Dose shadowing and prosthesis involvement for megavoltage photon In vivo diode dosimetry

Ade, Nicholas; Eeden, Déte van; Plessis, F.C.P. du

doi:10.4103/jmp.jmp_59_19

Cited by 2 publications

(4 citation statements)

References 34 publications

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“…The dose shadowing effect of the diode is well documented, and our selective diode use also limits this dose shadowing effect to selected patient cases where a benefit of diode use is greater than the dose shadowing. 6,21 Our data demonstrate a rapid change in practice based on a simple intervention backed by stakeholder and leadership engagement, and a sound rationale for the change. Based on the success of this initiative, we anticipate conducting a similar review process of other potentially low-value practices in our department.…”

Section: F I G U R Ementioning

confidence: 73%

“…Finally, the benefit of unnecessary diode use extends to the patient. The dose shadowing effect of the diode is well documented, and our selective diode use also limits this dose shadowing effect to selected patient cases where a benefit of diode use is greater than the dose shadowing 6,21 …”

Section: Discussionmentioning

confidence: 99%

“…However, its accuracy may be limited, as the dose captured is a point dose and is sensitive to minor variations in diode orientation and position 5 . The shadow effect of diode detectors leading to dose reduction in the radiation treatment field has also been previously reported 6 . As such, it is a tool that can be useful for detection of major errors in patient setup, dose calculation, or treatment beam parameters including beam energy and the use of wedges, but it generally has a wide tolerance range from 5% to 10% without incorporating beam‐dependent and intrinsic correction factors suggested in AAPM Task Group 62, such as wedge, SSD, field size, temperature, angular dependence, etc 5 .…”

Section: Introductionmentioning

confidence: 99%

“…5 The shadow effect of diode detectors leading to dose reduction in the radiation treatment field has also been previously reported. 6 As such, it is a tool that can be useful for detection of major errors in patient setup, dose calculation, or treatment beam parameters including beam energy and the use of wedges, but it generally has a wide tolerance range from 5% to 10% without incorporating beam-dependent and intrinsic correction factors suggested in AAPM Task Group 62, such as wedge, SSD, field size, temperature, angular dependence,etc. 5 The tighter tolerance is possibly applied with better accuracy achieved with optimal placement of a diode and use of the correction factors, but still up to 5%.…”

Section: Introductionmentioning

confidence: 99%

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Selective de‐implementation of routine in vivo dosimetry

Mao

Han‐Oh

Moore

et al. 2023

J Applied Clin Med Phys

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As cone‐beam computed tomography (CBCT) has become the localization method for a majority of cases, the indications for diode‐based confirmation of accurate patient set‐up and treatment are now limited and must be balanced between proper resource allocation and optimizing efficiency without compromising safety. We undertook a de‐implementation quality improvement project to discontinue routine diode use in non‐intensity modulated radiotherapy (IMRT) cases in favor of tailored selection of scenarios where diodes may be useful. After analysis of safety reports from the last 5 years, literature review, and stakeholder discussions, our safety and quality (SAQ) committee introduced a recommendation to limit diode use to specific scenarios in which in vivo verification may add value to standard quality assurance (QA) processes. To assess changes in patterns of use, we reviewed diode use by clinical indication 4 months prior and after the implementation of the revised policy, which includes use of diodes for: 3D conformal photon fields set up without CBCT; total body irradiation (TBI); electron beams; cardiac devices within 10 cm of the treatment field; and unique scenarios on a case‐by‐case basis. We identified 4459 prescriptions and 1038 unique instances of diode use across five clinical sites from 5/2021 to 1/2022. After implementation of the revised policy, we observed an overall decrease in diode use from 32% to 13.2%, with a precipitous drop in 3D cases utilizing CBCT (from 23.2% to 4%), while maintaining diode utilization in the 5 selected scenarios including 100% of TBI and electron cases. By identifying specific indications for diode use and creating a user‐friendly platform for case selection, we have successfully de‐implemented routine diode use in favor of a selective process that identifies cases where the diode is important for patient safety. In doing so, we have streamlined patient care and decreased cost without compromising patient safety.

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Section: F I G U R Ementioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%