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Title: Institutional Patient-specific IMRT QA Does Not Predict Unacceptable Plan Delivery

Abstract

Purpose: To determine whether in-house patient-specific intensity modulated radiation therapy quality assurance (IMRT QA) results predict Imaging and Radiation Oncology Core (IROC)-Houston phantom results. Methods and Materials: IROC Houston's IMRT head and neck phantoms have been irradiated by numerous institutions as part of clinical trial credentialing. We retrospectively compared these phantom results with those of in-house IMRT QA (following the institution's clinical process) for 855 irradiations performed between 2003 and 2013. The sensitivity and specificity of IMRT QA to detect unacceptable or acceptable plans were determined relative to the IROC Houston phantom results. Additional analyses evaluated specific IMRT QA dosimeters and analysis methods. Results: IMRT QA universally showed poor sensitivity relative to the head and neck phantom, that is, poor ability to predict a failing IROC Houston phantom result. Depending on how the IMRT QA results were interpreted, overall sensitivity ranged from 2% to 18%. For different IMRT QA methods, sensitivity ranged from 3% to 54%. Although the observed sensitivity was particularly poor at clinical thresholds (eg 3% dose difference or 90% of pixels passing gamma), receiver operator characteristic analysis indicated that no threshold showed good sensitivity and specificity for the devices evaluated. Conclusions: IMRT QA is not a reasonablemore » replacement for a credentialing phantom. Moreover, the particularly poor agreement between IMRT QA and the IROC Houston phantoms highlights surprising inconsistency in the QA process.« less

Authors:
 [1]; ; ; ; ;  [1];  [1];  [2];  [1]
  1. Imaging and Radiation Oncology Core at Houston, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  2. The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, Texas (United States)
Publication Date:
OSTI Identifier:
22420513
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 90; Journal Issue: 5; Other Information: Copyright (c) 2014 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOMEDICAL RADIOGRAPHY; CLINICAL TRIALS; COMPARATIVE EVALUATIONS; DOSEMETERS; HEAD; NECK; PATIENTS; PHANTOMS; QUALITY ASSURANCE; RADIOTHERAPY; SPECIFICITY

Citation Formats

Kry, Stephen F., E-mail: sfkry@mdanderson.org, Molineu, Andrea, Kerns, James R., Faught, Austin M., Huang, Jessie Y., Pulliam, Kiley B., Tonigan, Jackie, The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, Texas, Alvarez, Paola, Stingo, Francesco, Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, Followill, David S., and The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, Texas. Institutional Patient-specific IMRT QA Does Not Predict Unacceptable Plan Delivery. United States: N. p., 2014. Web. doi:10.1016/J.IJROBP.2014.08.334.
Kry, Stephen F., E-mail: sfkry@mdanderson.org, Molineu, Andrea, Kerns, James R., Faught, Austin M., Huang, Jessie Y., Pulliam, Kiley B., Tonigan, Jackie, The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, Texas, Alvarez, Paola, Stingo, Francesco, Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, Followill, David S., & The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, Texas. Institutional Patient-specific IMRT QA Does Not Predict Unacceptable Plan Delivery. United States. https://doi.org/10.1016/J.IJROBP.2014.08.334
Kry, Stephen F., E-mail: sfkry@mdanderson.org, Molineu, Andrea, Kerns, James R., Faught, Austin M., Huang, Jessie Y., Pulliam, Kiley B., Tonigan, Jackie, The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, Texas, Alvarez, Paola, Stingo, Francesco, Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, Followill, David S., and The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, Texas. 2014. "Institutional Patient-specific IMRT QA Does Not Predict Unacceptable Plan Delivery". United States. https://doi.org/10.1016/J.IJROBP.2014.08.334.
@article{osti_22420513,
title = {Institutional Patient-specific IMRT QA Does Not Predict Unacceptable Plan Delivery},
author = {Kry, Stephen F., E-mail: sfkry@mdanderson.org and Molineu, Andrea and Kerns, James R. and Faught, Austin M. and Huang, Jessie Y. and Pulliam, Kiley B. and Tonigan, Jackie and The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, Texas and Alvarez, Paola and Stingo, Francesco and Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas and Followill, David S. and The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, Texas},
abstractNote = {Purpose: To determine whether in-house patient-specific intensity modulated radiation therapy quality assurance (IMRT QA) results predict Imaging and Radiation Oncology Core (IROC)-Houston phantom results. Methods and Materials: IROC Houston's IMRT head and neck phantoms have been irradiated by numerous institutions as part of clinical trial credentialing. We retrospectively compared these phantom results with those of in-house IMRT QA (following the institution's clinical process) for 855 irradiations performed between 2003 and 2013. The sensitivity and specificity of IMRT QA to detect unacceptable or acceptable plans were determined relative to the IROC Houston phantom results. Additional analyses evaluated specific IMRT QA dosimeters and analysis methods. Results: IMRT QA universally showed poor sensitivity relative to the head and neck phantom, that is, poor ability to predict a failing IROC Houston phantom result. Depending on how the IMRT QA results were interpreted, overall sensitivity ranged from 2% to 18%. For different IMRT QA methods, sensitivity ranged from 3% to 54%. Although the observed sensitivity was particularly poor at clinical thresholds (eg 3% dose difference or 90% of pixels passing gamma), receiver operator characteristic analysis indicated that no threshold showed good sensitivity and specificity for the devices evaluated. Conclusions: IMRT QA is not a reasonable replacement for a credentialing phantom. Moreover, the particularly poor agreement between IMRT QA and the IROC Houston phantoms highlights surprising inconsistency in the QA process.},
doi = {10.1016/J.IJROBP.2014.08.334},
url = {https://www.osti.gov/biblio/22420513}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 5,
volume = 90,
place = {United States},
year = {Mon Dec 01 00:00:00 EST 2014},
month = {Mon Dec 01 00:00:00 EST 2014}
}