Nelms B.E.,Canis Lupus LLC |
Opp D.,H. Lee Moffitt Cancer Center and Research Institute |
Robinson J.,University of South Florida |
Wolf T.K.,Oak Technologies |
And 3 more authors.
Medical Physics | Year: 2012
Purpose: To develop and validate a volume-modulated arc therapy (VMAT) quality assurance (QA) tool that takes as input a time-resolved, low-density (∼10 mm) cylindrical surface dose map from a commercial helical diode array, and outputs a high density, volumetric, time-resolved dose matrix on an arbitrary patient dataset. This first validation study is limited to a homogeneous patient. Methods: A VMAT treatment is delivered to a diode array phantom (ARCCHECK, Sun Nuclear Corp., Melbourne, FL). 3DVH software (Sun Nuclear) derives the high-density volumetric dose using measurement-guided dose reconstruction (MGDR). MGDR cylindrical phantom results are then used to perturb the three-dimensional (3D) treatment planning dose on the patient dataset, producing a semiempirical volumetric dose grid. Four-dimensional (4D) dose reconstruction on the patient is also possible by morphing individual sub-beam doses instead of the composite. For conventional (3D) dose comparison two methods were developed, using the four plans (Multi-Target, C-shape, Mock Prostate, and Head and Neck), including their structures and objectives, from the AAPM TG-119 report. First, 3DVH and treatment planning system (TPS) cumulative point doses were compared to ion chamber in a cube water-equivalent phantom (patient). The shape of the phantom is different from the ARCCHECK and furthermore the targets were placed asymmetrically. Second, coronal and sagittal absolute film dose distributions in the cube were compared with 3DVH and TPS. For time-resolved (4D) comparisons, three tests were performed. First, volumetric dose differences were calculated between the 3D MGDR and cumulative time-resolved patient (4D MGDR) dose at the end of delivery, where they ideally should be identical. Second, time-resolved (10 Hz sampling rate) ion chamber doses were compared to cumulative point dose vs time curves from 4D MGDR. Finally, accelerator output was varied to assess the linearity of the 4D MGDR with global fluence change. Results: Across four TG-119 plans, the average PTV point dose difference in the cube between 3DVH and ion chamber is 0.1 ± 1.0. Average film vs TPS γ-analysis passing rates are 83.0, 91.1, and 98.4 for 12 mm, 22 mm, and 33 mm threshold combinations, respectively, while average film vs 3DVH γ-analysis passing rates are 88.6, 96.1, and 99.5 for the same respective criteria. 4D MGDR was also sufficiently accurate. First, for 99.5 voxels in each case, the doses from 3D and 4D MGDR at the end of delivery agree within 0.5 local dose-error1 mm distance. Moreover, all failing voxels are confined to the edge of the cylindrical reconstruction volume. Second, dose vs time curves track between the ion chamber and 4D MGDR within 1. Finally, 4D MGDR dose changes linearly with the accelerator output: the difference between cumulative ion chamber and MGDR dose changed by no more than 1 (randomly) with the output variation range of 10. Conclusions: Even for a well-commissioned TPS, comparison metrics show better agreement on average to MGDR than to TPS on the arbitrary-shaped measurable patient. The method requires no more accelerator time than standard QA, while producing more clinically relevant information. Validation in a heterogeneous thoracic phantom is under way, as is the ultimate application of 4D MGDR to virtual motion studies. © 2012 American Association of Physicists in Medicine.
Nelms B.E.,Canis Lupus LLC |
Chan M.F.,Sloan Kettering Cancer Center |
Jarry G.,Hopital Maisonneuve Rosemont |
Lemire M.,Hopital Maisonneuve Rosemont |
And 3 more authors.
Medical Physics | Year: 2013
Purpose: This study (1) examines a variety of real-world cases where systematic errors were not detected by widely accepted methods for IMRT/VMAT dosimetric accuracy evaluation, and (2) drills-down to identify failure modes and their corresponding means for detection, diagnosis, and mitigation. The primary goal of detailing these case studies is to explore different, more sensitive methods and metrics that could be used more effectively for evaluating accuracy of dose algorithms, delivery systems, and QA devices. Methods: The authors present seven real-world case studies representing a variety of combinations of the treatment planning system (TPS), linac, delivery modality, and systematic error type. These case studies are typical to what might be used as part of an IMRT or VMAT commissioning test suite, varying in complexity. Each case study is analyzed according to TG-119 instructions for gamma passing rates and action levels for per-beam and/or composite plan dosimetric QA. Then, each case study is analyzed in-depth with advanced diagnostic methods (dose profile examination, EPID-based measurements, dose difference pattern analysis, 3D measurement-guided dose reconstruction, and dose grid inspection) and more sensitive metrics (2% local normalization/2 mm DTA and estimated DVH comparisons). Results: For these case studies, the conventional 3%/3 mm gamma passing rates exceeded 99% for IMRT per-beam analyses and ranged from 93.9% to 100% for composite plan dose analysis, well above the TG-119 action levels of 90% and 88%, respectively. However, all cases had systematic errors that were detected only by using advanced diagnostic techniques and more sensitive metrics. The systematic errors caused variable but noteworthy impact, including estimated target dose coverage loss of up to 5.5% and local dose deviations up to 31.5%. Types of errors included TPS model settings, algorithm limitations, and modeling and alignment of QA phantoms in the TPS. Most of the errors were correctable after detection and diagnosis, and the uncorrectable errors provided useful information about system limitations, which is another key element of system commissioning. Conclusions: Many forms of relevant systematic errors can go undetected when the currently prevalent metrics for IMRT/VMAT commissioning are used. If alternative methods and metrics are used instead of (or in addition to) the conventional metrics, these errors are more likely to be detected, and only once they are detected can they be properly diagnosed and rooted out of the system. Removing systematic errors should be a goal not only of commissioning by the end users but also product validation by the manufacturers. For any systematic errors that cannot be removed, detecting and quantifying them is important as it will help the physicist understand the limits of the system and work with the manufacturer on improvements. In summary, IMRT and VMAT commissioning, along with product validation, would benefit from the retirement of the 3%/3 mm passing rates as a primary metric of performance, and the adoption instead of tighter tolerances, more diligent diagnostics, and more thorough analysis. © 2013 American Association of Physicists in Medicine.
Nelms B.E.,Canis Lupus LLC |
Tome W.A.,University of Wisconsin - Madison |
Robinson G.,Radiation Oncology Resources |
Wheeler J.,Goshen Health System
International Journal of Radiation Oncology Biology Physics | Year: 2012
Purpose: Anatomy contouring is critical in radiation therapy. Inaccuracy and variation in defining critical volumes will affect everything downstream: treatment planning, dose-volume histogram analysis, and contour-based visual guidance used in image-guided radiation therapy. This study quantified: (1) variation in the contouring of organs at risk (OAR) in a clinical test case and (2) corresponding effects on dosimetric metrics of highly conformal plans. Methods and Materials: A common CT data set with predefined targets from a patient with oropharyngeal cancer was provided to a population of clinics, which were asked to (1) contour OARs and (2) design an intensity-modulated radiation therapy plan. Thirty-two acceptable plans were submitted as DICOM RT data sets, each generated by a different clinical team. Using those data sets, we quantified: (1) the OAR contouring variation and (2) the impact this variation has on dosimetric metrics. New technologies were employed, including a software tool to quantify three-dimensional structure comparisons. Results: There was significant interclinician variation in OAR contouring. The degree of variation is organ-dependent. We found substantial dose differences resulting strictly from contouring variation (differences ranging from -289% to 56% for mean OAR dose; -22% to 35% for maximum dose). However, there appears to be a threshold in the OAR comparison metric beyond which the dose differences stabilize. Conclusions: The effects of interclinician variation in contouring organs-at-risk in the head and neck can be large and are organ-specific. Physicians need to be aware of the effect that variation in OAR contouring can play on the final treatment plan and not restrict their focus only to the target volumes. Copyright © 2012 Elsevier Inc. Printed in the USA. All rights reserved.
Feygelman V.,H. Lee Moffitt Cancer Center and Research Institute |
Zhang G.,H. Lee Moffitt Cancer Center and Research Institute |
Stevens C.,H. Lee Moffitt Cancer Center and Research Institute |
Nelms B.E.,Canis Lupus LLC
Journal of Applied Clinical Medical Physics | Year: 2011
We introduce a logical process of three distinct phases to begin the evaluation of a new 3D dosimetry array. The array under investigation is a hollow cylinder phantom with diode detectors fixed in a helical shell forming an "O" axial detector cross section (ArcCHECK), with comparisons drawn to a previously studied 3D array with diodes fixed in two crossing planes forming an "X" axial cross section (Delta4). Phase I testing of the ArcCHECK establishes: robust relative calibration (response equalization) of the individual detectors, minor field size dependency of response not present in a 2D predecessor, and uncorrected angular response dependence in the axial plane. Phase II testing reveals vast differences between the two devices when studying fixed-width full circle arcs. These differences are primarily due to arc discretization by the TPS that produces low passing rates for the peripheral detectors of the ArcCHECK, but high passing rates for the Delta4. Similar, although less pronounced, effects are seen for the test VMAT plans modeled after the AAPM TG119 report. The very different 3D detector locations of the two devices, along with the knock-on effect of different percent normalization strategies, prove that the analysis results from the devices are distinct and noninterchangeable; they are truly measuring different things. The value of what each device measures, namely their correlation with -or ability to predict -clinically relevant errors in calculation and/or delivery of dose is the subject of future Phase III work.
Zhen H.,University of Wisconsin - Madison |
Nelms B.E.,University of Wisconsin - Madison |
Nelms B.E.,Canis Lupus LLC |
Tome W.A.,University of Wisconsin - Madison
Medical Physics | Year: 2011
Purpose: The purpose of this work is to explore the usefulness of the gamma passing rate metric for per-patient, pretreatment dose QA and to validate a novel patient-doseDVH-based method and its accuracy and correlation. Specifically, correlations between: (1) gamma passing rates for three 3D dosimeter detector geometries vs clinically relevant patient DVH-based metrics; (2) Gamma passing rates of whole patient dose grids vs DVH-based metrics, (3) gamma passing rates filtered by region of interest (ROI) vs DVH-based metrics, and (4) the capability of a novel software algorithm that estimates corrected patient Dose-DVH based on conventional phan-tom QA data are analyzed. Methods: Ninety six unique imperfect step-and-shoot IMRT plans were generated by applying four different types of errors on 24 clinical HeadNeck patients. The 3D patient doses as well as the dose to a cylindrical QA phantom were then recalculated using an error-free beam model to serve as a simulated measurement for comparison. Resulting deviations to the planned vs simulated measured DVH-based metrics were generated, as were gamma passing rates for a variety of differencedistance criteria covering: dose-in-phantom comparisons and dose-in-patient comparisons, with the in-patient results calculated both over the whole grid and per-ROI volume. Finally, patient dose and DVH were predicted using the conventional per-beam planar data as input into a commercial planned dose perturbation (PDP) algorithm, and the results of these predicted DVH-based metrics were compared to the known values. Results: A range of weak to moderate correlations were found between clinically relevant patient DVH metrics (CTV-D95, parotid D mean, spinal cord D1cc, and larynx D mean) and both 3D detector and 3D patient gamma passing rate (3%/3 mm, 2%/2 mm) for dose-in-phantom along with dose-in-patient for both whole patient volume and filtered per-ROI. There was considerable scatter in the gamma passing rate vs DVH-based metric curves. However, for the same input data, the PDP estimates were in agreement with actual patient DVH results. Conclusions: Gamma passing rate, even if calculated based on patient dose grids, has generally weak correlation to critical patient DVH errors. However, the PDP algorithm was shown to accurately predict the DVH impact using conventional planar QA results. Using patient-DVH-based metrics IMRT QA allows per-patient dose QA to be based on metrics that are both sensitive and specific. Further studies are now required to analyze new processes and action levels associated with DVH-based metrics to ensure effectiveness and practicality in the clinical setting. © 2011 American Association of Physicists in Medicine.
Nelms B.,Canis Lupus LLC |
Feygelman V.,H. Lee Moffitt Cancer Center and Research Institute
Journal of Physics: Conference Series | Year: 2013
As IMRT/VMAT technology continues to evolve, so do the dosimetric QA methods. We present the theoretical framework for the novel planned dose perturbation algorithm. It allows not only to reconstruct the 3D volumetric doe on a patient from a measurement in a cylindrical phantom, but also to incorporate the effects of the interplay between the intrafractional organ motion and dynamic delivery. Unlike in our previous work, this 4D dose reconstruction does not require the knowledge of the TPS dose for each control point of the plan, making the method much more practical. Motion is viewed as just another source of error, accounted for by perturbing (morphing) the planned dose distribution based on the limited empirical dose from the phantom measurement. The strategy for empirical verification of the algorithm is presented as the necessary next step.
Canis Lupus LLC | Date: 2013-07-12
Canis Lupus LLC | Date: 2013-02-28
Computer software for creating customized patient electronic medical records for radiation therapy plans.
Sun Nuclear Corporation and Canis Lupus LLC | Date: 2013-07-09
Canis Lupus LLC | Date: 2013-07-11
Computer software for radiation therapy.