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Saw CB, Battin F, Churilla T, Haggerty M, Peters CA. TEAM participation in the irradiation of IROC phantoms for cooperative group clinical trials. Med Dosim 2024:S0958-3947(24)00019-0. [PMID: 38735780 DOI: 10.1016/j.meddos.2024.04.002] [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: 12/12/2023] [Revised: 03/16/2024] [Accepted: 04/09/2024] [Indexed: 05/14/2024]
Abstract
The participation of radiation oncology team members in the irradiation of Imaging and Radiation Oncology Core (IROC) phantom for cooperative group clinical trials is essential to comply with the latest quality management philosophy. Medical dosimetrists are expected to develop treatment plans for the irradiation of IROC phantoms. For advanced treatment techniques, such as three-dimensional conformal radiation therapy (3DCRT), intensity-modulated radiation therapy (IMRT), and volumetric-modulated arc therapy (VMAT), the irradiation of the IROC phantoms serves as quality audit. If successful, the irradiation processes demonstrate that the institution has the knowledge of the protocol, and has the appropriate equipment to comply with the protocol requirements. This article describes three IROC phantoms used for credentialing external beam photon beam therapy, delivered using conventional medical linear accelerators, to the medical dosimetry community. Guidance and strategies for the development of treatment plans are discussed. Our institutional irradiation of the three IROC phantoms, delivered using the Truebeam medical linear accelerator, resulted in consistent dose accuracy to within ±1%. The participation of the team members may reduce the overall published failing rate stated to be about one-third of all participating institutions.
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Affiliation(s)
- Cheng B Saw
- Northeast Radiation Oncology Centers (NROC), Dunmore, PA 18512, USA.
| | - Frank Battin
- Northeast Radiation Oncology Centers (NROC), Dunmore, PA 18512, USA
| | - Thomas Churilla
- Northeast Radiation Oncology Centers (NROC), Dunmore, PA 18512, USA
| | - Meghan Haggerty
- Northeast Radiation Oncology Centers (NROC), Dunmore, PA 18512, USA
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FitzGerald TJ, Bishop-Jodoin M, Laurie F, Iandoli M, Smith K, Ulin K, Ding L, Moni J, Cicchetti MG, Knopp M, Kry S, Xiao Y, Rosen M, Prior F, Saltz J, Michalski J. The Importance of Quality Assurance in Radiation Oncology Clinical Trials. Semin Radiat Oncol 2023; 33:395-406. [PMID: 37684069 DOI: 10.1016/j.semradonc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Clinical trials have been the center of progress in modern medicine. In oncology, we are fortunate to have a structure in place through the National Clinical Trials Network (NCTN). The NCTN provides the infrastructure and a forum for scientific discussion to develop clinical concepts for trial design. The NCTN also provides a network group structure to administer trials for successful trial management and outcome analyses. There are many important aspects to trial design and conduct. Modern trials need to ensure appropriate trial conduct and secure data management processes. Of equal importance is the quality assurance of a clinical trial. If progress is to be made in oncology clinical medicine, investigators and patient care providers of service need to feel secure that trial data is complete, accurate, and well-controlled in order to be confident in trial analysis and move trial outcome results into daily practice. As our technology has matured, so has our need to apply technology in a uniform manner for appropriate interpretation of trial outcomes. In this article, we review the importance of quality assurance in clinical trials involving radiation therapy. We will include important aspects of institution and investigator credentialing for participation as well as ongoing processes to ensure that each trial is being managed in a compliant manner. We will provide examples of the importance of complete datasets to ensure study interpretation. We will describe how successful strategies for quality assurance in the past will support new initiatives moving forward.
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Affiliation(s)
- Thomas J FitzGerald
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA..
| | | | - Fran Laurie
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - Matthew Iandoli
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - Koren Smith
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - Kenneth Ulin
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - Linda Ding
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - Janaki Moni
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - M Giulia Cicchetti
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - Michael Knopp
- Department of Radiology, University of Cincinnati, Cincinnati, OH
| | - Stephen Kry
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Mark Rosen
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Fred Prior
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University in St Louis, St Louis, MO
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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.
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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
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Meyer T, Quirk S, Husain S, Hilts M, Crook J, Watt E, Guebert A, Frederick A, Batchelar D, Kry SF, Roumeliotis M. Peer-based credentialing for brachytherapy: Application in permanent seed implant. Brachytherapy 2020; 19:794-799. [DOI: 10.1016/j.brachy.2020.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/17/2020] [Accepted: 03/26/2020] [Indexed: 11/29/2022]
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Edward SS, C Glenn M, Peterson CB, Balter PA, Pollard-Larkin JM, Howell RM, S Followill D, Kry SF. Dose calculation errors as a component of failing IROC lung and spine phantom irradiations. Med Phys 2020; 47:4502-4508. [PMID: 32452027 DOI: 10.1002/mp.14258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/19/2020] [Accepted: 05/11/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Between July 2013 and August 2019, 22% of the imaging and radiation oncology core (IROC) spine, and 15% of the moving lung phantom irradiations have failed to meet established acceptability criteria. The spine phantom simulates a highly modulated stereotactic body radiation therapy (SBRT) case, whereas the lung phantom represents a low-to-none modulation moving target case. In this study, we assessed the contribution of dose calculation errors to these phantom results and evaluated their effects on failure rates. METHODS We evaluated dose calculation errors by comparing the calculation accuracy of various institutions' treatment planning systems (TPSs) vs IROC-Houston's previously established independent dose recalculation system (DRS). Each calculation was compared with the measured dose actually delivered to the phantom; cases in which the recalculation was more accurate were interpreted as a deficiency in the institution's TPS. A total of 258 phantom irradiation plans (172 lung and 86 spine) were recomputed. RESULTS Overall, the DRS performed better than the TPSs in 47% of the spine phantom cases. However, the DRS was more accurate in 93% of failing spine phantom cases (with an average improvement of 2.35%), indicating a deficiency in the institution's treatment planning system. Deficiencies in dose calculation accounted for 60% of the overall discrepancy between measured and planned doses among spine phantoms. In contrast, lung phantom DRS calculations were more accurate in only 35% and 42% of all and failing lung phantom cases respectively, indicating that dose calculation errors were not substantially present. These errors accounted for only 30% of the overall discrepancy between measured and planned doses. CONCLUSIONS Dose calculation errors are common and substantial in IROC spine phantom irradiations, highlighting a major failure mode in this phantom and in clinical treatment management of these cases. In contrast, dose calculation accuracy had only a minimal contribution to failing lung phantom results, indicating that other failure modes drive problems with this phantom and similar clinical treatments.
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Affiliation(s)
- Sharbacha S Edward
- The University of Texas MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston, TX, 77030, USA.,IROC Houston Quality Assurance Center, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Mallory C Glenn
- The University of Texas MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston, TX, 77030, USA.,IROC Houston Quality Assurance Center, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Christine B Peterson
- The University of Texas MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston, TX, 77030, USA.,Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Peter A Balter
- The University of Texas MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston, TX, 77030, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Julianne M Pollard-Larkin
- The University of Texas MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston, TX, 77030, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Rebecca M Howell
- The University of Texas MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston, TX, 77030, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - David S Followill
- The University of Texas MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston, TX, 77030, USA.,IROC Houston Quality Assurance Center, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Stephen F Kry
- The University of Texas MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston, TX, 77030, USA.,IROC Houston Quality Assurance Center, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
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El Naqa I, Irrer J, Ritter TA, DeMarco J, Al‐Hallaq H, Booth J, Kim G, Alkhatib A, Popple R, Perez M, Farrey K, Moran JM. Machine learning for automated quality assurance in radiotherapy: A proof of principle using
EPID
data description. Med Phys 2019; 46:1914-1921. [DOI: 10.1002/mp.13433] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/02/2019] [Accepted: 01/30/2019] [Indexed: 11/07/2022] Open
Affiliation(s)
- Issam El Naqa
- Department of Radiation Oncology University of Michigan Ann Arbor MI 48103 USA
| | - Jim Irrer
- Department of Radiation Oncology University of Michigan Ann Arbor MI 48103 USA
| | - Tim A. Ritter
- Department of Radiation Oncology Virginia Commonwealth University Richmond VA 23298 USA
| | - John DeMarco
- Department of Radiation Oncology Cedars‐Sinai Medical Center Los Angeles California 90048 USA
| | - Hania Al‐Hallaq
- University of Chicago Radiation and Cellular Oncology Chicago IL 60637 USA
| | - Jeremy Booth
- Royal North Shore Hospital St Leonards New South Wales 2065 Australia
| | - Grace Kim
- University of California at San Diego San Diego CA 92093 USA
| | - Ahmad Alkhatib
- Karmanos Cancer Institute McLaren‐Flint Flint MI 48532 USA
| | - Richard Popple
- University of Alabama at Birmingham Birmingham AL 35249 USA
| | - Mario Perez
- Royal North Shore Hospital St Leonards New South Wales 2065 Australia
| | - Karl Farrey
- University of Chicago Radiation and Cellular Oncology Chicago IL 60637 USA
| | - Jean M. Moran
- Department of Radiation Oncology University of Michigan Ann Arbor MI 48103 USA
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Dunn L, Jolly D. Automated data mining of a plan-check database and example application. J Appl Clin Med Phys 2018; 19:739-748. [PMID: 29956454 PMCID: PMC6123163 DOI: 10.1002/acm2.12396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/15/2018] [Accepted: 05/24/2018] [Indexed: 12/02/2022] Open
Abstract
Purpose The aim of this work was to present the development and example application of an automated data mining software platform that preforms bulk analysis of results and patient data passing through the 3D plan and delivery QA system, Mobius3D. Methods Python, matlab, and Java were used to create an interface that reads JavaScript Object Notation (JSON) created for every approved Mobius3D pre‐treatment plan‐check. The aforementioned JSON files contain all the information for every pre‐treatment QA check performed by Mobius3D, including all 3D dose, CT, structure set information, as well as all plan information and patient demographics. Two Graphical User Interfaces (GUIs) were created, the first is called Mobius3D‐Database (M3D‐DB) and presents the check results in both filterable tabular and graphical form. These data are presented for all patients and includes mean dose differences, 90% coverage, 3D gamma pass rate percentages, treatment sites, machine, beam energy, Multi‐Leaf Collimator (MLC) mode, treatment planning system (TPS), plan names, approvers, dates and times. Group statistics and statistical process control levels are then calculated based on filter settings. The second GUI, called Mobius3D organ at risk (M3DOAR), analyzes dose‐volume histogram data for all patients and all Organs‐at‐Risk (OAR). The design of the software is such that all treatment parameters and treatment site information are able to be filtered and sorted with the results, plots, and statistics updated. Results The M3D‐DB software can summarize and filter large numbers of plan‐checks from Mobius3D. The M3DOAR software is also able to analyze large amounts of dose‐volume data for patient groups which may prove useful in clinical trials, where OAR doses for large numbers of patients can be compared and correlated. Target DVHs can also be analyzed en mass. Conclusions This work demonstrates a method to extract the large amount of treatment data for every patient that is stored by Mobius3D but not easily accessible. With scripting, it is possible to mine this data for research and clinical trials as well as patient and TPS QA.
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Affiliation(s)
- Leon Dunn
- Icon Cancer Centre - The Valley, Mulgrave, Melbourne, Vic, Australia
| | - David Jolly
- Icon Cancer Centre - Richmond, Richmond, Melbourne, Vic, Australia
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Roumeliotis M, Quirk S, Skarsgard M, Trumpour T, Watt E, Meyer T. Development and characterization of an anthropomorphic breast phantom for permanent breast seed implant brachytherapy credentialing. Brachytherapy 2017; 17:506-513. [PMID: 29241704 DOI: 10.1016/j.brachy.2017.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE To develop an anthropomorphic breast phantom for use in credentialing of permanent breast seed implant brachytherapy. METHODS AND MATERIALS A representative external contour and target volume was used as the basis of mold manufacturing for anthropomorphic breast phantom development. Both target and normal tissue were composed of gel-like materials that provide suitable computed tomography and ultrasound contrast for brachytherapy delivery. The phantoms were evaluated for consistency in construction (target location) and Hounsfield unit (computed tomography contrast). For both target and normal tissue, the speed of sound was measured and compared to the image reconstruction algorithm's expectation value. Five phantoms were imaged preimplant and postimplant to assess interphantom similarity as well as to evaluate the uncertainty in quantifying seed position. RESULTS The average Hounsfield units of the target and normal tissue gels is -146 ± 5 and 23 ± 1, respectively. The average speed of sound of the target and normal tissue gels is 1485 ± 7 m/s and 1558 ± 9 m/s, respectively, resulting in an estimated 0.4 mm uncertainty in image guidance. The registration/deformation uncertainty was determined to be 0.8 mm. The standard combined uncertainty in assessing seed position spatial accuracy, also including a 0.9 mm estimate based on literature for seed localization, is estimated to be 1.3 mm. CONCLUSIONS The development of the anthropomorphic breast phantom and evaluation of both the consistency as well as overall seed position uncertainty illustrates the suitability of this phantom for use in brachytherapy end-to-end delivery and implant accuracy evaluation. When evaluating a user's implant accuracy, we estimate a standard combined uncertainty of 1.3 mm.
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Affiliation(s)
- Michael Roumeliotis
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada; Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta, Canada; Department of Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada.
| | - Sarah Quirk
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada; Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta, Canada; Department of Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Matthew Skarsgard
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Tiana Trumpour
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada; Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Elizabeth Watt
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada; Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Tyler Meyer
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada; Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta, Canada; Department of Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
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Jurado-Bruggeman D, Hernández V, Sáez J, Navarro D, Pino F, Martínez T, Alayrach ME, Ailleres N, Melero A, Jornet N. Multi-centre audit of VMAT planning and pre-treatment verification. Radiother Oncol 2017; 124:302-310. [DOI: 10.1016/j.radonc.2017.05.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/24/2017] [Accepted: 05/24/2017] [Indexed: 11/24/2022]
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Patient-related quality assurance with different combinations of treatment planning systems, techniques, and machines : A multi-institutional survey. Strahlenther Onkol 2016; 193:46-54. [PMID: 27812732 DOI: 10.1007/s00066-016-1064-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE This project compares the different patient-related quality assurance systems for intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques currently used in the central Germany area with an independent measuring system. MATERIALS AND METHODS The participating institutions generated 21 treatment plans with different combinations of treatment planning systems (TPS) and linear accelerators (LINAC) for the QUASIMODO (Quality ASsurance of Intensity MODulated radiation Oncology) patient model. The plans were exposed to the ArcCHECK measuring system (Sun Nuclear Corporation, Melbourne, FL, USA). The dose distributions were analyzed using the corresponding software and a point dose measured at the isocenter with an ionization chamber. RESULTS According to the generally used criteria of a 10 % threshold, 3 % difference, and 3 mm distance, the majority of plans investigated showed a gamma index exceeding 95 %. Only one plan did not fulfill the criteria and three of the plans did not comply with the commonly accepted tolerance level of ±3 % in point dose measurement. CONCLUSION Using only one of the two examined methods for patient-related quality assurance is not sufficiently significant in all cases.
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12
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Global Harmonization of Quality Assurance Naming Conventions in Radiation Therapy Clinical Trials. Int J Radiat Oncol Biol Phys 2014; 90:1242-9. [DOI: 10.1016/j.ijrobp.2014.08.348] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/05/2014] [Accepted: 08/28/2014] [Indexed: 11/23/2022]
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Weber DC, Vallet V, Molineu A, Melidis C, Teglas V, Naudy S, Moeckli R, Followill DS, Hurkmans CW. IMRT credentialing for prospective trials using institutional virtual phantoms: results of a joint European Organization for the Research and Treatment of Cancer and Radiological Physics Center project. Radiat Oncol 2014; 9:123. [PMID: 24885438 PMCID: PMC4046849 DOI: 10.1186/1748-717x-9-123] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 05/02/2014] [Indexed: 11/29/2022] Open
Abstract
Background and purpose Intensity-modulated radiotherapy (IMRT) credentialing for a EORTC study was performed using an anthropomorphic head phantom from the Radiological Physics Center (RPC; RPCPH). Institutions were retrospectively requested to irradiate their institutional phantom (INSTPH) using the same treatment plan in the framework of a Virtual Phantom Project (VPP) for IMRT credentialing. Materials and methods CT data set of the institutional phantom and measured 2D dose matrices were requested from centers and sent to a dedicated secure EORTC uploader. Data from the RPCPH and INSTPH were thereafter centrally analyzed and inter-compared by the QA team using commercially available software (RIT; ver.5.2; Colorado Springs, USA). Results Eighteen institutions participated to the VPP. The measurements of 6 (33%) institutions could not be analyzed centrally. All other centers passed both the VPP and the RPC ±7%/4 mm credentialing criteria. At the 5%/5 mm gamma criteria (90% of pixels passing), 11(92%) as compared to 12 (100%) centers pass the credentialing process with RPCPH and INSTPH (p = 0.29), respectively. The corresponding pass rate for the 3%/3 mm gamma criteria (90% of pixels passing) was 2 (17%) and 9 (75%; p = 0.01), respectively. Conclusions IMRT dosimetry gamma evaluations in a single plane for a H&N prospective trial using the INSTPH measurements showed agreement at the gamma index criteria of ±5%/5 mm (90% of pixels passing) for a small number of VPP measurements. Using more stringent, criteria, the RPCPH and INSTPH comparison showed disagreement. More data is warranted and urgently required within the framework of prospective studies.
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Affiliation(s)
- Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, Villigen CH-5232, Switzerland.
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14
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Radiation therapy quality assurance in clinical trials--Global Harmonisation Group. Radiother Oncol 2014; 111:327-9. [PMID: 24813094 DOI: 10.1016/j.radonc.2014.03.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 03/31/2014] [Accepted: 03/31/2014] [Indexed: 01/08/2023]
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Ibbott GS, Haworth A, Followill DS. Quality assurance for clinical trials. Front Oncol 2013; 3:311. [PMID: 24392352 PMCID: PMC3867736 DOI: 10.3389/fonc.2013.00311] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/05/2013] [Indexed: 11/13/2022] Open
Abstract
Cooperative groups, of which the Radiation Therapy Oncology Group is one example, conduct national clinical trials that often involve the use of radiation therapy. In preparation for such a trial, the cooperative group prepares a protocol to define the goals of the trial, the rationale for its design, and the details of the treatment procedure to be followed. The Radiological Physics Center (RPC) is one of several quality assurance (QA) offices that is charged with assuring that participating institutions deliver doses that are clinically consistent and comparable. The RPC does this by conducting a variety of independent audits and credentialing processes. The RPC has compiled data showing that credentialing can help institutions comply with the requirements of a cooperative group clinical protocol. Phantom irradiations have been demonstrated to exercise an institution's procedures for planning and delivering advanced external beam techniques (1-3). Similarly, RPC data indicate that a rapid review of patient treatment records or planning procedures can improve compliance with clinical trials (4). The experiences of the RPC are presented as examples of the contributions that a national clinical trials QA center can make to cooperative group trials. These experiences illustrate the critical need for comprehensive QA to assure that clinical trials are successful and cost-effective. The RPC is supported by grants CA 10953 and CA 81647 from the National Cancer Institute, NIH, DHHS.
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Affiliation(s)
- Geoffrey S Ibbott
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
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Fairchild A, Straube W, Laurie F, Followill D. Does quality of radiation therapy predict outcomes of multicenter cooperative group trials? A literature review. Int J Radiat Oncol Biol Phys 2013; 87:246-60. [PMID: 23683829 DOI: 10.1016/j.ijrobp.2013.03.036] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 03/29/2013] [Accepted: 03/31/2013] [Indexed: 10/26/2022]
Abstract
Central review of radiation therapy (RT) delivery within multicenter clinical trials was initiated in the early 1970s in the United States. Early quality assurance publications often focused on metrics related to process, logistics, and timing. Our objective was to review the available evidence supporting correlation of RT quality with clinical outcomes within cooperative group trials. A MEDLINE search was performed to identify multicenter studies that described central subjective assessment of RT protocol compliance (quality). Data abstracted included method of central review, definition of deviations, and clinical outcomes. Seventeen multicenter studies (1980-2012) were identified, plus one Patterns of Care Study. Disease sites were hematologic, head and neck, lung, breast, and pancreas. Between 0 and 97% of treatment plans received an overall grade of acceptable. In 7 trials, failure rates were significantly higher after inadequate versus adequate RT. Five of 9 and 2 of 5 trials reported significantly worse overall and progression-free survival after poor-quality RT, respectively. One reported a significant correlation, and 2 reported nonsignificant trends toward increased toxicity with noncompliant RT. Although more data are required, protocol-compliant RT may decrease failure rates and increase overall survival and likely contributes to the ability of collected data to answer the central trial question.
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Affiliation(s)
- Alysa Fairchild
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada.
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