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Title: SU-D-201-01: A Multi-Institutional Study Quantifying the Impact of Simulated Linear Accelerator VMAT Errors for Nasopharynx

Abstract

Purpose: To quantify the impact of differing magnitudes of simulated linear accelerator errors on the dose to the target volume and organs at risk for nasopharynx VMAT. Methods: Ten nasopharynx cancer patients were retrospectively replanned twice with one full arc VMAT by two institutions. Treatment uncertainties (gantry angle and collimator in degrees, MLC field size and MLC shifts in mm) were introduced into these plans at increments of 5,2,1,−1,−2 and −5. This was completed using an in-house Python script within Pinnacle3 and analysed using 3DVH and MatLab. The mean and maximum dose were calculated for the Planning Target Volume (PTV1), parotids, brainstem, and spinal cord and then compared to the original baseline plan. The D1cc was also calculated for the spinal cord and brainstem. Patient average results were compared across institutions. Results: Introduced gantry angle errors had the smallest effect of dose, no tolerances were exceeded for one institution, and the second institutions VMAT plans were only exceeded for gantry angle of ±5° affecting different sided parotids by 14–18%. PTV1, brainstem and spinal cord tolerances were exceeded for collimator angles of ±5 degrees, MLC shifts and MLC field sizes of ±1 and beyond, at the first institution. At the secondmore » institution, sensitivity to errors was marginally higher for some errors including the collimator error producing doses exceeding tolerances above ±2 degrees, and marginally lower with tolerances exceeded above MLC shifts of ±2. The largest differences occur with MLC field sizes, with both institutions reporting exceeded tolerances, for all introduced errors (±1 and beyond). Conclusion: The plan robustness for VMAT nasopharynx plans has been demonstrated. Gantry errors have the least impact on patient doses, however MLC field sizes exceed tolerances even with relatively low introduced errors and also produce the largest errors. This was consistent across both departments. The authors acknowledge funding support from the NSW Cancer Council.« less

Authors:
 [1];  [2];  [2];  [3];  [4]; ;  [1]; ; ; ; ; ;  [5];  [1];  [2];  [2];  [2];  [2]
  1. Institute of Medical Physics, The University of Sydney, Sydney, NSW (Australia)
  2. (Australia)
  3. Laboratory of Radiation Physics, Odense University Hospital, Odense (Denmark)
  4. (Denmark)
  5. Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW (Australia)
Publication Date:
OSTI Identifier:
22624366
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; COLLIMATORS; COMPARATIVE EVALUATIONS; ERRORS; HAZARDS; LINEAR ACCELERATORS; NEOPLASMS; PATIENTS; PHARYNX; PLANNING; RADIATION DOSES; RADIOTHERAPY; SENSITIVITY; SIMULATION; SPINAL CORD; TOLERANCE

Citation Formats

Pogson, E, Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Ingham Institute for Applied Medical Research, Sydney, NSW, Hansen, C, Institute of Clinical Research, University of Southern Denmark, Odense, Blake, S, Thwaites, D, Arumugam, S, Juresic, J, Ochoa, C, Yakobi, J, Haman, A, Trtovac, A, Holloway, L, Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Ingham Institute for Applied Medical Research, Sydney, NSW, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, and University of Wollongong, Wollongong, NSW. SU-D-201-01: A Multi-Institutional Study Quantifying the Impact of Simulated Linear Accelerator VMAT Errors for Nasopharynx. United States: N. p., 2016. Web. doi:10.1118/1.4955613.
Pogson, E, Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Ingham Institute for Applied Medical Research, Sydney, NSW, Hansen, C, Institute of Clinical Research, University of Southern Denmark, Odense, Blake, S, Thwaites, D, Arumugam, S, Juresic, J, Ochoa, C, Yakobi, J, Haman, A, Trtovac, A, Holloway, L, Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Ingham Institute for Applied Medical Research, Sydney, NSW, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, & University of Wollongong, Wollongong, NSW. SU-D-201-01: A Multi-Institutional Study Quantifying the Impact of Simulated Linear Accelerator VMAT Errors for Nasopharynx. United States. doi:10.1118/1.4955613.
Pogson, E, Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Ingham Institute for Applied Medical Research, Sydney, NSW, Hansen, C, Institute of Clinical Research, University of Southern Denmark, Odense, Blake, S, Thwaites, D, Arumugam, S, Juresic, J, Ochoa, C, Yakobi, J, Haman, A, Trtovac, A, Holloway, L, Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Ingham Institute for Applied Medical Research, Sydney, NSW, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, and University of Wollongong, Wollongong, NSW. 2016. "SU-D-201-01: A Multi-Institutional Study Quantifying the Impact of Simulated Linear Accelerator VMAT Errors for Nasopharynx". United States. doi:10.1118/1.4955613.
@article{osti_22624366,
title = {SU-D-201-01: A Multi-Institutional Study Quantifying the Impact of Simulated Linear Accelerator VMAT Errors for Nasopharynx},
author = {Pogson, E and Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW and Ingham Institute for Applied Medical Research, Sydney, NSW and Hansen, C and Institute of Clinical Research, University of Southern Denmark, Odense and Blake, S and Thwaites, D and Arumugam, S and Juresic, J and Ochoa, C and Yakobi, J and Haman, A and Trtovac, A and Holloway, L and Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW and Ingham Institute for Applied Medical Research, Sydney, NSW and South Western Sydney Clinical School, University of New South Wales, Sydney, NSW and University of Wollongong, Wollongong, NSW},
abstractNote = {Purpose: To quantify the impact of differing magnitudes of simulated linear accelerator errors on the dose to the target volume and organs at risk for nasopharynx VMAT. Methods: Ten nasopharynx cancer patients were retrospectively replanned twice with one full arc VMAT by two institutions. Treatment uncertainties (gantry angle and collimator in degrees, MLC field size and MLC shifts in mm) were introduced into these plans at increments of 5,2,1,−1,−2 and −5. This was completed using an in-house Python script within Pinnacle3 and analysed using 3DVH and MatLab. The mean and maximum dose were calculated for the Planning Target Volume (PTV1), parotids, brainstem, and spinal cord and then compared to the original baseline plan. The D1cc was also calculated for the spinal cord and brainstem. Patient average results were compared across institutions. Results: Introduced gantry angle errors had the smallest effect of dose, no tolerances were exceeded for one institution, and the second institutions VMAT plans were only exceeded for gantry angle of ±5° affecting different sided parotids by 14–18%. PTV1, brainstem and spinal cord tolerances were exceeded for collimator angles of ±5 degrees, MLC shifts and MLC field sizes of ±1 and beyond, at the first institution. At the second institution, sensitivity to errors was marginally higher for some errors including the collimator error producing doses exceeding tolerances above ±2 degrees, and marginally lower with tolerances exceeded above MLC shifts of ±2. The largest differences occur with MLC field sizes, with both institutions reporting exceeded tolerances, for all introduced errors (±1 and beyond). Conclusion: The plan robustness for VMAT nasopharynx plans has been demonstrated. Gantry errors have the least impact on patient doses, however MLC field sizes exceed tolerances even with relatively low introduced errors and also produce the largest errors. This was consistent across both departments. The authors acknowledge funding support from the NSW Cancer Council.},
doi = {10.1118/1.4955613},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: To identify the robustness of different treatment techniques in respect to simulated linac errors on the dose distribution to the target volume and organs at risk for step and shoot IMRT (ssIMRT), VMAT and Autoplan generated VMAT nasopharynx plans. Methods: A nasopharynx patient dataset was retrospectively replanned with three different techniques: 7 beam ssIMRT, one arc manual generated VMAT and one arc automatically generated VMAT. Treatment simulated uncertainties: gantry, collimator, MLC field size and MLC shifts, were introduced into these plans at increments of 5,2,1,−1,−2 and −5 (degrees or mm) and recalculated in Pinnacle. The mean and maximum dosesmore » were calculated for the high dose PTV, parotids, brainstem, and spinal cord and then compared to the original baseline plan. Results: Simulated gantry angle errors have <1% effect on the PTV, ssIMRT is most sensitive. The small collimator errors (±1 and ±2 degrees) impacted the mean PTV dose by <2% for all techniques, however for the ±5 degree errors mean target varied by up to 7% for the Autoplan VMAT and 10% for the max dose to the spinal cord and brain stem, seen in all techniques. The simulated MLC shifts introduced the largest errors for the Autoplan VMAT, with the larger MLC modulation presumably being the cause. The most critical error observed, was the MLC field size error, where even small errors of 1 mm, caused significant changes to both the PTV and the OAR. The ssIMRT is the least sensitive and the Autoplan the most sensitive, with target errors of up to 20% over and under dosages observed. Conclusion: For a nasopharynx patient the plan robustness observed is highest for the ssIMRT plan and lowest for the Autoplan generated VMAT plan. This could be caused by the more complex MLC modulation seen for the VMAT plans. This project is supported by a grant from NSW Cancer Council.« less
  • Purpose: There is increased interest in the Radiation Oncology Physics community regarding sensitivity of pre-treatment IMRT/VMAT QA to delivery errors. Consequently, tools mapping pre-treatment QA to the patient DVH have been developed. However, the quantity of plan degradation that is acceptable remains uncertain. Using DVHs adapted from prior patients’ plans, we developed a technique to determine the magnitude of various delivery errors required to degrade a treatment plan to outside the clinically accepted range. Methods: DVHs for relevant organs at risk were adapted from a population of prior patients’ plans using a machine learning algorithm to establish the clinically acceptablemore » DVH range specific to the patient’s anatomy. We applied this technique to six low-risk prostate cancer patients treated with single-arc VMAT and compared error-induced DVH changes to the adapted DVHs to determine the magnitude of error required to push the plan outside of the acceptable range. The procedure follows: (1) Errors (systematic ' random shift of MLCs, gantry-MLC desynchronization, dose rate fluctuations, etc.) were simulated and degraded DVHs calculated using the Varian Eclipse TPS. (2) Adapted DVHs and acceptable ranges for DVHs were established. (3) Relevant dosimetric indices and corresponding acceptable ranges were calculated from the DVHs. Key indices included NTCP (Lyman-Kutcher-Burman Model) and QUANTEC’s dose-volume Objectives: s of V75Gy≤0.15 for the rectum and V75Gy≤0.25 for the bladder. Results: Degradations to the clinical plan became “unacceptable” for 19±29mm and 1.9±2.0mm systematic outward shifts of a single leaf and leaf bank, respectively. All other simulated errors fell within the acceptable range. Conclusion: Utilizing machine learning and prior patients’ plans one can predict a clinically acceptable range of DVH degradation for a specific patient. Comparing error-induced DVH degradations to this range, it is shown that single-arc VMAT plans for low-risk prostate are relatively insensitive to many potential delivery errors.« less
  • Purpose: Latest generation linear accelerators (linacs), i.e., TrueBeam (Varian Medical Systems, Palo Alto, CA) and its stereotactic counterpart, TrueBeam STx, have several unique features, including high-dose-rate flattening-filter-free (FFF) photon modes, reengineered electron modes with new scattering foil geometries, updated imaging hardware/software, and a novel control system. An evaluation of five TrueBeam linacs at three different institutions has been performed and this work reports on the commissioning experience. Methods: Acceptance and commissioning data were analyzed for five TrueBeam linacs equipped with 120 leaf (5 mm width) MLCs at three different institutions. Dosimetric data and mechanical parameters were compared. These included measurementsmore » of photon beam profiles (6X, 6XFFF, 10X, 10XFFF, 15X), photon and electron percent depth dose (PDD) curves (6, 9, 12 MeV), relative photon output factors (Scp), electron cone factors, mechanical isocenter accuracy, MLC transmission, and dosimetric leaf gap (DLG). End-to-end testing and IMRT commissioning were also conducted. Results: Gantry/collimator isocentricity measurements were similar (0.27-0.28 mm), with overall couch/gantry/collimator values of 0.46-0.68 mm across the three institutions. Dosimetric data showed good agreement between machines. The average MLC DLGs for 6, 10, and 15 MV photons were 1.33 {+-} 0.23, 1.57 {+-} 0.24, and 1.61 {+-} 0.26 mm, respectively. 6XFFF and 10XFFF modes had average DLGs of 1.16 {+-} 0.22 and 1.44 {+-} 0.30 mm, respectively. MLC transmission showed minimal variation across the three institutions, with the standard deviation <0.2% for all linacs. Photon and electron PDDs were comparable for all energies. 6, 10, and 15 MV photon beam quality, %dd(10){sub x} varied less than 0.3% for all linacs. Output factors (Scp) and electron cone factors agreed within 0.27%, on average; largest variations were observed for small field sizes (1.2% coefficient of variation, 10 MV, 2 Multiplication-Sign 2 cm{sup 2}) and small cone sizes (<1% coefficient of variation, 6 Multiplication-Sign 6 cm{sup 2} cone), respectively. Conclusions: Overall, excellent agreement was observed in TrueBeam commissioning data. This set of multi-institutional data can provide comparison data to others embarking on TrueBeam commissioning, ultimately improving the safety and quality of beam commissioning.« less
  • Purpose: A survey was taken by NRG Oncology to assess Full Time Equivalent (FTE) contributions to multi institutional clinical trials by medical physicists.No current quantification of physicists’ efforts in FTE units associated with clinical trials is available. The complexity of multi-institutional trials increases with new technologies and techniques. Proper staffing may directly impact the quality of trial data and outcomes. The demands on physics time supporting clinical trials needs to be assessed. Methods: The NRG Oncology Medical Physicist Subcommittee created a sixteen question survey to obtain this FTE data. IROC Houston distributed the survey to their list of 1802 contactmore » physicists. Results: After three weeks, 363 responded (20.1% response). 187 (51.5%) institutions reporting external beam participation were processed. There was a wide range in number of protocols active and supported at each institution. Of the 187 clinics, 134 (71.7%) participate in 0 to 10 trials, 28 (15%) in 11 to 20 trials, 10 (5.3%) in 21 to 30 trials, 9 (4.8%) had 40 to 75 trials. On average, physicist spent 2.7 hours (SD: 6.0) per week supervising or interacting with clinical trial staff. 1.25 hours (SD: 3.37), 1.83 hours (SD: 4.13), and 0.64 hours(SD: 1.13) per week were spent on patient simulation, reviewing treatment plans, and maintaining a DICOM server, respectively. For all protocol credentialing activities, physicist spent an average of 37.05 hours (SD: 96.94) yearly. To support dosimetrists, clinicians, and therapists, physicist spend on average 2.07 hours (SD: 3.52) per week just reading protocols. Physicist attended clinical trial meetings for on average 1.13 hours (SD: 1.85) per month. Conclusion: Responding physicists spend a nontrivial amount of time: 8.8 hours per week (0.22 FTE) supporting, on average, 9 active multi-institutional clinical trials.« less