Auditing local methods for quality assurance in radiotherapy using the same set of predefined treatment plans

Seravalli, Enrica; Houweling, Antonetta C.; Battum, L. van; Kuik, M.; Pooter, Jacco de; Gellekom, Marion P.R. Van; Kaas, J.; Vries, W de; Loeff, E.A.; Kamer, Jeroen B. van de

doi:10.1016/j.phro.2018.01.002

Cited by 9 publications

(11 citation statements)

References 35 publications

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“…However, it was noticeable that 1 center had lower gamma pass rates (93.8% with 3%/3 mm, and 91.5% with 2%/2 mm) than the other centers using the same Varian-Rapid Arc technique. The accuracy of Varian plans has been reported in a study by Servavalli et al 26 They used predefined treatment plans to audit local methods to assess quality assurance in radiotherapy, and the average pass rates obtained from the array audits of all of the Varian plans were 97.8% (3%/3 mm) and 96.2% (3%/2 mm), which were similar to our Varian results. The treatment workflow was reviewed, and the planning isocenter for this VMAT plan was found to be located 2 cm laterally and 4 cm inferior to the center of PTV.…”

Section: Discussionsupporting

confidence: 89%

“…The overall results showed excellent agreement of the measured and planned doses, and they were in line with other multi-institutional IMRT/VMAT audits. 16,22,[24][25][26]29 In our survey, the acceptable levels of dose discrepancies at the specification points of ±3% for PTV and ±5% for OARS were achieved by the large majority of the 8 centers. However, the TPS dose for the lungs was underestimated by about 6% at 2 centers (C and D); both institutions used RapidArc/Varian/AAA.…”

Section: Discussionmentioning

confidence: 64%

“…[17][18][19][20] In addition, a number of studies in a range of countries have evaluated multi-institutional IMRT/VMAT accuracy using various methodologies. [21][22][23][24][25][26] The reports have emphasized the need for high accuracy levels in the use of these complex technologies in radiation oncology.…”

Section: Introductionmentioning

confidence: 99%

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Multi-institutional evaluation using the end-to-end test for implementation of dynamic techniques of radiation therapy in Thailand

Tuntipumiamorn

Tangboonduangjit

Sanghangthum

et al. 2019

Reports of Practical Oncology & Radiotherapy

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Quality assurance Accuracy End-to-end test and the dose distribution from the radiochromic films. The global gamma indices of the measurement doses and the treatment planning system calculation doses were compared. Results: The large majority of the RT centers (6/8) fulfilled the dosimetric goals, with the measured and calculated doses at the specification points agreeing within ±3% for PTV and ±5% for OARS. At 2 centers, TPS underestimated the lung doses by about 6% and spinal cord doses by 8%. The mean percentage gamma pass rates for the 8 centers were 98.29 ± 0.67% (for the 3%/3 mm criterion) and 96.72 ± 0.84% (for the 2%/2 mm criterion). Conclusions: The 8 participating RT centers achieved a satisfactory quality level of IMRT/VMAT clinical implementation.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 64%

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Multi-institutional evaluation using the end-to-end test for implementation of dynamic techniques of radiation therapy in Thailand

Tuntipumiamorn

Tangboonduangjit

Sanghangthum

et al. 2019

Reports of Practical Oncology & Radiotherapy

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“…As mentioned above, three participants repeated the exercise and in all these cases the local IMRT verification methods were passed with good results. The finding that local QA methods do not always correlate with the audit results has also been reported by others [19,20,30].…”

Section: Discussionsupporting

confidence: 73%

Testing the methodology for a dosimetric end-to-end audit of IMRT/VMAT: results of IAEA multicentre and national studies

et al. 2019

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Introduction: Within an International Atomic Energy Agency (IAEA) coordinated research project (CRP), a remote end-to-end dosimetric quality audit for intensity modulated radiation therapy (IMRT)/ volumetric arc therapy (VMAT) was developed to verify the radiotherapy chain including imaging, treatment planning and dose delivery. The methodology as well as the results obtained in a multicentre pilot study and national trial runs conducted in close cooperation with dosimetry audit networks (DANs) of IAEA Member States are presented. Material and methods: A solid polystyrene phantom containing a dosimetry insert with an irregular solid water planning target volume (PTV) and organ at risk (OAR) was designed for this audit. The insert can be preloaded with radiochromic film and four thermoluminescent dosimeters (TLDs). For the audit, radiotherapy centres were asked to scan the phantom, contour the structures, create an IMRT/VMAT treatment plan and irradiate the phantom. The dose prescription was to deliver 4 Gy to the PTV in two fractions and to limit the OAR dose to a maximum of 2.8 Gy. The TLD measured doses and film measured dose distributions were compared with the TPS calculations. Results: Sixteen hospitals from 13 countries and 64 hospitals from 6 countries participated in the multicenter pilot study and in the national runs, respectively. The TLD results for the PTV were all within ±5% acceptance limit for the multicentre pilot study, whereas for national runs, 17 participants failed to meet this criterion. All measured doses in the OAR were below the treatment planning constraint. The film analysis identified seven plans in national runs below the 90% passing rate gamma criteria. Conclusion: The results proved that the methodology of the IMRT/VMAT dosimetric end-to-end audit was feasible for its intended purpose, i.e., the phantom design and materials were suitable; the phantom was easy to use and it was robust enough for shipment. Most importantly the audit methodology was capable of identifying suboptimal IMRT/VMAT delivery.

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“…Also, time consuming on-site visits and expensive mailing of audit phantoms are not required. While the approach of using local pre-treatment verification methods is convenient and easy to apply, data shows that local QA measurements do not necessarily correlate with external audit phantom measurements [12,25,27,31,37,46]. These discrepancies can be due to different sensitivities and limitations of each QA equipment, as well as to differences in their evaluation software.…”

Section: Conventional Linacsmentioning

confidence: 99%

Novel methodologies for dosimetry audits: Adapting to advanced radiotherapy techniques

Pasler¹,

Hernández

Jornet

et al. 2018

Physics and Imaging in Radiation Oncology

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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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Auditing local methods for quality assurance in radiotherapy using the same set of predefined treatment plans

Cited by 9 publications

References 35 publications

Multi-institutional evaluation using the end-to-end test for implementation of dynamic techniques of radiation therapy in Thailand

Multi-institutional evaluation using the end-to-end test for implementation of dynamic techniques of radiation therapy in Thailand

Testing the methodology for a dosimetric end-to-end audit of IMRT/VMAT: results of IAEA multicentre and national studies

Novel methodologies for dosimetry audits: Adapting to advanced radiotherapy techniques

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