Extending in aqua portal dosimetry with dose inhomogeneity conversion maps for accurate patient dose reconstruction in external beam radiotherapy

Olaciregui-Ruiz, Ígor; Osinga-Blaettermann, Julia-Maria; Ortega-Marin, Karen; Mijnheer, Ben J.; Mans, A.

doi:10.1016/j.phro.2022.04.001

Cited by 3 publications

(1 citation statement)

References 36 publications

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“…Further sensitivity studies are necessary for the optimal determination of indicators and tolerance limit values (Torres-Xirau et al 2020, Olaciregui-Ruiz et al 2021). Some EPID-based method for ART using in aqua portal dosimetry with dose inhomogeneity conversion maps or portal images only, and 3D GPR (2 mm/2%, 50% threshold) of 0.70 could be achieved (Matsushita et al 2020, Olaciregui-Ruiz et al 2022. These methods may have the drawback of inability to accurately estimate the dose delivered to the patients.…”

Section: Discussionmentioning

confidence: 99%

A clinically relevant online patient QA solution with daily CT scans and EPID-based in vivo dosimetry: a feasibility study on rectal cancer

Chen¹,

Zhang²,

Lei³

et al. 2022

Phys. Med. Biol.

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Objective: Adaptive radiation therapy (ART) could protect organs at risk (OARs) while maintain high dose coverage to targets. However, there is still a lack of efficient online patient quality assurance (QA) methods, which is an obstacle to large-scale adoption of ART. We aim to develop a clinically relevant online patient QA solution for ART using daily CT scans and EPID-based in vivo dosimetry. Approach: Ten patients with rectal cancer at our center were included. Patients’ daily CT scans and portal images were collected to generate reconstructed 3D dose distributions. Contours of targets and OARs were recontoured on these daily CT scans by a clinician or an auto-segmentation algorithm, then dose-volume indices were calculated, and the percent deviation of these indices to their original plans were determined. This deviation was regarded as the metric for clinically relevant patient QA. The tolerance level was obtained using a 95% confidence interval of the QA metric distribution. These deviations could be further divided into anatomically relevant or delivery relevant indicators for error source analysis. Finally, our QA solution was validated on an additional six clinical patients. Main results: In rectal cancer, the 95% confidence intervals of the QA metric for PTV ΔD95 (%) were [-3.11%, 2.35%], and for PTV ΔD2 (%) were [-0.78%, 3.23%]. In validation, 68% for PTV ΔD95 (%), and 79% for PTV ΔD2 (%) of the 28 fractions are within tolerances of the QA metrics. one patient’s dosimetric impact of anatomical variations during treatment were observed through the source of error analysis. Significance: The online patient QA solution using daily CT scans and EPID-based in vivo dosimetry is clinically feasible. Source of error analysis has the potential for distinguishing sources of error and guiding ART for future treatments.

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Section: Discussionmentioning

confidence: 99%

A clinically relevant online patient QA solution with daily CT scans and EPID-based in vivo dosimetry: a feasibility study on rectal cancer

Chen¹,

Zhang²,

Lei³

et al. 2022

Phys. Med. Biol.

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Towards real-time EPID-based 3D in vivo dosimetry for IMRT with Deep Neural Networks: A feasibility study

Martins,

Maier,

Gianoli

et al. 2023

Physica Medica

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IPEM topical report: guidance for the clinical implementation of online treatment monitoring solutions for IMRT/VMAT

Stevens

Moloney

Blackmore³

et al. 2023

Phys. Med. Biol.

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This report provides guidance for the implementation of online treatment monitoring (OTM) solutions in radiotherapy (RT), with a focus on modulated treatments. Support is provided covering the implementation process, from identification of an OTM solution to local implementation strategy. Guidance has been developed by a RT special interest group (RTSIG) working party (WP) on behalf of the Institute of Physics and Engineering in Medicine (IPEM). Recommendations within the report are derived from the experience of the WP members (in consultation with manufacturers, vendors and user groups), existing guidance or legislation and a UK survey conducted in 2020 (Stevens et al., 2021).OTM is an inclusive term representing any system capable of providing a direct or inferred measurement of the delivered dose to a RT patient. Information on each type of OTM is provided but, commensurate with UK demand, guidance is largely influenced by in vivo dosimetry (IVD) methods utilising the electronic portal imager device (EPID).Sections are included on the choice of OTM solutions, acceptance and commissioning methods with recommendations on routine quality control, analytical methods and tolerance setting, clinical introduction and staffing/resource requirements. The guidance aims to give a practical solution to sensitivity and specificity testing. Functionality is provided for the user to introduce known errors into treatment plans for local testing. Receiver operating characteristic (ROC) analysis is discussed as a tool to performance assess OTM systems. OTM solutions can help verify the correct delivery of radiotherapy treatment. Furthermore, modern systems are increasingly capable of providing clinical decision-making information which can impact the course of a patient’s treatment. However, technical limitations persist. It is not within the scope of this guidance to critique each available solution, but the user is encouraged to carefully consider workflow and engage with manufacturers in resolving compatibility issues. 

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Extending in aqua portal dosimetry with dose inhomogeneity conversion maps for accurate patient dose reconstruction in external beam radiotherapy

Cited by 3 publications

References 36 publications

A clinically relevant online patient QA solution with daily CT scans and EPID-based in vivo dosimetry: a feasibility study on rectal cancer

A clinically relevant online patient QA solution with daily CT scans and EPID-based in vivo dosimetry: a feasibility study on rectal cancer

Towards real-time EPID-based 3D in vivo dosimetry for IMRT with Deep Neural Networks: A feasibility study

IPEM topical report: guidance for the clinical implementation of online treatment monitoring solutions for IMRT/VMAT

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