open
Abstract
PURPOSE The Medical Physics Working Group of the Radiation Therapy Study Group at the Japan Clinical Oncology Group is currently developing a virtual audit system for intensity-modulated radiation therapy dosimetry credentialing. The target dosimeters include films and array detectors, such as ArcCHECK (Sun Nuclear Corporation, Melbourne, Florida, USA) and Delta4 (ScandiDos, Uppsala, Sweden). This pilot study investigated the feasibility of our virtual audit system using previously acquired data. METHODS We analyzed 46 films (32 and 14 in the axial and coronal planes, respectively) from 29 institutions. Global gamma analysis between measured and planned dose distributions used the following settings: 3%/3 mm criteria (the dose denominator was 2 Gy), 30% threshold dose, no scaling of the datasets, and 90% tolerance level. In addition, 21 datasets from nine institutions were obtained for array evaluation. Five institutions used ArcCHECK, while the others used Delta4. Global gamma analysis was performed with 3%/2 mm criteria (the dose denominator was the maximum calculated dose), 10% threshold dose, and 95% tolerance level. The film calibration and gamma analysis were conducted with in-house software developed using Python (version 3.9.2). RESULTS The means ± standard deviations of the gamma passing rates were 99.4 ± 1.5% (range, 92.8%-100%) and 99.2 ± 1.0% (range, 97.0%-100%) in the film and array evaluations, respectively. CONCLUSION This pilot study demonstrated the feasibility of virtual audits. The proposed virtual audit system will contribute to more efficient, cheaper, and more rapid trial credentialing than on-site and postal audits; however, the limitations should be considered when operating our virtual audit system.
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Affiliation(s)
- Mitsuhiro Nakamura
- Department of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Dejun Zhou
- Department of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Satoshi Kito
- Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Hiroyuki Okamoto
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Naoki Tohyama
- Division of Medical Physics, Tokyo Bay Makuhari Clinic for Advanced Imaging, Cancer Screening, and High-Precision Radiotherapy, Chiba, Japan
| | - Masahiko Kurooka
- Department of Radiation Therapy, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yu Kumazaki
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | | | - Catharine H Clark
- National Radiotherapy Trials Quality Assurance (RTTQA) Group, Royal Surrey NHS Foundation Trust, London, UK
- Department of Radiotherapy Physics, University College London Hospital, London, UK
- Department of Medical Physics and Bioengineering, University College London, London, UK
- Medical Physics department, National Physical Laboratory (NPL), Teddington, UK
| | - Elizabeth Miles
- National Radiotherapy Trials Quality Assurance (RTTQA) Group, Mount Vernon Cancer Centre, Northwood, UK
| | - Joerg Lehmann
- Trans Tasman Radiation Oncology Group (TROG), Newcastle, Australia
- Department of Radiation Oncology, Calvary Mater Hospital, Newcastle, Australia
- School of Information and Physical Sciences, University of Newcastle, Newcastle, Australia
- Institute of Medical Physics, University of Sydney, Sydney, Australia
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Stephen Kry
- Imaging and Radiation Oncology Core (IROC), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Satoshi Ishikura
- Division of Radiation Oncology, Tokyo Bay Makuhari Clinic for Advanced Imaging, Cancer Screening, and High-Precision Radiotherapy, Chiba, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Teiji Nishio
- Medical Physics Laboratory, Division of Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan
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Taylor PA, Miles E, Hoffmann L, Kelly SM, Kry SF, Sloth Møller D, Palmans H, Akbarov K, Aznar MC, Clementel E, Corning C, Effeney R, Healy B, Moore A, Nakamura M, Patel S, Shaw M, Stock M, Lehmann J, Clark CH. Prioritizing clinical trial quality assurance for photons and protons: A failure modes and effects analysis (FMEA) comparison. Radiother Oncol 2023; 182:109494. [PMID: 36708923 DOI: 10.1016/j.radonc.2023.109494] [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: 12/02/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE The Global Clinical Trials RTQA Harmonization Group (GHG) set out to evaluate and prioritize clinical trial quality assurance. METHODS The GHG compiled a list of radiotherapy quality assurance (QA) tests performed for proton and photon therapy clinical trials. These tests were compared between modalities to assess whether there was a need for different types of assessments per modality. A failure modes and effects analysis (FMEA) was performed to assess the risk of each QA failure. RESULTS The risk analysis showed that proton and photon therapy shared four out of five of their highest-risk failures (end-to-end anthropomorphic phantom test, phantom tests using respiratory motion, pre-treatment patient plan review of contouring/outlining, and on-treatment/post-treatment patient plan review of dosimetric coverage). While similar trends were observed, proton therapy had higher risk failures, driven by higher severity scores. A sub-analysis of occurrence × severity scores identified high-risk scores to prioritize for improvements in RTQA detectability. A novel severity scaler was introduced to account for the number of patients affected by each failure. This scaler did not substantially alter the ranking of tests, but it elevated the QA program evaluation to the top 20th percentile. This is the first FMEA performed for clinical trial quality assurance. CONCLUSION The identification of high-risk errors associated with clinical trials is valuable to prioritize and reduce errors in radiotherapy and improve the quality of trial data and outcomes, and can be applied to optimize clinical radiotherapy QA.
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Affiliation(s)
- Paige A Taylor
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; The Imaging and Radiation Oncology Core, USA.
| | - Elizabeth Miles
- National Radiotherapy Trials Quality Assurance (RTTQA) Group, Mount Vernon Cancer Centre, Northwood, UK
| | - Lone Hoffmann
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Sarah M Kelly
- SIOP Europe, The European Society for Paediatric Oncology, Clos Chapelle-aux-Champs 30, Brussels, Belgium; EORTC Headquarters, European Organisation for Research and Treatment of Cancer, Avenue E. Mounier 83, Brussels, Belgium; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Stephen F Kry
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; The Imaging and Radiation Oncology Core, USA
| | - Ditte Sloth Møller
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Hugo Palmans
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria; Metrology for Medical Physics, National Physical Laboratory, Teddington, UK
| | - Kamal Akbarov
- Division of Human Health, Department of Nuclear Sciences and Applications, IAEA, Vienna, Austria
| | - Marianne C Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Enrico Clementel
- EORTC Headquarters, European Organisation for Research and Treatment of Cancer, Avenue E. Mounier 83, Brussels, Belgium
| | - Coreen Corning
- EORTC Headquarters, European Organisation for Research and Treatment of Cancer, Avenue E. Mounier 83, Brussels, Belgium
| | | | - Brendan Healy
- Australian Clinical Dosimetry Service, ARPANSA, Melbourne, Australia
| | | | - Mitsuhiro Nakamura
- Department of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Samir Patel
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Maddison Shaw
- Australian Clinical Dosimetry Service, ARPANSA, Melbourne, Australia; School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Markus Stock
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria; Karl Landsteiner University for Health Sciences, Austria
| | - Joerg Lehmann
- TROG Cancer Research, Newcastle, Australia; Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, Australia; School of Information and Physical Sciences, University of Newcastle, Newcastle, Australia; Institute of Medical Physics, University of Sydney, Sydney, Australia
| | - Catharine H Clark
- Metrology for Medical Physics, National Physical Laboratory, Teddington, UK; National Radiotherapy Trials Quality Assurance (RTTQA) Group, Mount Vernon Cancer Centre, Northwood, UK; Radiotherapy Physics, University College London Hospital, London, UK; Medical Physics and Bioengineering Department, University College London, London, UK
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Anetai Y, Sumida I, Kumazaki Y, Kito S, Kurooka M, Ueda Y, Otani Y, Narita Y, Kawamorita R, Akita K, Kato T, Nakamura M. Assessment of using a gamma index analysis for patient-specific quality assurance in Japan. J Appl Clin Med Phys 2022; 23:e13745. [PMID: 36018627 PMCID: PMC9588274 DOI: 10.1002/acm2.13745] [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: 03/08/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE The Task Group 218 (TG-218) report was published by the American Association of Physicists in Medicine in 2018, recommending the appropriate use of gamma index analysis for patient-specific quality assurance (PSQA). The paper demonstrates that PSQA for radiotherapy in Japan appropriately applies the gamma index analysis considering TG-218. MATERIALS/METHODS This survey estimated the acceptance state of radiotherapeutic institutes or facilities in Japan for the guideline using a web-based questionnaire. To investigate an appropriate PSQA of the facility-specific conditions, we researched an optimal tolerance or action level for various clinical situations, including different treatment machines, clinical policies, measurement devices, staff or their skills, and patient conditions. The responded data were analyzed using principal component analysis (PCA) and multidimensional scaling (MDS). The PCA focused on factor loading values of the first contribution over 0.5, whereas the MDS focused on mapped distances among data. RESULTS Responses were obtained from 148 facilities that use intensity-modulated radiation therapy (IMRT), which accounted for 42.8% of the probable IMRT use in Japan. This survey revealed the appropriate application of the following universal criteria for gamma index analysis from the guideline recommendation despite the facility-specific variations (treatment machines/the number of IMRT cases/facility attributes/responded [representative] expertise or staff): (a) 95% pass rate, (b) 3% dose difference and 2-mm distance-to-agreement, and (c) 10% threshold dose. Conditions (a)-(c) were the principal components of the data by the PCA method and were mapped in a similar distance range, which was easily clustered from other gamma index analytic factors by the MDS method. Conditions (a)-(c) were the universally essential factors for the PSQA in Japan. CONCLUSION We found that the majority of facilities using IMRT in each region of Japan complied with the guideline and conducted PSQA with deliberation under the individual facility-specific conditions.
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Affiliation(s)
- Yusuke Anetai
- Department of Radiology, Kansai Medical University, Hirakata-shi, Osaka, Japan
| | - Iori Sumida
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita-shi, Osaka, Japan.,Physics and clinical support, Accuray Japan K.K., Chiyoda-ku, Tokyo, Japan
| | - Yu Kumazaki
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan
| | - Satoshi Kito
- Department of Radiotherapy, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Masahiko Kurooka
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka-shi, Osaka, Japan
| | - Yuki Otani
- Department of Radiology, Kaizuka City Hospital, Kaizuka, Osaka, Japan
| | - Yuichiro Narita
- Department of Medical Physics, High Precision Radiation Therapy Center, Aomori Shintoshi Hospital, Aomori-shi, Aomori, Japan
| | - Ryu Kawamorita
- Department of Radiation Oncology, Tane General Hospital, Osaka-shi, Osaka, Japan
| | - Kazuhiko Akita
- Kansai BNCT Medical Center, Osaka Medical and Pharmaceutical University, Takatsuki-shi, Osaka, Japan
| | - Takahiro Kato
- Department of Radiological Sciences, School of Health Sciences, Fukushima Medical University, Fukushima-shi, Fukushima, Japan
| | - Mitsuhiro Nakamura
- Division of Medical Physics, Department of Information Technology and Medical engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
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Taylor PA, Lowenstein J, Followill D, Kry SF. The Value of On-Site Proton Audits. Int J Radiat Oncol Biol Phys 2022; 112:1004-1011. [PMID: 34780973 PMCID: PMC8863623 DOI: 10.1016/j.ijrobp.2021.10.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/06/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aimed to highlight the value and key findings of on-site proton audits. METHODS AND MATERIALS The authors performed 38 on-site measurement-based peer reviews of proton centers participating in National Cancer Institute-funded clinical trials. The reviews covered beam calibration, lateral and depth measurements, mechanical checks, treatment planning and clinical practice, and quality assurance (QA) practices. Program deficiencies were noted, and recommendations were made about ways institutions could improve their practices. RESULTS Institutions received an average of 3 (range, 1-8) recommendations for practice improvements. The number of deficiencies did not decrease over time, highlighting the continued need for this type of peer review. The most common deficiencies were for Task Group-recommended QA compliance (97% of centers), computed tomography number (CTN) to relative linear stopping power conversion (59%), and QA procedures (53%). In addition, 32% of institutions assessed failed at least 1 lateral beam profile measurement (<90% of pixels passing 3% [global]/3 mm; 10% threshold), despite passing internal QA measurements. These failures occurred for several different plan configurations (large, small, shallow, and deep targets) and at different depths in the beam path (proximal to target, central, and distal). CTN to relative linear stopping power conversion curves showed deviations at low, mid, and high CTNs and highlighted areas of inconsistency between proton centers, with many centers falling outside of 2 sigma of the mean curve of their peers. All deficiencies from the peer review were discussed with the institutions, and many implemented dosimetric treatment planning and practice changes to improve the accuracy of their system and consistency with other institutions. CONCLUSIONS This peer review program has been integral in confirming and promoting consistency and best practice across proton centers for clinical trials, minimizing deviations for outcomes data.
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Affiliation(s)
- Paige A Taylor
- The University of Texas, MD Anderson Cancer Center, Houston, Texas.
| | | | - David Followill
- The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Stephen F Kry
- The University of Texas, MD Anderson Cancer Center, Houston, Texas
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