Data Collected During Audits for Clinical...
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Data Collected During Audits for Clinical Trials
July 21, 2010 Geoffrey S. Ibbott, Ph.D.
and RPC Staff
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AAPM Philadelphia July 2010
RPC Programs Assure ...Constancy of basic machine calibration (TLD/OSLD Audits)Validity of treatment planning data (On-site dosimetry reviews)Consistency of treatment records (Chart reviews)Understanding of advanced technology procedures (Questionnaires, phantoms,, etc.)
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AAPM Philadelphia July 2010
Constancy ofBasic Machine Calibration
RPC monitors 1,768 institutions, of which ~1,600 are in the US
Increase from 1,338 in 2005 (32%)
Number of radiation beams has increased more rapidly Year
Machines
Facilities
US Machines & Facilities
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AAPM Philadelphia July 2010
Annual TLD/OSLD Audits
• Monitor ~ 14,000 beams/yr
• Conversion from TLD to OSLD
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AAPM Philadelphia July 2010
Distribution of TLD resultsPhotons beams
within 7%Number of beams: 3051
Avg. RPC/Inst.: 0.999Stdev.: 1.6%
Electrons beamswithin 7%
Number of beams 4310Avg. RPC/Inst: 0.998
Stdev.: 1.7%
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AAPM Philadelphia July 2010
Data for other machines
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AAPM Philadelphia July 2010
Data for other machines
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AAPM Philadelphia July 2010
Data for other machines
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AAPM Philadelphia July 2010
TLD measurements in proton beams
0
5
10
15
20
25
Frequency (%
)
<0.94 0.94 0.95 0.96 0.97 0.98 0.99 1 1.01 1.02 1.03 1.04 1.05 1.06 >1.06
RPC/Institution
Proton TLD Frequency Distribution
Protons: 109 measurementsPhotons: > 6,000 measurements
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Parameters MeasuredReview QA Program
Implementation of TG-51Review Temp/Press Correction
Photon Calibration Photon FSD (incl. small field)
Photon Depth DoseOff-axis Factors/Beam symmetry
Electron CalibrationElectron Depth DoseElectron Cone RatiosWedge Transmission
Consistent use of Data
On-Site Dosimetry Review Visit
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In response to new radiotherapy treatments in trials, new audit techniques have been implemented such as:
1. TomoTherapy2. CyberKnife3. Proton therapy4. Small field dosimetry5. 2D water scanner and electrometers6. Electronic transfer of Visit data (2010) 7. Incorporate new AAPM TG-142 QA review (2010) 8. Image guidance (in development)
Comprehensive On-Site Audit Improvements and Additions
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In response to new radiotherapy treatments in trials, new audit techniques have been implemented such as:
1. TomoTherapy2. CyberKnife3. Proton therapy4. Small field dosimetry5. 2D water scanner and electrometers6. Electronic transfer of Visit data (2010) 7. Incorporate new AAPM TG-142 QA review (2010) 8. Image guidance (in development)
Comprehensive On-Site Audit Improvements and Additions
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In response to new radiotherapy treatments in trials, new audit techniques have been implemented such as:
1. TomoTherapy2. CyberKnife3. Proton therapy4. Small field dosimetry5. 2D water scanner and electrometers6. Electronic transfer of Visit data (2010) 7. Incorporate new AAPM TG-142 QA review (2010) 8. Image guidance (in development)
Comprehensive On-Site Audit Improvements and Additions
![Page 14: Data Collected During Audits for Clinical Trialsirochouston.mdanderson.org/RPC/Publications/RPC... · Data Collected During Audits for Clinical Trials July 21, 2010 Geoffrey S. Ibbott,](https://reader033.fdocuments.net/reader033/viewer/2022041807/5e55162e744ce92f3d6bc107/html5/thumbnails/14.jpg)
In response to new radiotherapy treatments in trials, new audit techniques have been implemented such as:
1. TomoTherapy2. CyberKnife3. Proton therapy4. Small field dosimetry5. 2D water scanner and electrometers6. Electronic transfer of Visit data (2010) 7. Incorporate new AAPM TG-142 QA review (2010) 8. Image guidance (in development)
Comprehensive On-Site Audit Improvements and Additions
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In response to new radiotherapy treatments in trials, new audit techniques have been implemented such as:
1. TomoTherapy2. CyberKnife3. Proton therapy4. Small field dosimetry5. 2D water scanner and electrometers6. Electronic transfer of Visit data (2010) 7. Incorporate new AAPM TG-142 QA review (2010) 8. Image guidance (in development)
As radiotherapy treatment techniques change, so do the visit audit techniques
Comprehensive On-Site Audit Improvements and Additions
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Measurement of small-field output factors
Field Size Varian(64) Siemens(4) Elekta(10)10 x 10 1.000 1.000 1.000
6 x 6 0.922 (0.012) 0.910 (0.004) 0.924 (0.004)
4 x 4 0.866 (0.019) 0.851 (0.004) 0.869 (0.007)
3 x 3 0.833 (0.025) 0.817 (0.003) 0.837 (0.005)
2 x 2 0.785 (0.013) 0.757 (0.014) 0.793 (0.007)
1 x 1 0.694 (0.042) - 0.659 (0.025)
6 MV, d = 10 cm
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Virtual Dosimetry Review Visit
• Use of the RPC’s standard data
- Compilation of RPC measured avg. data
• 2700 photon beams and 81 linac model/ energy combinations
- Specific to make/model/energy with ≥ 5 sets of RPC measured data
- Analyses of these data indicate that machines of same make/model/energy have same radiation characteristics.
- Successful at predicting “specific” errors 88% of the time.
- Available to Med. Phys. community upon request.
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Web-Based Facility Questionnaire
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Web-Based Facility Questionnaire
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TPC Houston: Apr. 20, 2010
RPC Phantoms
Pelvis (10)
Thorax (13)
Liver (2)H&N (31)SRS Head (4)
Spine (3)
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Treat phantom as if it were a patient
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AAPM Philadelphia July 2010
Good Agreement
PlanMeasurement
OAR
Primary PTVSecondary PTV
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AAPM Philadelphia July 2010
Phantom ResultsComparison between institution’s plan
and delivered dose. Phantom H&N Prostate Spine Lung Liver
Irradiations 752 174 19 174 23Pass 585 143 13 124 12
Pass % 78% 82% 68% 71% 52%
Criteria 7%/4mm 7%/4mm 5%/3mm 5%/5mm 7%/4mm
Year introduced 2001 2004 2009 2004 2005
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HN results grouped by TPS
Treatment planning system
Pass Rate (%) Attempts
Criteria FailedCriteria FailedCriteria FailedTreatment planning system
Pass Rate (%) Attempts
Dose DTA Dose and DTA
Corvus 75 32 7 0 1
Eclipse 85 114 10 4 3
Pinnacle 73 168 33 4 8
TomoTherapy 73 22 5 1 0
XiO 73 59 7 4 5
Other 79 24 3 0 2
Total 419 65 13 19
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IAEA, July 6, 2010
Explanations for Failures
Explanation Minimum # of occurrences
incorrect output factors in TPS 1
incorrect PDD in TPS 1
IMRT Technique 3
Software error 1inadequacies in beam modeling at leaf
ends (Cadman, et al; PMB 2002) 14
QA procedures 3errors in couch indexing with Peacock
system 3
equipment performance 2
setup errors 7
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AAPM Philadelphia July 2010
Supported by NCI grants CA10953 and CA81647