Numerous commercial technologies for online treatment monitoring (OTM) in radiotherapy (RT) are currently available including electronic portal imaging device (EPID) in vivo dosimetry (IVD), transmission detectors and log files analysis. Despite this, in the UK there exists limited guidance on how to implement and commission a system for clinical use or information about the resources required to set up and maintain a service. A Radiotherapy Special Interest Group working party, established by Institute of Physics and Engineering in Medicine was formed with a view to reassess the current practice for OTM in the UK and an aim to develop consensus guidelines for the implementation of a system. A survey distributed to Heads of Medical Physics at 71 UK RT departments investigated: availability of OTM in the UK; estimates of workload; clinical implementation; methods of analysis; quality assurance; and opinions on future directions. The survey achieved a 76% response rate and demonstrated that OTM is widely supported in the UK, with 87% of respondents indicating all patients should undergo OTM. EPID IVD (EIVD) was the most popular form of OTM. An active EIVD service was reported by 37% of respondents, with 84% believing it was the optimal solution. This demonstrates a steady increase in adoption since 2012. Other forms of OTM were in use but they had only been adopted by a minority of centres. Financial barriers and the increase of staff workload continue to hinder wider implementation in other centres. Device automation and integration is a key factor for successful future adoption and requires support between treatment machine and OTM manufacturers. The survey has provided an updated analysis on the use of OTM methods across the UK. Future guidance is recommended on commissioning, adoption of local tolerances and root-cause analysis strategies to assist departments intending to implement OTM.
Margin-growing algorithms are commonly used tools that are available within virtual simulation and treatment planning software. We report on the accuracy of the margin-growing algorithms available in six commercially available radiotherapy software environments. A phantom containing two differently sized spheres and two rods (one level and one inclined) was constructed and scanned by CT with 1.25 mm, 2.5 mm, 3.75 mm and 5 mm slice thicknesses. The objects were outlined on a GE Advantage Simulator, and the outlined volumes recorded. Images and structures were transferred to MasterPlan, Xio, Pinnacle, Eclipse and Prosoma, where imported volumes were recorded. The contours on each system were grown isotropically by 10 mm, 20 mm and 30 mm, and volumes for each grown contour were recorded. Transfer of structure sets created in GE Advantage Simulator to the other software environments showed that the reported volumes of the four structures differ on each system. Results showed no correlation between volume accuracy and slice thickness. In general, margin growth of up to 30 mm for the rods and spheres is shown to be consistent between systems to within 1.33 mm for all slice thicknesses. Slice thickness did not appear to influence the accuracy of margin growth. Although this work highlights apparent differences in the reported volumes grown from the same original structure sets, the significance of this aspect of the planning process needs to weighed against reported intra- and inter-clinician variability in contour definition. It is not unreasonable, however, to expect that software packages should at least be consistent in volume information provided to the user.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.