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Roy S, Sarkar B, Pradhan A. Application of a Comprehensive Treatment Planning Test for Credentialing Intensity-Modulated Radiotherapy and RapidArc in a TrueBeam Linear Accelerator Setup. J Med Phys 2023; 48:204-209. [PMID: 37576093 PMCID: PMC10419748 DOI: 10.4103/jmp.jmp_56_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 03/29/2023] [Accepted: 04/01/2023] [Indexed: 08/15/2023] Open
Abstract
An extended version of task group report (TG)-119 dosimetric tests was introduced and tested on the TrueBeam linear accelerator setup. Treatment plan results and quality assurance (QA) results of RapidArc (RA) and intensity-modulated radiotherapy (IMRT) were compared to understand the limitation and efficacy of the RA and IMRT system of the linear accelerator. Test structure sets were drawn on OCTAVIUS four-dimensional (4D) phantom computed tomography scan data for this study. We generated treatment plans based on the specified goal in the Eclipse™ treatment planning system using RA and IMRT in the study phantom. We used the same planning objectives for RA and IMRT techniques. Planar dose verification was performed using electronic portal imaging device and OCTAVIUS 4D phantom. The treatment log file was further analyzed using Pylinac (V2.4.0 (Open Source Code library available on Github, runs under Python programming language)) to compare the dosimetric outcome of RA and IMRT. Dose to the planning target volume (PTV) 1-5 and organ at risk (OAR) were analyzed in this study for the efficiency comparison of RA and IMRT. The primary objective was accomplished by adhering to the dose constraints associated with PTV 2 and the OAR. RA and IMRT also met the secondary objective. The tertiary goal of dose delivery to PTV 4 was met with RA but not IMRT. This study can be utilized to compare different institutions' planning and patient-specific QA (PSQA) procedures. The findings of this study were in line with the published works of the literature. A multi-institutional planning and delivery accuracy audit can be built using this structure and set of planning objectives having similar PSQA phantom. The TG-119 report incorporated test challenges that were combined in a single study set and a single plan. This reduces the complexity of performing the original TG-119 tests, whereas keeping the challenges as introduced in the TG-119 report. This study's planning and dosimetric results could be further utilized for dosimetry audit with any institute having a linear accelerator and OCTAVIUS 4D phantom for PSQA.
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Affiliation(s)
- Soumya Roy
- Department of Radiation Oncology, Manipal Hospital, New Delhi, India
- Department of Physics, GLA University, Mathura, Uttar Pradesh, India
| | - Biplab Sarkar
- Department of Physics, GLA University, Mathura, Uttar Pradesh, India
- Department of Radiation Oncology, Apollo Multispeciality Hospital, Kolkata, West Bengal, India
| | - Anirudh Pradhan
- Centre for Cosmology, Astrophysics and Space Science (CCASS), GLA University, Mathura, Uttar Pradesh, India
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A virtual dosimetry audit - Towards transferability of gamma index analysis between clinical trial QA groups. Radiother Oncol 2018; 125:398-404. [PMID: 29100698 DOI: 10.1016/j.radonc.2017.10.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE Quality assurance (QA) for clinical trials is important. Lack of compliance can affect trial outcome. Clinical trial QA groups have different methods of dose distribution verification and analysis, all with the ultimate aim of ensuring trial compliance. The aim of this study was to gain a better understanding of different processes to inform future dosimetry audit reciprocity. MATERIALS Six clinical trial QA groups participated. Intensity modulated treatment plans were generated for three different cases. A range of 17 virtual 'measurements' were generated by introducing a variety of simulated perturbations (such as MLC position deviations, dose differences, gantry rotation errors, Gaussian noise) to three different treatment plan cases. Participants were blinded to the 'measured' data details. Each group analysed the datasets using their own gamma index (γ) technique and using standardised parameters for passing criteria, lower dose threshold, γ normalisation and global γ. RESULTS For the same virtual 'measured' datasets, different results were observed using local techniques. For the standardised γ, differences in the percentage of points passing with γ < 1 were also found, however these differences were less pronounced than for each clinical trial QA group's analysis. These variations may be due to different software implementations of γ. CONCLUSIONS This virtual dosimetry audit has been an informative step in understanding differences in the verification of measured dose distributions between different clinical trial QA groups. This work lays the foundations for audit reciprocity between groups, particularly with more clinical trials being open to international recruitment.
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Pasler M, Hernandez V, Jornet N, Clark CH. Novel methodologies for dosimetry audits: Adapting to advanced radiotherapy techniques. Phys Imaging Radiat Oncol 2018; 5:76-84. [PMID: 33458373 PMCID: PMC7807589 DOI: 10.1016/j.phro.2018.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 11/25/2022] Open
Abstract
With new radiotherapy techniques, treatment delivery is becoming more complex and accordingly, these treatment techniques require dosimetry audits to test advanced aspects of the delivery to ensure best practice and safe patient treatment. This review of novel methodologies for dosimetry audits for advanced radiotherapy techniques includes recent developments and future techniques to be applied in dosimetry audits. Phantom-based methods (i.e. phantom-detector combinations) including independent audit equipment and local measurement equipment as well as phantom-less methods (i.e. portal dosimetry, transmission detectors and log files) are presented and discussed. Methodologies for both conventional linear accelerator (linacs) and new types of delivery units, i.e. Tomotherapy, stereotactic devices and MR-linacs, are reviewed. Novel dosimetry audit techniques such as portal dosimetry or log file evaluation have the potential to allow parallel auditing (i.e. performing an audit at multiple institutions at the same time), automation of data analysis and evaluation of multiple steps of the radiotherapy treatment chain. These methods could also significantly reduce the time needed for audit and increase the information gained. However, to maximise the potential, further development and harmonisation of dosimetry audit techniques are required before these novel methodologies can be applied.
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Affiliation(s)
- Marlies Pasler
- Lake Constance Radiation Oncology Center Singen-Friedrichshafen, Germany
| | - Victor Hernandez
- Department of Medical Physics, Hospital Sant Joan de Reus, IISPV, Tarragona, Spain
| | - Núria Jornet
- Servei de RadiofísicaiRadioprotecció, Hospital de la Santa CreuiSant Pau, Spain
| | - Catharine H. Clark
- Department of Medical Physics, Royal Surrey County Hospital, Guildford, Surrey, UK
- Metrology for Medical Physics (MEMPHYS), National Physical Laboratory, Teddington, Middlesex, UK
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Mans A, Schuring D, Arends MP, Vugts CAJM, Wolthaus JWH, Lotz HT, Admiraal M, Louwe RJW, Öllers MC, van de Kamer JB. The NCS code of practice for the quality assurance and control for volumetric modulated arc therapy. Phys Med Biol 2016; 61:7221-7235. [PMID: 27649474 DOI: 10.1088/0031-9155/61/19/7221] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In 2010, the NCS (Netherlands Commission on Radiation Dosimetry) installed a subcommittee to develop guidelines for quality assurance and control for volumetric modulated arc therapy (VMAT) treatments. The report (published in 2015) has been written by Dutch medical physicists and has therefore, inevitably, a Dutch focus. This paper is a condensed version of these guidelines, the full report in English is freely available from the NCS website www.radiationdosimetry.org. After describing the transition from IMRT to VMAT, the paper addresses machine quality assurance (QA) and treatment planning system (TPS) commissioning for VMAT. The final section discusses patient specific QA issues such as the use of class solutions, measurement devices and dose evaluation methods.
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Affiliation(s)
- Anton Mans
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Bulk evaluation and comparison of radiotherapy treatment plans for breast cancer. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2016; 39:633-44. [PMID: 27325526 DOI: 10.1007/s13246-016-0454-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 05/29/2016] [Indexed: 12/25/2022]
Abstract
This study provides a bulk, retrospective analysis of 151 breast and chest wall radiotherapy treatment plans, as a small-scale demonstration of the potential breadth and value of the information that may be obtained from clinical data mining. The treatments were planned at three centres belonging to one organisation over a period of 3 months. All 151 plans were used to evaluate inter-centre consistency and compliance with a local planning protocol. A subset of 79 plans, from one centre, were used in a more detailed evaluation of the effects of anatomical asymmetry on heart and lung dose, the effects of a metallic temporary tissue expander port on dose homogeneity and the overall conformity and homogeneity achieved in routine breast treatment planning. Differences in anatomical structure contouring and nomenclature were identified between the three centres, with all centres showing some non-compliance with the local planning protocol. When evaluated against standard conformity indices, these breast plans performed relatively poorly. However, when evaluated against recommended organ-at-risk tolerances, all evaluated plans performed sufficiently well that tighter planning tolerances could be recommended for future planning. Heart doses calculated in left breast and chest wall treatments were significantly higher than heart doses calculated in right sided breast and chest wall treatments (p < 0.001). In the treatment involving a temporary tissue expander, the inflated implant effectively pushed the targeted breast tissue away from the healthy tissues, leading to a dose distribution that was relatively conformal, although attenuation through the tissue expander's metallic port may have been underestimated by the treatment planning system. The results of this study exemplify the use of bulk treatment planning data to evaluate clinical workloads and inform ongoing treatment planning.
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McGarry CK, Agnew CE, Hussein M, Tsang Y, Hounsell AR, Clark CH. The use of log file analysis within VMAT audits. Br J Radiol 2016; 89:20150489. [PMID: 27072390 DOI: 10.1259/bjr.20150489] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This work investigated the delivery accuracy of different Varian linear accelerator models using log file-derived multileaf collimator (MLC) root mean square (RMS) values. METHODS Seven centres independently created a plan on the same virtual phantom using their own planning system, and the log files were analyzed following delivery of the plan in each centre to assess MLC positioning accuracy. A single standard plan was also delivered by the seven centres to remove variations in complexity, and the log files were analyzed for Varian TrueBeams and Clinacs (2300IX or 2100CD models). RESULTS Varian TrueBeam accelerators had better MLC positioning accuracy (<1.0 mm) than the 2300IX (<2.5 mm) following delivery of the plans created by each centre and also the standard plan. In one case, log files provided evidence that reduced delivery accuracy was not associated with the linear accelerator model but was due to planning issues. CONCLUSION Log files are useful in identifying differences between linear accelerator models and isolate errors during end-to-end testing in volumetric-modulated arc therapy (VMAT) audits. Log file analysis can rapidly eliminate the machine delivery from the process and divert attention with confidence to other aspects. ADVANCES IN KNOWLEDGE Log file evaluation was shown to be an effective method to rapidly verify satisfactory treatment delivery when a dosimetric evaluation fails during end-to-end dosimetry audits. MLC RMS values for Varian TrueBeams were shown to be much smaller than those for Varian Clinacs for VMAT deliveries.
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Affiliation(s)
- Conor K McGarry
- 1 Radiotherapy Physics, Belfast Health and Social Care Trust, Belfast, UK.,2 Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - Christina E Agnew
- 1 Radiotherapy Physics, Belfast Health and Social Care Trust, Belfast, UK
| | - Mohammad Hussein
- 3 Department of Medical Physics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.,4 Department of Physics, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, UK
| | - Yatman Tsang
- 5 RTTQA Group, Mount Vernon Hospital, Northwood, UK
| | - Alan R Hounsell
- 1 Radiotherapy Physics, Belfast Health and Social Care Trust, Belfast, UK.,2 Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - Catharine H Clark
- 3 Department of Medical Physics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.,4 Department of Physics, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, UK.,6 Radiation Dosimetry Group, National Physical Laboratory, Teddington, UK
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McGarry CK, Agnew CE, Hussein M, Tsang Y, McWilliam A, Hounsell AR, Clark CH. The role of complexity metrics in a multi-institutional dosimetry audit of VMAT. Br J Radiol 2015; 89:20150445. [PMID: 26511276 DOI: 10.1259/bjr.20150445] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To demonstrate the benefit of complexity metrics such as the modulation complexity score (MCS) and monitor units (MUs) in multi-institutional audits of volumetric-modulated arc therapy (VMAT) delivery. METHODS 39 VMAT treatment plans were analysed using MCS and MU. A virtual phantom planning exercise was planned and independently measured using the PTW Octavius(®) phantom and seven29(®) 2D array (PTW-Freiburg GmbH, Freiburg, Germany). MCS and MU were compared with the median gamma index pass rates (2%/2 and 3%/3 mm) and plan quality. The treatment planning systems (TPS) were grouped by VMAT modelling being specifically designed for the linear accelerator manufacturer's own treatment delivery system (Type 1) or independent of vendor for VMAT delivery (Type 2). Differences in plan complexity (MCS and MU) between TPS types were compared. RESULTS For Varian(®) linear accelerators (Varian(®) Medical Systems, Inc., Palo Alto, CA), MCS and MU were significantly correlated with gamma pass rates. Type 2 TPS created poorer quality, more complex plans with significantly higher MUs and MCS than Type 1 TPS. Plan quality was significantly correlated with MU for Type 2 plans. A statistically significant correlation was observed between MU and MCS for all plans (R = -0.84, p < 0.01). CONCLUSION MU and MCS have a role in assessing plan complexity in audits along with plan quality metrics. Plan complexity metrics give some indication of plan deliverability but should be analysed with plan quality. ADVANCES IN KNOWLEDGE Complexity metrics were investigated for a national rotational audit involving 34 institutions and they showed value. The metrics found that more complex plans were created for planning systems which were independent of vendor for VMAT delivery.
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Affiliation(s)
- Conor K McGarry
- 1 Radiotherapy Physics, Belfast Health and Social Care Trust, Belfast, UK.,2 Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - Christina E Agnew
- 1 Radiotherapy Physics, Belfast Health and Social Care Trust, Belfast, UK
| | - Mohammad Hussein
- 3 Department of Medical Physics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.,4 Department of Physics, University of Surrey, Guildford, UK
| | - Yatman Tsang
- 5 RTTQA Group, Mount Vernon Hospital, Northwood, Middlesex, UK
| | - Alan McWilliam
- 6 Medical Physics and Engineering Department, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Alan R Hounsell
- 1 Radiotherapy Physics, Belfast Health and Social Care Trust, Belfast, UK.,2 Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - Catharine H Clark
- 3 Department of Medical Physics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.,4 Department of Physics, University of Surrey, Guildford, UK.,7 Radiation Dosimetry Group, National Physical Laboratory, Teddington, Middlesex, UK
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Eaton DJ, Bolton S, Thomas RAS, Clark CH. Inter-departmental dosimetry audits - development of methods and lessons learned. J Med Phys 2015; 40:183-9. [PMID: 26865753 PMCID: PMC4728888 DOI: 10.4103/0971-6203.170791] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/05/2015] [Accepted: 08/05/2015] [Indexed: 11/10/2022] Open
Abstract
External dosimetry audits give confidence in the safe and accurate delivery of radiotherapy. In the United Kingdom, such audits have been performed for almost 30 years. From the start, they included clinically relevant conditions, as well as reference machine output. Recently, national audits have tested new or complex techniques, but these methods are then used in regional audits by a peer-to-peer approach. This local approach builds up the radiotherapy community, facilitates communication, and brings synergy to medical physics.
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Affiliation(s)
- David J. Eaton
- Radiotherapy Trials Quality Assurance Group, Mount Vernon Hospital, London, UK
| | - Steve Bolton
- Inter-departmental Audit Group, Institute of Physics and Engineering in Medicine, York, UK
- Department of Medical Physics and Engineering, Christie Hospital, Manchester, UK
| | | | - Catharine H. Clark
- Radiation Dosimetry Group, National Physical Laboratory, London, UK
- Department of Medical Physics, Royal Surrey County Hospital, Guildford, UK
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Clark CH, Aird EGA, Bolton S, Miles EA, Nisbet A, Snaith JAD, Thomas RAS, Venables K, Thwaites DI. Radiotherapy dosimetry audit: three decades of improving standards and accuracy in UK clinical practice and trials. Br J Radiol 2015; 88:20150251. [PMID: 26329469 DOI: 10.1259/bjr.20150251] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Dosimetry audit plays an important role in the development and safety of radiotherapy. National and large scale audits are able to set, maintain and improve standards, as well as having the potential to identify issues which may cause harm to patients. They can support implementation of complex techniques and can facilitate awareness and understanding of any issues which may exist by benchmarking centres with similar equipment. This review examines the development of dosimetry audit in the UK over the past 30 years, including the involvement of the UK in international audits. A summary of audit results is given, with an overview of methodologies employed and lessons learnt. Recent and forthcoming more complex audits are considered, with a focus on future needs including the arrival of proton therapy in the UK and other advanced techniques such as four-dimensional radiotherapy delivery and verification, stereotactic radiotherapy and MR linear accelerators. The work of the main quality assurance and auditing bodies is discussed, including how they are working together to streamline audit and to ensure that all radiotherapy centres are involved. Undertaking regular external audit motivates centres to modernize and develop techniques and provides assurance, not only that radiotherapy is planned and delivered accurately but also that the patient dose delivered is as prescribed.
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Affiliation(s)
- Catharine H Clark
- 1 Department of Medical Physics, Royal Surrey County Hospital, Guildford, Surrey, UK.,2 Radiation Dosimetry Group, National Physical Laboratory, Teddington, Middlesex, UK
| | - Edwin G A Aird
- 3 RTTQA Group, Mount Vernon Hospital, Northwood, Middlesex, UK
| | - Steve Bolton
- 4 Medical Physics and Engineering Department, Christie Hospital NHS Foundation Trust, Manchester, UK.,5 Institute of Physics and Engineering in Medicine, York, UK
| | | | - Andrew Nisbet
- 1 Department of Medical Physics, Royal Surrey County Hospital, Guildford, Surrey, UK.,6 Department of Physics, University of Surrey, Guildford, UK
| | - Julia A D Snaith
- 2 Radiation Dosimetry Group, National Physical Laboratory, Teddington, Middlesex, UK
| | - Russell A S Thomas
- 2 Radiation Dosimetry Group, National Physical Laboratory, Teddington, Middlesex, UK
| | - Karen Venables
- 3 RTTQA Group, Mount Vernon Hospital, Northwood, Middlesex, UK
| | - David I Thwaites
- 7 Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia
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Clark CH, Hussein M, Tsang Y, Thomas R, Wilkinson D, Bass G, Snaith J, Gouldstone C, Bolton S, Nutbrown R, Venables K, Nisbet A. A multi-institutional dosimetry audit of rotational intensity-modulated radiotherapy. Radiother Oncol 2014; 113:272-8. [DOI: 10.1016/j.radonc.2014.11.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 11/04/2014] [Accepted: 11/06/2014] [Indexed: 11/26/2022]
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12
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A methodology for dosimetry audit of rotational radiotherapy using a commercial detector array. Radiother Oncol 2013; 108:78-85. [DOI: 10.1016/j.radonc.2013.05.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 04/29/2013] [Accepted: 05/18/2013] [Indexed: 11/17/2022]
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