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Title: MO-FG-202-05: Identifying Treatment Planning System Errors in IROC-H Phantom Irradiations

Abstract

Purpose: Treatment Planning System (TPS) errors can affect large numbers of cancer patients receiving radiation therapy. Using an independent recalculation system, the Imaging and Radiation Oncology Core-Houston (IROC-H) can identify institutions that have not sufficiently modelled their linear accelerators in their TPS model. Methods: Linear accelerator point measurement data from IROC-H’s site visits was aggregated and analyzed from over 30 linear accelerator models. Dosimetrically similar models were combined to create “classes”. The class data was used to construct customized beam models in an independent treatment dose verification system (TVS). Approximately 200 head and neck phantom plans from 2012 to 2015 were recalculated using this TVS. Comparison of plan accuracy was evaluated by comparing the measured dose to the institution’s TPS dose as well as the TVS dose. In cases where the TVS was more accurate than the institution by an average of >2%, the institution was identified as having a non-negligible TPS error. Results: Of the ∼200 recalculated plans, the average improvement using the TVS was ∼0.1%; i.e. the recalculation, on average, slightly outperformed the institution’s TPS. Of all the recalculated phantoms, 20% were identified as having a non-negligible TPS error. Fourteen plans failed current IROC-H criteria; the average TVSmore » improvement of the failing plans was ∼3% and 57% were found to have non-negligible TPS errors. Conclusion: IROC-H has developed an independent recalculation system to identify institutions that have considerable TPS errors. A large number of institutions were found to have non-negligible TPS errors. Even institutions that passed IROC-H criteria could be identified as having a TPS error. Resolution of such errors would improve dose delivery for a large number of IROC-H phantoms and ultimately, patients.« less

Authors:
; ; ; ; ;  [1]
  1. UT MD Anderson Cancer Center, Houston, TX (United States)
Publication Date:
OSTI Identifier:
22653876
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; BIOMEDICAL RADIOGRAPHY; ERRORS; LINEAR ACCELERATORS; PHANTOMS; PLANNING; RADIATION DOSES

Citation Formats

Kerns, J, Followill, D, Howell, R, Melancon, A, Stingo, F, and Kry, S. MO-FG-202-05: Identifying Treatment Planning System Errors in IROC-H Phantom Irradiations. United States: N. p., 2016. Web. doi:10.1118/1.4957307.
Kerns, J, Followill, D, Howell, R, Melancon, A, Stingo, F, & Kry, S. MO-FG-202-05: Identifying Treatment Planning System Errors in IROC-H Phantom Irradiations. United States. doi:10.1118/1.4957307.
Kerns, J, Followill, D, Howell, R, Melancon, A, Stingo, F, and Kry, S. 2016. "MO-FG-202-05: Identifying Treatment Planning System Errors in IROC-H Phantom Irradiations". United States. doi:10.1118/1.4957307.
@article{osti_22653876,
title = {MO-FG-202-05: Identifying Treatment Planning System Errors in IROC-H Phantom Irradiations},
author = {Kerns, J and Followill, D and Howell, R and Melancon, A and Stingo, F and Kry, S},
abstractNote = {Purpose: Treatment Planning System (TPS) errors can affect large numbers of cancer patients receiving radiation therapy. Using an independent recalculation system, the Imaging and Radiation Oncology Core-Houston (IROC-H) can identify institutions that have not sufficiently modelled their linear accelerators in their TPS model. Methods: Linear accelerator point measurement data from IROC-H’s site visits was aggregated and analyzed from over 30 linear accelerator models. Dosimetrically similar models were combined to create “classes”. The class data was used to construct customized beam models in an independent treatment dose verification system (TVS). Approximately 200 head and neck phantom plans from 2012 to 2015 were recalculated using this TVS. Comparison of plan accuracy was evaluated by comparing the measured dose to the institution’s TPS dose as well as the TVS dose. In cases where the TVS was more accurate than the institution by an average of >2%, the institution was identified as having a non-negligible TPS error. Results: Of the ∼200 recalculated plans, the average improvement using the TVS was ∼0.1%; i.e. the recalculation, on average, slightly outperformed the institution’s TPS. Of all the recalculated phantoms, 20% were identified as having a non-negligible TPS error. Fourteen plans failed current IROC-H criteria; the average TVS improvement of the failing plans was ∼3% and 57% were found to have non-negligible TPS errors. Conclusion: IROC-H has developed an independent recalculation system to identify institutions that have considerable TPS errors. A large number of institutions were found to have non-negligible TPS errors. Even institutions that passed IROC-H criteria could be identified as having a TPS error. Resolution of such errors would improve dose delivery for a large number of IROC-H phantoms and ultimately, patients.},
doi = {10.1118/1.4957307},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: To understand the uncertainties in proton therapy treatment planning for the IROC- Houston proton phantom QA program due to variations in CT technique and proton energy. Methods: A CT phantom used by IROC-H during therapy site visits was scanned using three CT techniques (80, 120, 140kV) with a CT scanner used for proton therapy simulations and irradiated with a passively scattered beam at three energies (140, 200, 250 MeV) to measure, respectively, HU and Relative Linear Stopping Power (RLSP) in order to create HU to RLSP calibration curves for comparison with reference curves used by current proton treatment planningmore » systems. The phantom has proton equivalent materials with a wide variety of HU and RLSPs to allow for the creation of a calibration curve for common tissue equivalent materials. Treatment plans were created for a lung phantom using the various CT technique/ beam energy calibration curves to determine the differences in the dose distributions by performing a gamma analysis. Results: Comparison of the calibration curves created using the phantom materials showed a maximum difference of 12% for a given material between the custom curve and the reference curve currently used by the treatment planning system. The highest differences were a Result of using an 80 kV CT technique and a 250 MeV high proton energy. A comparison of the completed treatment plans will be presented. Conclusion: These results indicate the possibility of differences in proton HU to RLSP calibration curves caused by varying CT technique and proton energy that could manifest as differences in planned and delivered dose distributions, particularly at high proton energies and low kV CT techniques. These differences could Result in discrepancies not accounted for by IROC-Houston and could possibly affect proton institutions’ pass rate when irradiating the proton phantoms.« less
  • Purpose: Analyze the results from irradiations of an anthropomorphic liver phantom based on irradiation technique and number of isocenters used for the SBRT delivery. Methods: The phantom consists of a water-fillable plastic shell that has a polystyrene insert, representing the liver which includes two Solid WaterTM targets (PTV1 and PTV2) mimicking liver metastases. The two targets, PTV1 and PTV2 are non-coplanar and are an ovoid 2 cm in diameter and 2.5 cm long and a 3 cm diameter sphere, respectively. Each PTV houses one TLD and 2 planes of radiochromic film. The phantom and a motion table to simulate respiratorymore » motion is sent to institutions sthat are instructed to design and deliver a stereotactic treatment plan that delivers 6 Gy to ≥ 95% of each PTV. The maximum motion of the phantom on the motion table was 1 cm in the superior-inferior direction. Results: Irradiations from 93 institutions have been analyzed. The acceptance criteria are ±7% for the TLD and 85% of the pixels in a region surrounding each PTV passing a ±7%/4 mm global gamma analysis. Sixty-seven (71%) irradiations meet this criteria. The majority, 74 (80%), of the irradiations were performed with IMRT. 73% of the IMRT deliveries were within criteria and 68% of the 3D CRT delivery were within criteria. 32 of the irradiations had a single isocenter plan, 50 were performed with two isocenters and 11 irradiations were performed with CyberKnife and TomoTherapy units where the concept of isocenter is not applicable. The pass rate for the single, dual and no isocenter irradiations were 69%, 74% and 73%, respectively and are not statistically different. Conclusion: The pass rate for the anthropomorphic liver phantom is approximately 70%. There does not seem to be any correlation with number of isocenters used or irradiation technique used for the delivery. This work was supported by PHS CA180803 awarded by NCI, DHHS.« less
  • Purpose: The purpose of this study is to evaluate any effects of converted CT density variation in treatment planning system (TPS) of spot scanning proton therapy with an IROC proton prostate phantom at our new ProteusOne Proton Therapy Center. Methods: A proton prostate phantom was requested from the Imaging and Radiation Oncology Core Houston (IROC), The University of Texas MD Anderson Cancer Center, Houston, TX, where GAF Chromic films and couples of thermo luminescent dosemeter (TLD) capsules in target and adjacent structures were embedded for imaging and dose monitoring. Various material such as PVC, PBT HI polystyrene as dosimetry insertsmore » and acrylic were within phantom. Relative stopping power (SP) were provided. However our treatment planning system (TPS) doesn’t require SP instead relative density was converted relative to water in TPS. Phantom was irradiated and the results were compared with IROC measurements. The range of relative density was converted from SP into relative density of water as a new assigned material and tested. Results: The summary of TLD measurements of the prostate and femoral heads were well within 2% of the TPS and met the criteria established by IROC. The film at coronal plane was found to be shift in superior-inferior direction due to locking position of cylinder insert was off and was corrected. The converted CT density worked precisely to correlated relative stopping power. Conclusion: The proton prostate phantom provided by IROC is a useful methodology to evaluate our new commissioned proton pencil beam and TPS within certain confidence in proton therapy. The relative stopping power was converted into relative physical density relatively to water and the results were satisfied.« less
  • Purpose: Base of skull meningioma can be treated with both intensity modulated radiation therapy (IMRT) and spot scanned proton therapy (PT). One of the main benefits of PT is better sparing of organs at risk, but due to the physical and dosimetric characteristics of protons, spot scanned PT can be more sensitive to the uncertainties encountered in the treatment process compared with photon treatment. Therefore, robustness analysis should be part of a comprehensive comparison between these two treatment methods in order to quantify and understand the sensitivity of the treatment techniques to uncertainties. The aim of this work was tomore » benchmark a spot scanning treatment planning system for planning of base of skull meningioma and to compare the created plans and analyze their robustness to setup errors against the IMRT technique. Methods: Plans were produced for three base of skull meningioma cases: IMRT planned with a commercial TPS [Monaco (Elekta AB, Sweden)]; single field uniform dose (SFUD) spot scanning PT produced with an in-house TPS (PSI-plan); and SFUD spot scanning PT plan created with a commercial TPS [XiO (Elekta AB, Sweden)]. A tool for evaluating robustness to random setup errors was created and, for each plan, both a dosimetric evaluation and a robustness analysis to setup errors were performed. Results: It was possible to create clinically acceptable treatment plans for spot scanning proton therapy of meningioma with a commercially available TPS. However, since each treatment planning system uses different methods, this comparison showed different dosimetric results as well as different sensitivities to setup uncertainties. The results confirmed the necessity of an analysis tool for assessing plan robustness to provide a fair comparison of photon and proton plans. Conclusions: Robustness analysis is a critical part of plan evaluation when comparing IMRT plans with spot scanned proton therapy plans.« less
  • Purpose: To describe the proton phantoms that IROC Houston uses to approve and credential proton institutions to participate in NCI-sponsored clinical trials. Methods: Photon phantoms cannot necessarily be used for proton measurements because protons react differently than photons in some plastics. As such plastics that are tissue equivalent for protons were identified. Another required alteration is to ensure that the film dosimeters are housed in the phantom with no air gap to avoid proton streaming. Proton-equivalent plastics/materials used include RMI Solid Water, Techron HPV, blue water, RANDO soft tissue material, balsa wood, compressed cork and polyethylene. Institutions wishing to bemore » approved or credentialed request a phantom and are prioritized for delivery. At the institution, the phantom is imaged, a treatment plan is developed, positioned on the treatment couch and the treatment is delivered. The phantom is returned and the measured dose distributions are compared to the institution’s electronically submitted treatment plan dosimetry data. Results: IROC Houston has developed an extensive proton phantom approval/credentialing program consisting of five different phantoms designs: head, prostate, lung, liver and spine. The phantoms are made with proton equivalent plastics that have HU and relative stopping powers similar (within 5%) of human tissues. They also have imageable targets, avoidance structures, and heterogeneities. TLD and radiochromic film are contained in the target structures. There have been 13 head, 33 prostate, 18 lung, 2 liver and 16 spine irradiations with either passive scatter, or scanned proton beams. The pass rates have been: 100%, 69.7%, 72.2%, 50%, and 81.3%, respectively. Conclusion: IROC Houston has responded to the recent surge in proton facilities by developing a family of anthropomorphic phantoms that are able to be used for remote audits of proton beams. Work supported by PHS grant CA10953 and CA081647.« less