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Yang, J., Vedam, S., Lee, B., Castillo, P., Sobremonte, A., Hughes, N., Mohammedsaid, M., Wang, J. and Choi, S. Online adaptive planning for prostate stereotactic body radiotherapy using a 1.5 Tesla magnetic resonance imaging-guided linear accelerator 2021 Physics and Imaging in Radiation Oncology
Vol. 17, pp. 20-24 
article DOI  
Abstract: Recent advances in integrating 1.5 Tesla magnetic resonance (MR) imaging with a linear accelerator (MR-Linac) allow MR-guided stereotactic body radiotherapy (SBRT) for prostate cancer. Choosing an optimal strategy for daily online plan adaptation is particularly important for MR-guided radiotherapy. We analyzed deformable dose accumulation on scans from four patients and found that daily anatomy changes had little impact on the delivered dose, with the dose to the prostate within 0.5% and dose to the rectum/bladder mostly less than 0.5 Gy. These findings could help in the choice of an optimal strategy for online plan adaptation for MR-guided prostate SBRT.
Comment: =Verification
=Linac
=MR
BibTeX:
@article{Yang2021,
  author = {Jinzhong Yang and Sastry Vedam and Belinda Lee and Pamela Castillo and Angela Sobremonte and Neil Hughes and Mustefa Mohammedsaid and Jihong Wang and Seungtaek Choi},
  title = {Online adaptive planning for prostate stereotactic body radiotherapy using a 1.5 Tesla magnetic resonance imaging-guided linear accelerator},
  journal = {Physics and Imaging in Radiation Oncology},
  publisher = {Elsevier BV},
  year = {2021},
  volume = {17},
  pages = {20--24},
  doi = {https://doi.org/10.1016/j.phro.2020.12.001}
}
Yorke, A., Zhai, J. and Gonzalez, A. Implementation of the Full Sun Check Platform Dose Check and PerFraction in a Community Setting 2020 Medical Physics  conference DOI  
Abstract: Verifying IMRT and 3D patient plans is recommended before the start of radiation treatment. Traditionally, this is done by verifying the accuracy of the treatment plan computer software (TPS) calculations by identifying any clinical errors during radiation delivery. In this study, the novel SunCHECKTM, DoseCHECKTM, and PerFRACTIONTM software were implemented in our clinic to carry out the verification procedure of the TPS Pinnacle version 16.2 with two beam matched Elekta Linear Accelerators (LINAC) with 160 MLCs. Methods: Five IMRT and five 3D patient cases with beam energies ranging from 6 to 10 MV were studied. Dose calculations of Monitor Units (MU) from the TPS are compared to RADCALC® and Dose-CHECKTM for all cases. IMRT plans were also delivered to the ArcCHECKTM (AC) phantom. The Results were compared to those from the PerFRACTIONTM using the Electronic Portal Imaging Device (EPID). Both LINACs were used for comparison. Results: The planned and measured dose using AC and PerFRACTIONTM had close agreement when compared using gamma analysis for both LINACs. The calculated MU for RADCALC® and Dose- CHECKTM closely matched the planned MU. For 3D cases the average percent difference between the planned MU/Fraction (MU/Fx) and the calculated MU/Fx using DoseCHECKTM was 1.31% and for RADCALC® was 1.14%. For IMRT it was 1.27% for DoseCHECKTM and 2.78% RADCALC®. Conclusion: SunCHECKTM PerFRACTIONTM and DoseCHECKTM software have been validated since they gave very similar Results to the wellknown RADCALC® software and AC pretreatment QA. Hence this is ready to be incorporated into the clinical workflow. Also, the system is automated making it very realistic to perform daily in-vivo dosimetric QA on every field for every patient for every fraction using exit dose images. This feature makes using the EPID panel very convenient for per fraction QA to account for patient set up errors and changes to patient anatomy.
Comment: =Verification
=Linac
BibTeX:
@conference{Yorke2020,
  author = {A Yorke and J Zhai and A Gonzalez},
  title = {Implementation of the Full Sun Check Platform Dose Check and PerFraction in a Community Setting},
  booktitle = {Medical Physics},
  year = {2020},
  doi = {https://doi.org/10.1002/mp.14315}
}
Xia, P., LaHurd, D., Qi, P., Mastroianni, A., Lee, D., Magnelli, A., Murray, E., Kolar, M., Guo, B., Meier, T., Chao, S.T., Suh, J.H. and Yu, N. Combining automatic plan integrity check (APIC) with standard plan document and checklist method to reduce errors in treatment planning 2020 Journal of Applied Clinical Medical Physics
Vol. 21(9), pp. 124-133 
article DOI  
Abstract: To report our experience of combining three approaches of an automatic plan integrity check (APIC), a standard plan documentation, and checklist methods to minimize errors in the treatment planning process. We developed APIC program and standardized plan documentation via scripting in the treatment planning system, with an enforce function of APIC usage. We used a checklist method to check for communication errors in patient charts (referred to as chart errors). Any errors in the plans and charts (referred to as the planning errors) discovered during the initial chart check by the therapists were reported to our institutional Workflow Enhancement (WE) system. Clinical Implementation of these three methods is a progressive process while the APIC was the major progress among the three methods. Thus, we chose to compared the total number of planning errors before (including data from 2013 to 2014) and after (including data from 2015 to 2018) APIC implementation. We assigned the severity of these errors into five categories: serious (S), near miss with safety net (NM), clinical interruption (CLI), minor impediment (MI), and bookkeeping (BK). The Mann–Whitney U test was used for statistical analysis. A total of 253 planning error forms, containing 272 errors, were submitted during the study period, representing an error rate of 3.8%, 3.1%, 2.1%, 0.8%, 1.9% and 1.3% of total number of plans in these years respectively. A marked reduction of planning error rate in the S and NM categories was statistically significant (P < 0.01): from 0.6% before APIC to 0.1% after APIC. The error rate for all categories was also significantly reduced (P < 0.01), from 3.4% before APIC and 1.5% per plan after APIC. With three combined methods, we reduced both the number and the severity of errors significantly in the process of treatment planning.
Comment: =Verification
=Linac
BibTeX:
@article{Xia2020,
  author = {Ping Xia and Danielle LaHurd and Peng Qi and Anthony Mastroianni and Daesung Lee and Anthony Magnelli and Eric Murray and Matt Kolar and Bingqi Guo and Tim Meier and Samual T. Chao and John H. Suh and Naichang Yu},
  title = {Combining automatic plan integrity check (APIC) with standard plan document and checklist method to reduce errors in treatment planning},
  journal = {Journal of Applied Clinical Medical Physics},
  publisher = {Wiley},
  year = {2020},
  volume = {21},
  number = {9},
  pages = {124--133},
  doi = {https://doi.org/10.1002/acm2.12981}
}
Teruel, J.R., Malin, M., Liu, E.K., McCarthy, A., Hu, K., Cooper, B.T., Sulman, E.P., Silverman, J.S. and Barbee, D. Full automation of spinal stereotactic radiosurgery and stereotactic body radiation therapy treatment planning using Varian Eclipse scripting 2020 Journal of Applied Clinical Medical Physics
Vol. 21(10), pp. 122-131 
article DOI  
Abstract: The purpose of this feasibility study is to develop a fully automated procedure capable of generating treatment plans with multiple fractionation schemes to improve speed, robustness, and standardization of plan quality. A fully automated script was implemented for spinal stereotactic radiosurgery/stereotactic body radiation therapy (SRS/SBRT) plan generation using Eclipse v15.6 API. The script interface allows multiple dose/fractionation plan requests, planning target volume (PTV) expansions, as well as information regarding distance/overlap between spinal cord and targets to drive decision‐making. For each requested plan, the script creates the course, plans, field arrangements, and automatically optimizes and calculates dose. The script was retrospectively applied to ten computed tomography (CT) scans of previous cervical, thoracic, and lumbar spine SBRT patients. Three plans were generated for each patient — simultaneous integrated boost (SIB) 1800/1600 cGy to gross tumor volume (GTV)/PTV in one fraction; SIB 2700/2100 cGy to GTV/PTV in three fractions; and 3000 cGy to PTV in five fractions. Plan complexity and deliverability patient‐specific quality assurance (QA) was performed using ArcCHECK with an Exradin A16 chamber inserted. Dose objectives were met for all organs at risk (OARs) for each treatment plan. Median target coverage was GTV V100% = 87.3%, clinical target volume (CTV) V100% = 95.7% and PTV V100% = 88.0% for single fraction plans; GTV V100% = 95.6, CTV V100% = 99.6% and PTV V100% = 97.2% for three fraction plans; and GTV V100% = 99.6%, CTV V100% = 99.1% and PTV V100% = 97.2% for five fraction plans. All plans (n = 30) passed patient‐specific QA (>90%) at 2%/2 mm global gamma. A16 chamber dose measured at isocenter agreed with planned dose within 3% for all cases. Automatic planning for spine SRS/SBRT through scripting increases efficiency, standardizes plan quality and approach, and provides a tool for target coverage comparison of different fractionation schemes without the need for additional resources.
Comment: =Verification
=Linac
BibTeX:
@article{Teruel2020,
  author = {Jose R. Teruel and Martha Malin and Elisa K. Liu and Allison McCarthy and Kenneth Hu and Bejamin T. Cooper and Erik P. Sulman and Joshua S. Silverman and David Barbee},
  title = {Full automation of spinal stereotactic radiosurgery and stereotactic body radiation therapy treatment planning using Varian Eclipse scripting},
  journal = {Journal of Applied Clinical Medical Physics},
  publisher = {Wiley},
  year = {2020},
  volume = {21},
  number = {10},
  pages = {122--131},
  doi = {https://doi.org/10.1002/acm2.13017}
}
Syed, K., Sleeman, W., Hagan, M., Palta, J., Kapoor, R. and Ghosh, P. Automatic Incident Triage in Radiation Oncology Incident Learning System 2020 Healthcare
Vol. 8(3), pp. 272 
article DOI  
Abstract: The Radiotherapy Incident Reporting and Analysis System (RIRAS) receives incident reports from Radiation Oncology facilities across the US Veterans Health Affairs (VHA) enterprise and Virginia Commonwealth University (VCU). In this work, we propose a computational pipeline for analysis of radiation oncology incident reports. Our pipeline uses machine learning (ML) and natural language processing (NLP) based methods to predict the severity of the incidents reported in the RIRAS platform using the textual description of the reported incidents. These incidents in RIRAS are reviewed by a radiation oncology subject matter expert (SME), who initially triages some incidents based on the salient elements in the incident report. To automate the triage process, we used the data from the VHA treatment centers and the VCU radiation oncology department. We used NLP combined with traditional ML algorithms, including support vector machine (SVM) with linear kernel, and compared it against the transfer learning approach with the universal language model fine-tuning (ULMFiT) algorithm. In RIRAS, severities are divided into four categories; A, B, C, and D, with A being the most severe to D being the least. In this work, we built models to predict High (A & B) vs. Low (C & D) severity instead of all the four categories. Models were evaluated with macro-averaged precision, recall, and F1-Score. The Traditional ML machine learning (SVM-linear) approach did well on the VHA dataset with 0.78 F1-Score but performed poorly on the VCU dataset with 0.5 F1-Score. The transfer learning approach did well on both datasets with 0.81 F1-Score on VHA dataset and 0.68 F1-Score on the VCU dataset. Overall, our methods show promise in automating the triage and severity determination process from radiotherapy incident reports.
Comment: =Verification
=Linac
BibTeX:
@article{Syed2020,
  author = {Khajamoinuddin Syed and William Sleeman and Michael Hagan and Jatinder Palta and Rishabh Kapoor and Preetam Ghosh},
  title = {Automatic Incident Triage in Radiation Oncology Incident Learning System},
  journal = {Healthcare},
  publisher = {MDPI AG},
  year = {2020},
  volume = {8},
  number = {3},
  pages = {272},
  doi = {https://doi.org/10.3390/healthcare8030272}
}
Stathakis, S. and Kabat, C. Institutional Experience of 10 Years 2ndary Dose Calculations ofIntensity Modulated Beams 2020 Medical Physics  conference DOI  
Abstract: To study the performance of our secondary monitor units (MU) calculation over time and evaluate the linear accelerator models and beam model changes over time. Methods: 64,600 2ndary dose calculations over the last ten years of our independent verification software (RadCalc) have been accessed and categorized per linac model, treatment site and modality. From these 19,236 belong to modulated single beams or total dose of modulated beams. The linear accelerator beam models are those of Varian NovalisTX and ELEKTAVersaHD. The treatment planning system (TPS) used for all patient dose calculations was Pinnacle. The data was categorized in terms of treatment site, and beam models. Two beam models for each linear accelerator were created in the TPS over the period of calculations in an attempt to improve accuracy of dose calculations. Results: On average, no difference was observed between linac models from the TPS. The average for the ELEKTA VersaHD models was 0.10+/-2.75% (initial) and 0.04% +/- 2.64 (improved) and for the Varian NovalisTX were 0.81% +/- 2.26 and 0.37% +/- 2.08 respectively. Although a small improvement was observed in the averages before and after beam model improvements it was not statistically significant. Analysis of the 2nd MU dose calculations per anatomical site showed differences. Breast total dose calculations with RadCalc were 2.35 +/- 2.00% compared to the Pinnacle calculations and the rest of the sites were: abdomen 2.02 +/- 2.14%, pelvis 1.31 +/- 2.39%, brain 0.92 +/- 2.14%, thorax 0.96 +/- 2.52% and head-neck 0.30 +/- 2.37%. Conclusion: Our historical data of secondary dose verification with RadCalc showed no statistically significant differences between initial TPS beam models and improvements of them. Although some differences are observed in the averages of dose calculations when grouped by treatment site, the differences are not statistically significant. Such differences can be explained by the differences in the dose calculation algorithms between TPS and RadCalc.
Comment: =Evaluation
=Linac
BibTeX:
@conference{Stathakis2020,
  author = {S Stathakis and C Kabat},
  title = {Institutional Experience of 10 Years 2ndary Dose Calculations ofIntensity Modulated Beams},
  booktitle = {Medical Physics},
  year = {2020},
  doi = {https://doi.org/10.1002/mp.14315}
}
Sopher, D., Gibbons, F., O’Conner, P. and Byrnes, K. Fully Automatic – Commissioning Per Fraction for clinical use 2020 Australasian Physical & Engineering Sciences in Medicine
Vol. 43(1), pp. 297-462 
conference DOI  
Abstract: Automated patient specific quality assurance (PSQA) using portal MV images and Linear Accelerator (linac) log files greatly enhance patient throughput and safety. PerFraction is a PSQA system that provides secondary dose calculations, pre-treatment PSQA and in-vivo patient monitoring. This study aims to quantitatively assess the PerFraction system for clinical VMAT plans relative to metrics such as ArcCHECK Gamma, ion chamber point dose measurements in water and Radcalc. Method Patient plans were calculated on the Monaco (v5.11.02) Treatment Planning System (TPS). Measurements were performed on two beam matched Elekta Versa HD linacs using 6 and 10 MV photons. Each LINAC has an iView AP a-Si Electronic Portal Imaging Device (EPID) with an active area of 24cm2 and the images are processed using iViewGT R.4.1 software. PSQA plans were evaluated using a gamma criterion of 3%/2mm as recommended in TG-218 [1]. A subset of plans had point dose measurements made in water. ArcCHECK measured plans were subsequently analysed using the Fraction Zero Absolute Dose (FZAD) module. Results The average differences and ranges in point dose measurements are shown in Table 1. The average values are given with 95% statistical confidence. The ranges are given in absolute values. Conclusion Preliminary results show good agreement between the PerFraction system and existing results for point dose measurements. Poor results occurred in high dose gradient areas. The gamma analysis comparison shows that generally gamma pass rates for the FZAD module are systematically higher than the Arc-CHECK measurements, though this does not appear to be true for measurements made on LA1 at 6MV. Further investigation will be done to determine the cause.
Comment: =Verification
=Linac
BibTeX:
@conference{Sopher2020,
  author = {Sopher, D and Gibbons, F and O’Conner, P and Byrnes, K},
  title = {Fully Automatic – Commissioning Per Fraction for clinical use},
  journal = {Australasian Physical & Engineering Sciences in Medicine},
  publisher = {Springer Science and Business Media LLC},
  year = {2020},
  volume = {43},
  number = {1},
  pages = {297--462},
  doi = {https://doi.org/10.1007/s13246-019-00826-6}
}
Prusator, M.T., Zhao, T., Kavanaugh, J.A., Santanam, L., Dise, J., Goddu, S.M., Mitchell, T.J., Zoberi, J.E., Kim, T., Mutic, S. and Knutson, N.C. Evaluation of a new secondary dose calculation software for Gamma Knife radiosurgery 2020 Journal of applied clinical medical physics
Vol. 21(1), pp. 95-102 
article DOI  
Abstract: Current available secondary dose calculation software for Gamma Knife radiosurgery falls short in situations where the target is shallow in depth or when the patient is positioned with a gamma angle other than 90°. In this work, we evaluate a new secondary calculation software which utilizes an innovative method to handle nonstandard gamma angles and image thresholding to render the skull for dose calculation. 800 treatment targets previously treated with our GammaKnife Icon system were imported from our treatment planning system (GammaPlan 11.0.3) and a secondary dose calculation was conducted. The agreement between the new calculations and the TPS were recorded and compared to the original secondary dose calculation agreement with the TPS using a Wilcoxon Signed Rank Test. Further comparisons using a Mann-Whitney test were made for targets treated at a 90° gamma angle against those treated with either a 70 or 110 gamma angle for both the new and commercial secondary dose calculation systems. Correlations between dose deviations from the treatment planning system against average target depth were evaluated using a Kendall?s Tau correlation test for both programs. The Wilcoxon Signed Rank Test indicated a significant difference in the agreement between the two secondary calculations and the TPS, with a P-value < 0.0001. With respect to patients treated at nonstandard gamma angles, the new software was largely independent of patient setup, while the commercial software showed a significant dependence (P-value < 0.0001). The new secondary dose calculation software showed a moderate correlation with calculation depth, while the commercial software showed a weak correlation (Tau = ?.322 and Tau = ?.217 respectively). Overall, the new secondary software has better agreement with the TPS than the commercially available secondary calculation software over a range of diverse treatment geometries.
Comment: =Evaluation
=GK
BibTeX:
@article{Prusator2020,
  author = {Prusator, Michael T. and Zhao, Tianyu and Kavanaugh, James A. and Santanam, Lakshmi and Dise, Joe and Goddu, S. Murty and Mitchell, Timothy J. and Zoberi, Jacqueline E. and Kim, Taeho and Mutic, Sasa and Knutson, Nels C.},
  title = {Evaluation of a new secondary dose calculation software for Gamma Knife radiosurgery},
  journal = {Journal of applied clinical medical physics},
  publisher = {John Wiley & Sons, Ltd},
  year = {2020},
  volume = {21},
  number = {1},
  pages = {95--102},
  doi = {https://doi.org/10.1002/acm2.12794}
}
Poder, J., Howie, A., Brown, R., Bucci, J., Rosenfeld, A., Enari, K., Schreiber, K., Carrara, M., Bece, A., Malouf, D. and Cutajar, D. Towards real time in-vivo rectal dosimetry during trans-rectal ultrasound based high dose rate prostate brachytherapy using MOSkin dosimeters 2020 Radiotherapy and Oncology
Vol. 151, pp. 273-279 
article DOI  
Abstract: To compare the dose measured by MOSkin dosimeters coupled to a trans-rectal ultrasound (TRUS) probe to the dose predicted by the brachytherapy treatment planning system (BTPS) during high dose rate (HDR) prostate brachytherapy (pBT), and to examine the feasibility of performing real-time catheter-by-catheter analysis of in-vivo rectal dosimetry during TRUS based HDR pBT. Four MOSkin dosimeters were coupled to a TRUS probe during 20 TRUS-based HDR pBT treatment fractions. The measured MOSkin doses were retrospectively compared to those predicted by the BTPS for the total treatment fraction, as well as on a per catheter basis. The average relative percentage difference between MOSkin measured and BTPS predicted doses for a total treatment fraction was 0.3% ± 11.6% (k = 1), with a maximum of 23.2% and a minimum of −29.0%. The average relative percentage difference per catheter was +2.5% ± 16.9% (k = 1). The majority (64%) of per catheter MOSkin measured doses agreed with the treatment planning system within the calculated uncertainty budget of 12.3%. The results of the study agreed well with previously published data, despite differences in clinical workflows. To improve the redundancy to potential dosimeter errors, a minimum of 4 MOSkin dosimeters should be used when performing real-time in-vivo rectal dosimetry for HDR pBT, and error thresholds should be based off the total combined uncertainty estimate of measurement. ‘Real time’ error thresholds can be more confidently applied in the future through enhanced integration between IVD systems with both the imaging device and the BTPS/afterloader.
Comment: =Verification
=BT
BibTeX:
@article{Poder2020,
  author = {Joel Poder and Andrew Howie and Ryan Brown and Joseph Bucci and Anatoly Rosenfeld and Komiti Enari and Kristine Schreiber and Mauro Carrara and Andrej Bece and David Malouf and Dean Cutajar},
  title = {Towards real time in-vivo rectal dosimetry during trans-rectal ultrasound based high dose rate prostate brachytherapy using MOSkin dosimeters},
  journal = {Radiotherapy and Oncology},
  publisher = {Elsevier BV},
  year = {2020},
  volume = {151},
  pages = {273--279},
  doi = {https://doi.org/10.1016/j.radonc.2020.08.003}
}
Moustakis, C., Ebrahimi Tazehmahalleh, F., Elsayad, K., Fezeu, F. and Scobioala, S. A novel approach to SBRT patient quality assurance using EPID-based real-time transit dosimetry : A step to QA with in vivo EPID dosimetry. 2020 Strahlentherapie und Onkologie
Vol. 196, pp. 182-192 
article DOI  
Abstract: Intra- and inter-fraction organ motion is a major concern in stereotactic body radiation therapy (SBRT). It may cause substantial differences between the planned and delivered dose distribution. Such delivery errors may lead to medical harm and reduce life expectancy for patients. The project presented here investigates and improves a rapid method to detect such errors by performing online dose verification through the analysis of electronic portal imaging device (EPID) images. To validate the method, a respiratory phantom with inhomogeneous insert was examined under various scenarios: no-error and error-simulated measurements. Simulation of respiratory motions was practiced for target ranges up to 2 cm. Three types of treatment planning technique - 3DCRT (three-dimensional conformal radiation therapy), IMRT (intensity modulated radiation therapy), and VMAT (volumetric modulated arc therapy - were generated for lung SBRT. A total of 54 plans were generated to assess the influence of techniques on the performance of portal dose images. Subsequently, EPID images of 52 SBRT patients were verified. Both for phantom and patient cases, dose distributions were compared using the gamma index method according to analysis protocols in the target volume. The comparison of error-introduced EPID-measured images to reference images showed no significant differences with 3%/3 mm gamma evaluation, though target coverage was strongly underestimated. Gamma tolerance of 2%/2 mm reported noticeable detection in EPID sensitivity for simulated errors in 3DCRT and IMRT techniques. The passing rates for 3DCRT, IMRT, and VMAT with 1%/1 mm in open field were 84.86%, 92.91%, and 98.75%, and by considering MLC-CIAO + 1 cm (threshold 5%), were 68.25%, 83.19%, and 95.29%, respectively. This study demonstrates the feasibility of EPID for detecting the interplay effects. We recommend using thin computed tomography slices and adding sufficient tumor margin in order to limit the dosimetric organ motion in hypofractionated irradiation with preserved plan quality. In the presence of respiratory and gastrointestinal motion, tighter criteria and consequently using local gamma evaluation should be considered, especially for VMAT. This methodology offers a substantial step forward in in vivo dosimetry and the potential to distinguish errors depending on the gamma tolerances. Thus, the approach/prototype provides a fast and easy quality assurance procedure for treatment delivery verification.
Comment: =Promotion
=Linac
BibTeX:
@article{Moustakis2020,
  author = {Moustakis, Christos and Ebrahimi Tazehmahalleh, Fatemeh and Elsayad, Khaled and Fezeu, Francis and Scobioala, Sergiu},
  title = {A novel approach to SBRT patient quality assurance using EPID-based real-time transit dosimetry : A step to QA with in vivo EPID dosimetry.},
  journal = {Strahlentherapie und Onkologie},
  year = {2020},
  volume = {196},
  pages = {182--192},
  doi = {https://doi.org/10.1007/s00066-019-01549-z}
}
Mehrens, H., Taylor, P., Followill, D.S. and Kry, S.F. Survey results of 3D-CRT and IMRT quality assurance practice 2020 Journal of Applied Clinical Medical Physics
Vol. 21(7), pp. 70-76 
article DOI  
Abstract: To create a snapshot of common practices for 3D‐CRT and intensity‐modulated radiation therapy (IMRT) QA through a large‐scale survey and compare to TG‐218 recommendations. A survey of 3D‐CRT and IMRT QA was constructed at and distributed by the IROC‐Houston QA center to all institutions monitored by IROC (n = 2,861). The first part of the survey asked about methods to check dose delivery for 3D‐CRT. The bulk of the survey focused on IMRT QA, inquiring about treatment modalities, standard tools used to verify planned dose, how assessment of agreement is calculated and the comparison criteria used, and the strategies taken if QA fails. The most common tools for dose verification were a 2D diode array (52.8%), point(s) measurement (39.0%), EPID (27.4%), and 2D ion chamber array (23.9%). When IMRT QA failed, the highest average rank strategy utilized was to remeasure with the same setup, which had an average position ranking of 1.1 with 90.4% of facilities employing this strategy. The second highest average ranked strategy was to move to a new calculation point and remeasure (54.9%); this had an average ranking 2.1. The survey provided a snapshot of the current state of dose verification for IMRT radiotherapy. The results showed variability in approaches and that work is still needed to unify and tighten criteria in the medical physics community, especially in reference to TG‐218's recommendations.
Comment: =Verification
=Linac
BibTeX:
@article{Mehrens2020,
  author = {Hunter Mehrens and Paige Taylor and David S. Followill and Stephen F. Kry},
  title = {Survey results of 3D-CRT and IMRT quality assurance practice},
  journal = {Journal of Applied Clinical Medical Physics},
  publisher = {Wiley},
  year = {2020},
  volume = {21},
  number = {7},
  pages = {70--76},
  doi = {https://doi.org/10.1002/acm2.12885}
}
McDonald, B.A., Vedam, S., Yang, J., Wang, J., Castillo, P., Lee, B., Sobremonte, A., Ahmed, S., Ding, Y., Mohamed, A.S., Balter, P., Hughes, N., Thorwarth, D., Nachbar, M., Philippens, M.E., Terhaard, C.H., Zips, D., Böke, S., Awan, M.J., Christodouleas, J. and Fuller, C.D. Initial Feasibility and Clinical Implementation of Daily MR-guided Adaptive Head and Neck Cancer Radiotherapy on a 1.5T MR-Linac System: Prospective R-IDEAL 2a/2b Systematic Clinical Evaluation of Technical Innovation 2020 International Journal of Radiation Oncology∗Biology∗Physics  article DOI  
Abstract: This prospective study is the first report of daily adaptive radiotherapy (ART) for head & neck cancers (HNC) using a 1.5T MR-linac, with particular focus on safety & feasibility and dosimetric results of an on-line rigid registration-based adapt-to-position (ATP) workflow. Ten HNC patients received daily ART on a 1.5T/7MV MR-linac, six using ATP only and four using ATP with one off-line adapt-to-shape re-plan. Setup variability with custom immobilization masks was assessed by calculating the average systematic error (M), standard deviation of the systematic error (Σ), and standard deviation of the random error (σ) of the isocenter shifts. Quality assurance was performed with a cylindrical diode array using 3%/3mm γ criteria. Adaptive treatment plans were summed for each patient to compare delivered dose with planned dose from the reference plan. The impact of dosimetric variability between adaptive fractions on the summation plan doses was assessed by tracking the number of optimization constraint violations at each individual fraction. The random errors (mm) for the x, y, and z isocenter shifts, respectively, were M = -0.3, 0.7, 0.1; Σ = 3.3, 2.6, 1.4; and σ = 1.7, 2.9, 1.0. The median γ pass rate was 99.9% (range: 90.9%-100%). The differences between the reference and summation plan doses were within [-0.61%, 1.78%] for the CTV and [-11.74%, 8.11%] for organs at risk (OARs), though percent increases in OAR dose above 2% only occurred in three cases, each for a single OAR. All cases had at least two fractions with one or more constraint violations. However, in nearly all instances, constraints were still met in the summation plan despite multiple single-fraction violations. Daily ART on a 1.5T MR-linac using an on-line ATP workflow is safe and clinically feasible for HNC and results in delivered doses consistent with planned doses.
Comment: =Verification
=Linac
=MR
BibTeX:
@article{McDonald2020,
  author = {Brigid A. McDonald and Sastry Vedam and Jinzhong Yang and Jihong Wang and Pamela Castillo and Belinda Lee and Angela Sobremonte and Sara Ahmed and Yao Ding and Abdallah S.R. Mohamed and Peter Balter and Neil Hughes and Daniela Thorwarth and Marcel Nachbar and Marielle E.P. Philippens and Chris H.J. Terhaard and Daniel Zips and Simon Böke and Musaddiq J. Awan and John Christodouleas and Clifton D. Fuller},
  title = {Initial Feasibility and Clinical Implementation of Daily MR-guided Adaptive Head and Neck Cancer Radiotherapy on a 1.5T MR-Linac System: Prospective R-IDEAL 2a/2b Systematic Clinical Evaluation of Technical Innovation},
  journal = {International Journal of Radiation Oncology∗Biology∗Physics},
  publisher = {Elsevier BV},
  year = {2020},
  doi = {https://doi.org/10.1016/j.ijrobp.2020.12.015}
}
Livingstone, A.G., Crowe, S.B., Sylvander, S. and Kairn, T. Clinical implementation of a Monte Carlo based independent TPS dose checking system 2020 Physical and Engineering Sciences in Medicine
Vol. 43(3), pp. 1113-1123 
article DOI  
Abstract: The increase in complexity of treatment plans over time through modalities such as intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) has often not been met with an increase in capability of the secondary dose calculation checking systems typically used to verify the treatment planning system. Monte Carlo (MC) codes such as EGSnrc have become easily available and are capable of performing calculations of highly complex radiotherapy treatments. This educational note demonstrates a method for implementing and using a fully automated system for performing and analysing full MC calculations of conformal, IMRT and VMAT radiotherapy plans. Example calculations were based on BEAMnrc/DOSXYZnrc and are performed automatically after either uploading exported plan DICOM data through a Python-based web interface, or exporting DICOM data to a monitored network location. This note demonstrates how completed MC calculations can then be analysed using an automatically generated dose point comparison report, or easily re-imported back into the treatment planning system. Agreement between the TPS and MC calculation was an improvement on agreement between RadCalc and the TPS, with differences ranging from 1.2 to 5.5% between RadCalc and the treatment planning system (TPS), and 0.1–1.7% between MC and TPS. Comparison of the dose-volume histogram (DVH) parameters Dmean, D98%, D2%, and Dmax for the example VMAT plans showed agreement for the mean planning target volume dose within 0.25%, D98% and D2% generally within 1% with the exception of a brain case, and Dmax within 1%. Overall, this note provides a demonstration of a system that has been integrated well into existing clinical workflow, and has been shown to be a valuable additional tool in the secondary checking of treatment plan calculations.
Comment: =Evaluation
=Linac
=MC
BibTeX:
@article{Livingstone2020,
  author = {A. G. Livingstone and S. B. Crowe and S. Sylvander and T. Kairn},
  title = {Clinical implementation of a Monte Carlo based independent TPS dose checking system},
  journal = {Physical and Engineering Sciences in Medicine},
  publisher = {Springer Science and Business Media LLC},
  year = {2020},
  volume = {43},
  number = {3},
  pages = {1113--1123},
  doi = {https://doi.org/10.1007/s13246-020-00907-x}
}
Li, Y., Wang, B., Ding, S., Liu, H., Liu, B., Xia, Y., Song, T. and Huang, X. Feasibility of using a commercial collapsed cone dose engine for 1.5T MR-LINAC online independent dose verification 2020 Physica Medica
Vol. 80, pp. 288-296 
article DOI  
Abstract: To validate the feasibility and accuracy of commonly used collapsed cone (CC) dose engine for Elekta Unity 1.5T MR-LINAC online independent dose verification. The Unity beam model was built and commissioned in RayStation treatment planning system with CC dose engine. Four AAPM TG-119 test plans were created and measured with ArcCHECK phantom for comparison, another thirty patient plans from six tumor sites were also included. The dosimetric criteria for various ROIs and 3D gamma passing rates were quantitatively evaluated, and the effects of magnetic field and dose deposition type on the dose difference between two systems were further analyzed. ArcCHECK based measurement showed a clear magnetic field induced profile shift between CC with both measurement and GPUMCD. For clinical plans, gamma passing rates with criteria (3%, 3 mm) between GPUMCD and CC large than 90% can be achieved for most tumor sites except esophagus and lung cases, the mean dose difference of 3% can be satisfied for most ROIs from all tumor sites. The magnetic field caused a large dose impact on low density areas, the average gamma passing rates were improved from 85.54% to 96.43% and 87.40% to 99.54% for esophagus and lung cases when the magnetic field effect was excluded. It is feasible to use CC dose engine as a secondary dose calculation tool for Elekta Unity system for most tumor sites, while the accuracy is limited and should be used carefully for low density areas, such as esophagus and lung cases.
Comment: =Promotion
=Linac
=MR
BibTeX:
@article{Li2020,
  author = {Yongbao Li and Bin Wang and Shouliang Ding and Hongdong Liu and Biaoshui Liu and Yunfei Xia and Ting Song and Xiaoyan Huang},
  title = {Feasibility of using a commercial collapsed cone dose engine for 1.5T MR-LINAC online independent dose verification},
  journal = {Physica Medica},
  publisher = {Elsevier BV},
  year = {2020},
  volume = {80},
  pages = {288--296},
  doi = {https://doi.org/10.1016/j.ejmp.2020.11.014}
}
Kry, S.F., Feygelman, V., Balter, P., Knöös, T., Charlie Ma, C.-M., Snyder, M., Tonner, B. and Vassiliev, O.N. AAPM Task Group 329: Reference dose specification for dose calculations: Dose-to-water or dose-to-muscle? 2020 Medical Physics
Vol. 47, pp. e52-e64 
article DOI  
Abstract: Linac calibration is done in water, but patients are comprised primarily of soft tissue. Conceptually, and specified in NRG/RTOG trials, dose should be reported as dose-to-muscle to describe the dose to the patient. Historically, the dose-to-water of the linac calibration was often converted to dose-to-muscle for patient calculations through manual application of a 0.99 dose-to-water to dose-to-muscle correction factor, applied during the linac clinical reference calibration. However, many current treatment planning system (TPS) dose calculation algorithms approximately provide dose-to-muscle (tissue), making application of a manual scaling unnecessary. There is little guidance on when application of a scaling factor is appropriate, resulting in highly inconsistent application of this scaling by the community. In this report we provide guidance on the steps necessary to go from the linac absorbed dose-to-water calibration to dose-to-muscle in patient, for various commercial TPS algorithms. If the TPS does not account for the difference between dose-to-water and dose-to-muscle, then TPS reference dose scaling is warranted. We have tabulated the major vendors' TPS in terms of whether they approximate dose-to-muscle or calculate dose-to-water and recommend the correction factor required to report dose-to-muscle directly from the TPS algorithm. Physicists should use this report to determine the applicable correction required for specifying the reference dose in their TPS to achieve this goal and should remain attentive to possible changes to their dose calculation algorithm in the future.
Comment: =Evaluation
=Linac
BibTeX:
@article{Kry2020,
  author = {Kry, Stephen F. and Feygelman, Vladimir and Balter, Peter and Knöös, Tommy and Charlie Ma, C.-M. and Snyder, Michael and Tonner, Brian and Vassiliev, Oleg N.},
  title = {AAPM Task Group 329: Reference dose specification for dose calculations: Dose-to-water or dose-to-muscle?},
  journal = {Medical Physics},
  year = {2020},
  volume = {47},
  pages = {e52--e64},
  doi = {https://doi.org/10.1002/mp.13995}
}
Kim, C. and Na, Y. Planar Dosimetry as An Independent Verification of 3D Plans with MLC-Shaped Static Fields: Methodology and Application 2020 Medical Physics  conference DOI  
Abstract: To use portal dosimetry as an independent plan verification of 3D plans generated with static MLC using the sub-field (control point) and fields merging approach. Methods: For a MLC-shaped static field, a sub-field was generated with a weighting of 0.1% using a minor change of MLC position outside of field-shaping MLCs. Fields merge was followed to generate additional control point, which enabled the creation of a verification plan for portal dosimetry. Twenty-seven 3D fields, 13 field-in-field (FinF) and 14 statics, were tested in this study. Fields were delivered using a perpendicular fieldby- field (planned gantry) technique. For gamma analysis, the following parameter set was used: 1% dose threshold to remove background noise with varying doses and DTA to get a gamma score 95%. In comparison, RadCalc (Ver 6.2, LifeLine Software, Inc.) was used for point-dose calculation. Results: For the static MLC fields, the dose difference (%) using portal dosimetry was 1.9+/-0.44 with its corresponding value in RadCalc of 1.3+/-1.00. For 13 FinF, it was 2.5+/-0.33 and 3.4+/-1.88 for Portal dosimetry and RadCalc, respectively. There was a large dose variation found in RadCalc and for two FinF cases, even though the dose difference was <2.5% in portal dosimetry, its corresponding value was greater than 5% using RadCalc. It happened when the calculation point was located in a thin chest wall, lacking full scattering. Conclusion: For conventional 3D plans, a simple dose calculation algorithm has been used to perform an independent monitor unit (MU) or dose verification. A portal dosimetry can be used to include a full dosimetric information of the treating field with help of generating a subfield & merge approach. This study demonstrates that Portal Dosimetry is a viable independent plan verification tool even for MLC shaped 3D plans.
Comment: =Verification
=Linac
BibTeX:
@conference{Kim2020,
  author = {C Kim and Y Na},
  title = {Planar Dosimetry as An Independent Verification of 3D Plans with MLC-Shaped Static Fields: Methodology and Application},
  booktitle = {Medical Physics},
  year = {2020},
  doi = {https://doi.org/10.1002/mp.14315}
}
Kajikawa, T., Kadoya, N., Tanaka, S., Nemoto, H., Takahashi, N., Chiba, T., Ito, K., Katsuta, Y., Dobashi, S., Takeda, K., Yamada, K. and Jingu, K. Dose distribution correction for the influence of magnetic field using a deep convolutional neural network for online MR-guided adaptive radiotherapy 2020 Physica Medica
Vol. 80, pp. 186-192 
article DOI  
Abstract: This study aimed to develop a deep convolutional neural network (CNN)-based dose distribution conversion approach for the correction of the influence of a magnetic field for online MR-guided adaptive radiotherapy. Our model is based on DenseNet and consists of two 2D input channels and one 2D output channel. These three types of data comprise dose distributions without a magnetic field (uncorrected), electron density (ED) maps, and dose distributions with a magnetic field. These data were generated as follows: both types of dose distributions were created using 15-field IMRT in the same conditions except for the presence or absence of a magnetic field with the GPU Monte Carlo dose in Monaco version 5.4; ED maps were acquired with planning CT images using a clinical CT-to-ED table at our institution. Data for 50 prostate cancer patients were used; 30 patients were allocated for training, 10 for validation, and 10 for testing using 4-fold cross-validation based on rectum gas volume. The accuracy of the model was evaluated by comparing 2D gamma-indexes against the dose distributions in each irradiation field with a magnetic field (true). The gamma indexes in the body for CNN-corrected uncorrected dose against the true dose were 94.95% ± 4.69% and 63.19% ± 3.63%, respectively. The gamma indexes with 2%/2-mm criteria were improved by 10% in most test cases (99.36%). Our results suggest that the CNN-based approach can be used to correct the dose-distribution influences with a magnetic field in prostate cancer treatment.
Comment: =Promotion
=Linac
=MR
BibTeX:
@article{Kajikawa2020,
  author = {Tomohiro Kajikawa and Noriyuki Kadoya and Shohei Tanaka and Hikaru Nemoto and Noriyoshi Takahashi and Takahito Chiba and Kengo Ito and Yoshiyuki Katsuta and Suguru Dobashi and Ken Takeda and Kei Yamada and Keiichi Jingu},
  title = {Dose distribution correction for the influence of magnetic field using a deep convolutional neural network for online MR-guided adaptive radiotherapy},
  journal = {Physica Medica},
  publisher = {Elsevier BV},
  year = {2020},
  volume = {80},
  pages = {186--192},
  doi = {https://doi.org/10.1016/j.ejmp.2020.11.002}
}
Glide-Hurst, C.K., Lee, P., Yock, A.D., Olsen, J.R., Cao, M., Siddiqui, F., Parker, W., Doemer, A., Rong, Y., Kishan, A.U., Benedict, S.H., Li, X.A., Erickson, B.A., Sohn, J.W., Xiao, Y. and Wuthrick, E. Adaptive radiation therapy (ART) strategies and technical considerations: A state of the ART review from NRG Oncology 2020 International Journal of Radiation Oncology∗Biology∗Physics  article DOI  
Abstract: The integration of adaptive radiation therapy (ART), or modifying the treatment plan during the treatment course, is becoming more widely available in clinical practice. ART offers strong potential for minimizing treatment-related toxicity while escalating or de-escalating target doses based on the dose to organs at risk. Yet, ART workflows add complexity into the radiation therapy planning and delivery process that may introduce additional uncertainties. This work sought to review presently available ART workflows as well as technological considerations such as image quality, deformable image registration, and dose accumulation. Quality assurance considerations for ART components and minimum recommendations are described. Personnel and workflow efficiency recommendations are provided as well as a summary of currently available clinical evidence supporting the implementation of ART. Finally, to guide future clinical trial protocols, an example ART physician directive and a physics template following standard NRG Oncology protocol is provided.
Comment: =Promotion
=Linac
BibTeX:
@article{GlideHurst2020,
  author = {Carri K. Glide-Hurst and Percy Lee and Adam D. Yock and Jeffrey R. Olsen and Minsong Cao and Farzan Siddiqui and William Parker and Anthony Doemer and Yi Rong and Amar U. Kishan and Stanley H. Benedict and X Allen Li and Beth A. Erickson and Jason W. Sohn and Ying Xiao and Evan Wuthrick},
  title = {Adaptive radiation therapy (ART) strategies and technical considerations: A state of the ART review from NRG Oncology},
  journal = {International Journal of Radiation Oncology∗Biology∗Physics},
  publisher = {Elsevier BV},
  year = {2020},
  doi = {https://doi.org/10.1016/j.ijrobp.2020.10.021}
}
Esquivel, C., Tipton, A., Patton, L., Baldassari, D. and Lin, B. Retrospective Dosimetric Study of a Novel Automation Software for Whole Brain Planning Field-In-Field Treatment Plans 2020 Medical Physics  conference DOI  
Abstract: Comparison of traditional whole brain Field-in-Field (FiF) treatment plans with RADformation’s EZFluence software. Methods: A retrospective study on dosimetric comparison and feasibility of FiF plans created by EZFluence for 22 Whole Brain plans was conducted. Treatment plans included mixed energy fields of 6 and 18 MV in the Eclipse TPS. EZFluence, an embedded script in Eclipse, allows the planner to automate the FiF process. The target and critical structures are based on user specification with the desired coverage reviewed prior to creation of a FiF plan in the software. Comparison to the original plan’s prescription dose coverage, maximum dose to the target (brain), lens, globe of the eye and total MU of each field was evaluated. Time required to create an EZFluence plan, subfield merging, and normalization was additionally documented. Independent dosimetric verification was made with RadCalc and MapCHECK2. Finally, the quality of each plan was reviewed by a physician. Results: EZFluence produced comparable plans in a relatively shorter time. When normalized to produce the same coverage of the original plan, the dose distribution, hotspot and dose to normal tissue structures were on the average within 1% of the original plan. Total MUs increased, on average, 4.6% (14MUs). Average hotspot to homogenous plans was 106%. RadCalc was within 5% and MapCHECK2 demonstrated agreement of a passing rate of 95% (using 2%/2 cm/10). Average time commitment for the creation of FiF plans through traditional steps was 7–20 minutes. A significant reduction in planning time was observed with EZFluence, with a range between 4–8 minutes. Physician reviews were comparable. Conclusion: EZFluence generates comparable FiF whole brain plans (within 1%) to traditional planning and demonstrates a significant reduction of time. Dosimetric verification also demonstrates the feasibility of the software in the clinic. Physician plan evaluations were found to be comparable.
Comment: =Verification
=Linac
BibTeX:
@conference{Esquivel2020a,
  author = {C Esquivel and A Tipton and L Patton and D Baldassari and B Lin},
  title = {Retrospective Dosimetric Study of a Novel Automation Software for Whole Brain Planning Field-In-Field Treatment Plans},
  booktitle = {Medical Physics},
  year = {2020},
  doi = {https://doi.org/10.1002/mp.14315}
}
Esquivel, C., Patton, L., Doozan, Nelson, K., Boga, D. and Navarro, T. Evaluation of a Novel Automation Software for Generating Field-In-Field Plans for Various Treatment Sites 2020 Medical Physics  conference DOI  
Abstract: Comparison study of traditional Field-in-Field (FiF) treatment plans to an automated approach using RAD formation’s software, EZFluence. Methods: A study evaluating 50 treatment plans of varying sites including breast, whole brain and rectum were created using the traditional FiF planning. Treatment plans included mixed energy fields of 6 and 18 MV in the Eclipse TPS. EZFluence, an embedded script in Eclipse, allows the planner to automate the FiF process. The target and critical structures are based on user specification with the desired coverage reviewed prior to creation of a FiF plan in the software. Comparison to the original plan’s prescription dose coverage, maximum dose to the target and the total MU of each field were documented. Time required to create an EZFluence plan, subfield merging, and normalization was additionally recorded. Plans were validated with Rad- Calc and MapCheck2. Results: EZFluence produced comparable plans in a relatively shorter timeframe. When normalized to produce the same coverage of the original plan, the dose distribution, hotspot and dose to normal tissue structures were on the average within 1% of the original plan. Total MUs increased, on average, 4.5% (13 MUs). Average hotspot to homogenous plans was 106%. RadCalc was within 5% and MapCheck2 demonstrated agreement of a passing rate of 95% (using 2%/2 cm/10). Average time commitment for the creation of FiF plans through traditional steps was 10– 20 minutes. With EZFluence, time was greatly reduced to 4–9 minutes. Conclusion: EZFluence achieves comparable plans (within 1%) to traditional FiF planning and demonstrates a significant reduction in the time with the Field-in-Field planning process. Dosimetric evaluation with RadCalc and MapCheck confirm accuracy and feasibility of EZFluence within the clinical environment.
Comment: =Verification
=Linac
BibTeX:
@conference{Esquivel2020,
  author = {C Esquivel and L Patton and Doozan and K Nelson and D Boga and T Navarro},
  title = {Evaluation of a Novel Automation Software for Generating Field-In-Field Plans for Various Treatment Sites},
  booktitle = {Medical Physics},
  year = {2020},
  doi = {https://doi.org/10.1002/mp.14315}
}
Darafsheh, A., Lavvafi, H., Taleei, R. and Khan, R. Mitigating disruptions, and scalability of radiation oncology physics work during the COVID-19 pandemic 2020 Journal of Applied Clinical Medical Physics
Vol. 21(7), pp. 187-195 
article DOI  
Abstract: The COVID‐19 pandemic has led to disorder in work and livelihood of a majority of the modern world. In this work, we review its major impacts on procedures and workflow of clinical physics tasks, and suggest alternate pathways to avoid major disruption or discontinuity of physics tasks in the context of small, medium, and large radiation oncology clinics. We also evaluate scalability of medical physics under the stress of “social distancing”. Three models of facilities characterized by the number of clinical physicists, daily patient throughput, and equipment were identified for this purpose. For identical objectives of continuity of clinical operations, with constraints such as social distancing and unavailability of staff due to system strain, however with the possibility of remote operations, the performance of these models was investigated. General clinical tasks requiring on‐site personnel presence or otherwise were evaluated to determine the scalability of the three models at this point in the course of disease spread within their surroundings. The clinical physics tasks within three models could be divided into two categories. The former, which requires individual presence, include safety‐sensitive radiation delivery, high dose per fraction treatments, brachytherapy procedures, fulfilling state and nuclear regulatory commission's requirements, etc. The latter, which can be handled through remote means, include dose planning, physics plan review and supervision of quality assurance, general troubleshooting, etc. At the current level of disease in the United States, all three models have sustained major system stress in continuing reduced operation. However, the small clinic model may not perform if either the current level of infections is maintained for long or staff becomes unavailable due to health issues. With abundance, and diversity of innovative resources, medium and large clinic models can sustain further for physics‐related radiotherapy services.
Comment: =Promotion
=Linac
BibTeX:
@article{Darafsheh2020,
  author = {Arash Darafsheh and Hossein Lavvafi and Reza Taleei and Rao Khan},
  title = {Mitigating disruptions, and scalability of radiation oncology physics work during the COVID-19 pandemic},
  journal = {Journal of Applied Clinical Medical Physics},
  publisher = {Wiley},
  year = {2020},
  volume = {21},
  number = {7},
  pages = {187--195},
  doi = {https://doi.org/10.1002/acm2.12896}
}
Cousinsm, A. Lessons learned from a Couch Angle Convention Change 2020 Australasian Physical & Engineering Sciences in Medicine
Vol. 43(1), pp. 297-462 
conference DOI  
Abstract: Due to the move from a multi-vendor linear accelerator department to a single vendor linear accelerator department it was necessary to convert the couch rotation angle from IEC601 standard to IEC1217 standard on four clinical linear accelerators while maintaining correct treatments for all patients currently on treatment and correct historical treatment records. Method In order to do this a number of systems were changed synchronously, including the Monaco treatment planning system, RadCalc monitor unit calculation system, MOSAIQ record and verify, the Integrity linear accelerator control software, the XVI kV imaging system and the mechanical scales. Treatment delivery parameters for all patients under treatment were updated and verified. All the relevant controlled documents used for planning and quality assurance were also updated. Results The transition was successfully completed; however a number of safety issues were identified which will be detailed along with the procedures put in place to mitigate the associated risks. Conclusion Converting the IEC convention for the linear accelerator couch is a high-risk procedure. It requires careful planning and a multidisciplinary team including the vendor to ensure its safe completion.
Comment: =Evaluation
=Linac
BibTeX:
@conference{Cousinsm2020,
  author = {Cousinsm, A},
  title = {Lessons learned from a Couch Angle Convention Change},
  journal = {Australasian Physical & Engineering Sciences in Medicine},
  publisher = {Springer Science and Business Media LLC},
  year = {2020},
  volume = {43},
  number = {1},
  pages = {297--462},
  doi = {https://doi.org/10.1007/s13246-019-00826-6}
}
Ando, Y., Miki, K., Araki, J., Tsuneda, M., Kiriu, H., Nishio, T. and Nagata, Y. Verification system for intensity-modulated radiation therapy with scintillator 2020 Physical and Engineering Sciences in Medicine  article DOI  
Abstract: In the preparation of intensity-modulated radiation therapy (IMRT), patient-specific verification is widely employed to optimize the treatment. To accurately estimate the accumulated dose and obtain the field-by-field or segment-by-segment verification, an original IMRT verification tool using scintillator light and an analysis workflow was developed in this study. The raw light distribution was calibrated with respect to the irradiated field size dependency and light diffusion in the water. The calibrated distribution was converted to dose quantity and subsequently compared with the results of the clinically employed plan. A criterion of 2-mm dose-to-agreement and 3% dose difference was specified in the gamma analysis with a 10% dose threshold. By applying the light diffusion calibration, the maximum dose difference was corrected from 7.7 cGy to 3.9 cGy around the field edge for a 60 cGy dose, 7 × 7 cm2 irradiation field, and 10 MV beam energy. Equivalent performance was confirmed in the chromodynamic film. The average dose difference and gamma pass rate of the accumulated dose distributions in six patients were 0.8 ± 4.5 cGy and 97.4%, respectively. In the field-by-field analysis, the average dose difference and gamma pass rate in seven fields of Patient 1 were 0.2 ± 1.2 cGy and 93.9%, respectively. In the segment-by-segment analysis, the average dose difference and gamma pass rate in nine segments of Patient 1 and a 305° gantry angle were − 0.03 ± 0.2 cGy and 93.9%, respectively. This system allowed the simultaneous and independent analysis of each field or segment in the accumulated dose analysis.
Comment: =Promotion
=Linac
BibTeX:
@article{Ando2020,
  author = {Yasuharu Ando and Kentaro Miki and Jun Araki and Masato Tsuneda and Hiroshi Kiriu and Teiji Nishio and Yasushi Nagata},
  title = {Verification system for intensity-modulated radiation therapy with scintillator},
  journal = {Physical and Engineering Sciences in Medicine},
  publisher = {Springer Science and Business Media LLC},
  year = {2020},
  doi = {https://doi.org/10.1007/s13246-020-00946-4}
}
Yoder, T., Hsia, A.T., Xu, Z., Stessin, A. and Ryu, S. Usefulness of EZFluence software for radiotherapy planning of breast cancer treatment 2019 Medical Dosimetry
Vol. 44(4), pp. 339-343 
article DOI  
Abstract: This study compared the EZFluence planning technique for irradiation of the breast with commonly used Field-in-Field (FiF) technique by analyzing the dose uniformity, the dose to the lung, heart, and other organs at risk, the total Monitor Unit (MU), and the time spent for planning. Two different 3-dimensional conformal dose plans were created for 20 breast cancer patients. Six patients were treated to a dose of 5000 cGy in 25 fractions and 14 were treated to a dose of 4256 cGy in 16 fractions. Average breast volume was 800 cc (range 128 to 1892 cc). For the FiF technique, the planner manually created between 2 to 4 subfields per gantry angle and sequentially blocked the 115% and 110% isodose line until a homogenous dose distribution was achieved. For the EZFluence technique, the planner implemented the EZFluence script that created an optimal fluence pattern, which was then imported into Eclipse where dose was calculated. Both techniques were optimized to make sure 95% of the breast planning target volume (PTV) received at least 95% of the prescribed dose. Compared to FiF technique, the plans produced by using EZFluence technique, showed the MU increased by 36.9% (p?=?0.0002), whereas the planning time decreased significantly by 84.6% (p?=?0.00001). The mean heart dose and the relative volume of the heart receiving ≥ 30 Gy (V30) were similar for both techniques. The mean lung dose and the relative volume of lung receiving ≥ 20 Gy (V20) were also comparable between 2 techniques. The contralateral breast mean dose and its relative volume receiving ≥ 3 Gy (V3) and ≥10 Gy (V10) were equally spared and avoided. EZFluence planning technique yielded a 4.6% (p?=?0.04) reduction in PTV receiving 105% of the prescribed dose (V105) for the large breast with separation > 22 cm and PTV volume > 650 cc. The EZFluence planning technique yielded the overall comparable or improved dosimetry while significantly reducing planning time.
Comment: =Verification
=Linac
BibTeX:
@article{Yoder2019,
  author = {Yoder, Todd and Hsia, An Ting and Xu, Zhigang and Stessin, Alexander and Ryu, Samuel},
  title = {Usefulness of EZFluence software for radiotherapy planning of breast cancer treatment},
  journal = {Medical Dosimetry},
  publisher = {Elsevier},
  year = {2019},
  volume = {44},
  number = {4},
  pages = {339--343},
  doi = {https://doi.org/10.1016/j.meddos.2018.12.001}
}
Wilke, l., Ehrbar, S., Bogowicz, J., Krayenbühl, J., Andratschke, N., Guckenberger, M. and Tanadini-Lang, S. Quality assurance for the adaptive workflow on the MRI linac 2019 Strahlentherapie und Onkologie
Vol. 195(12), pp. 1122-1153 
conference DOI  
Abstract: The new MRidian MR Linac enables online adaptive treatment for daily changing anatomy of the patient. For these modulated treatments, no measurement of the treatment plan can be performed prior to treatment. Besides performing a secondary calculation within the system, we set up a chain of additional tests to ensure a safe treatment. Methods: For all patients the original treatment plan as well as all adapted plans were measured on an IMRT verification phantom (Delta 4, Scandidos). During the adaptive process, we did a point dose verification in an independent Software (Radcalc). Additionally, we calculated a value that is representative of the integral dose delivered to the patient and compared this value to the original plan. To ensure that the electron densities are correctly assigned to the new MRI, we compared the equivalent pathlength of the original and the adapted plan. Results: For the first 10 Patients, all measurements of the original plan passed the gamma-analysis with a 3%/3 mm criterion of on average 99.9% (range 99.6–100%). The adapted plans had equally good passing rates (average 99.8%, range 97.2–100%). For 89% of the plans the independent point dose calculation agreed within 10% with the original plan one (average 5.9%, range 0.3–21.4%). Values above 10% were connected to a lung treatment, where the scatter is incorrectly taken into account in the point dose calculation. The value representing the integral dose also agreed within 10% between the original plan and the treated adapted plan (average 4.0%, range 0.26–9.45%). The effective pathlength differed less than 2 cm from the original plan except for one case, where the change was traced back to a change in anatomy. Conclusion: We set up a QA chain for the online adaptive planning on the MRIdian MR Linac which ensures a save treatment of the patient.
Comment: =Verification
=Linac
=MR
BibTeX:
@conference{Wilke2019a,
  author = {Wilke, l and Ehrbar, S and Bogowicz, J and Krayenbühl, J and Andratschke, N and Guckenberger, M and Tanadini-Lang, S},
  title = {Quality assurance for the adaptive workflow on the MRI linac},
  journal = {Strahlentherapie und Onkologie},
  publisher = {Springer Science and Business Media LLC},
  year = {2019},
  volume = {195},
  number = {12},
  pages = {1122--1153},
  doi = {https://doi.org/10.1007/s00066-019-01531-9}
}
Sharif, A., Mamon, R., Gaunt, K. and McAndrew, N. A Multidisciplinary approach to Palliation - Rapid Access Targeted Personalised Radiotherapy Clinic 2019 Radiotherapy and Oncology
Vol. 133, pp. S878-S879 
conference DOI  
Abstract: To offer Palliative VMAT Radiotherapy as a standard care within a distributed network of centres to all eligible Palliative Patients within 24 hours of referral to treatment commencement (Rapid Access).Providing patients access to more personalised and targeted radiotherapy results in fewer side effects, reduced time in a hospital bed and reduced reliance on expensive drugs.Material and MethodsA mutlidisciplinary project group set up to map patient pathway and agreed pre- requisites to support delivery of the service.Efficiencies in the planning and checking processes were made using Protocol based automation and automated Phantomless plan QA.The planning and checking is completed by a distributed Medical Physics team using a Departure board to prioritise urgency of tasks. On Clinic days the palliative patients would be a priority. The software is accessed remotely via Citrix and includes Pinnacle treatment planning system (TPS) V14 (Philips), Mosaiq Record and Verify (R&V) SystemV2.62 (Elekta) together with RADCALC (RC) V 6.3 ( Lifeline software Inc) and PerFRACTION™ 3D from SunNuclearCorporation.Plan production, Plan quality assessment and Plan metrics using Dose Volume Protocol (DVP) and Quality Checks(QC)- A suite of scripts run within TPS based on the institutes clinical protocols and planning guidelines.Plan production– Palliative Scripted class solution DVP– reports the plan and DVH dose metrics independently extracted in a tabular format enables the planner to review OAR and PTV constraints using a visual traffic light system . Once plan is locked the report is auto generated and attached into the correct patient in R&V.QC-Checks plan integrity against planning guidelines such as beam energy, normalisation and calculation grid which can be configured. QC interrogate R&V for informationsuch as patient demographics and compare to TPS.RadCalc®- independent MU check and creates a configurable QA reports which is auto loaded into R&V for approval if it meets the tolerance.RadCalc® Reconciler - Ensures accurate reconciliation between the planning data in TPS and R&V. Comparison occurs in RC. prerequisites require data export of the final Clinical plan from TPS to RC and R&V to RC. The RTP-Filter informs the user of any differences and the report can be configured to display discrepancies only .PerFRACTION™3D– independent automated phantom-less end to end QA solution for all patient plans and fractions. A report is automatically compiled and accessed via the web user interface. A traffic light system efficiently flags any issues with the option of viewing more information if needed.ResultsLearning from the trial period from November 2018 to be presented together with detailed process map as well as Clinical case studies ConclusionUsing Standardisation as a prerequisite automation can be achieved. The automation allows production of consistently good plans and streamline of checks. The time saving can be utilised to support a Rapid Access Palliative clinic.
Comment: =Verification
=Linac
BibTeX:
@conference{Sharif2019,
  author = {A. Sharif and R. Mamon and K. Gaunt and N. McAndrew},
  title = {A Multidisciplinary approach to Palliation - Rapid Access Targeted Personalised Radiotherapy Clinic},
  journal = {Radiotherapy and Oncology},
  publisher = {Elsevier BV},
  year = {2019},
  volume = {133},
  pages = {S878--S879},
  doi = {https://doi.org/10.1016/s0167-8140(19)32050-x}
}
Santos, T., Lopes, M.d.C., Gershkevitsh, E., Vinagre, F., Faria, D., Carita, L., Pontes, M., Vieira, S., Poli, E., Faustino, S., Ribeiro, F., Trindade, M., Ponte, F., Marcelino, C., Batista, C., Oliveira, S., Figueira, R., Lencart, J., Diaz, E.G., Jacob, K., Brás, S., Pirraco, R. and Izewska, J. IMRT national audit in Portugal 2019 Physica medica
Vol. 65, pp. 128-136 
article DOI  
Abstract: The IAEA newly developed “end-to-end” audit methodology for on-site verification of IMRT dose delivery has been carried out in Portugal in 2018. The main goal was to evaluate the physical aspects of the head and neck (H&N) cancer IMRT treatments. This paper presents the national results. Methods: All institutions performing IMRT treatments in Portugal, 20 out of 24, have voluntarily participated in this audit. Following the adopted methodology, a Shoulder, Head and Neck End-to-End phantom (SHANE) – that mimics an H&N region, underwent all steps of an IMRT treatment, according to the local practices. The measurements using an ionization chamber placed inside the SHANE phantom at four reference locations (three in PTVs and one in the spinal cord) and an EBT3 film positioned in a coronal plane were compared with calculated doses. FilmQA Pro software was used for film analysis. Results: For ionization chamber measurements, the percent difference was within the specified tolerances of±5% for PTVs and±7% for the spinal cord in all participating institutions. Considering film analysis, gamma passing rates were on average 96.9%±2.9% for a criterion of 3%/3 mm, 20% threshold, all above the acceptance limit of 90%. Conclusions: The national results of the H&N IMRT audit showed a compliance between the planned and the delivered doses within the specified tolerances, confirming no major reasons for concern. At the same time the audit identified factors that contributed to increased uncertainties in the IMRT dose delivery in some institutions resulting in recommendations for quality improvement.
Comment: =Verification
=Linac
=TT
=CK
=GK
BibTeX:
@article{Santos2019,
  author = {Santos, Tania and Lopes, Maria do Carmo and Gershkevitsh, Eduard and Vinagre, Filipa and Faria, David and Carita, Liliana and Pontes, Miguel and Vieira, Sandra and Poli, Esmeralda and Faustino, Sofia and Ribeiro, Filipa and Trindade, Mauro and Ponte, Fernanda and Marcelino, Carlos and Batista, Cláudio and Oliveira, Susana and Figueira, Rita and Lencart, Joana and Diaz, Ester Gallego and Jacob, Katia and Brás, Sandra and Pirraco, Rui and Izewska, Joanna},
  title = {IMRT national audit in Portugal},
  journal = {Physica medica},
  publisher = {Elsevier},
  year = {2019},
  volume = {65},
  pages = {128--136},
  doi = {https://doi.org/10.1016/j.ejmp.2019.08.013}
}
Richmond, N., Allen, V., Wyatt, J. and Codling, R. Evaluation of the RayStation electron Monte Carlo dose calculation algorithm 2019 Medical Dosimetry  article DOI  
Abstract: The aim of this work was to evaluate the accuracy of the RayStation treatment planning system electron Monte Carlo algorithm against measured data for a range of clinically relevant scenarios. This was done by comparing measured percentage depth dose data (PDD) in water, profiles at oblique incidence and with heterogeneities in the beam path, and output factor data and that generated using the RayStation treatment planning system Monte Carlo VMC++ based calculation algorithm. While electron treatments are widely employed in the radiotherapy setting accurate modelling is challenging (TPS) in the presence of patient being both heterogeneous and nonrectangular. Watertank-based measurements were made on a Varian TrueBeam linear accelerator covering electron beam energies 6 to 18 MeV. These included both normal and oblique incidence, heterogeneous geometries, and irregular shaped cut-outs. The measured geometries were replicated in RayStation and the Monte Carlo dose calculation engine used to generate dosimetric data for comparison against measurement in what were considered clinically relevant settings. Water-based PDDs and profile comparisons showed excellent agreement for all electron beam energies. Profiles measured with oblique beam incidence demonstrated acceptable agreement to the treatment planning system calculations although the correspondence worsened as the angle increased with the planning system overestimating the dose in the shoulder region. Profile measurements under inhomogeneities were generally good. The planning system had a tendency to overestimate dose under the heterogeneity and also demonstrated a broader penumbra than measurement. Of the 170 different output factors calculated in RayStation over the range of electron energies commissioned, 141 were within ± 3% of measured values and 164 within ± 5%. Four of the 6 comparisons beyond 5% were at 18 MeV and all had a cut-out edge within 3 cm of the beam central axis/measurement point. The RayStation implementation of a VMC++ electron Monte Carlo dose calculation algorithm shows good agreement with measured data for a range of scenarios studied and represented sufficient accuracy for clinical use.
Comment: =Promotion
=Linac
=MC
BibTeX:
@article{Richmond2019,
  author = {Richmond, Neil and Allen, Vincent and Wyatt, Jonathan and Codling, Richard},
  title = {Evaluation of the RayStation electron Monte Carlo dose calculation algorithm},
  journal = {Medical Dosimetry},
  publisher = {Elsevier},
  year = {2019},
  doi = {https://doi.org/10.1016/j.meddos.2019.09.003}
}
Pagulayan, C., Heng, S.M. and Corde, S. Dosimetric validation of the Theragenics AgX-100® I-125 seed for ROPES eye plaque brachytherapy. 2019 Australasian physical & engineering sciences in medicine
Vol. 42, pp. 599-609 
article DOI  
Abstract: With the discontinued distribution of the I-125 Oncura Onco seed (model 6711), the Theragenics AgX100® I-125 seeds were considered as a suitable alternative for eye plaque brachytherapy as their physical properties matched the requirements for use with the ROPES eye plaques. The purpose of this study aims at validating the dosimetry of the AgX-100 loaded ROPES plaques (11 mm diameter, 15 mm diameter with flange, 15 mm diameter with notch, 18 mm diameter) and assess the differences with the discontinued I-125 6711 model. To independently verify the plaque dosimetry, the brachytherapy module of RADCALC® version 6.2.3.6 was commissioned for the new AgX-100 I-125 seed using the published AAPM TG43 data from the literature. Experimental dosimetry verification was performed using EBT3 Gafchromic™ film and TLD-100 micro-cubes in a specially designed Solid Water® phantom. Both RADCALC® and film confirmed the dosimetry calculated by Plaque Simulator (PS) version 6.4.6 The dose calculated by PS agrees with RADCALC® to within 2% for depths of 1-15 mm for the 4 available ROPES plaques. The dosimetric measurements agreed with the calculations of PS for clinically relevant depths (4 mm to 6 mm) within the evaluated uncertainties of 4.7% and 7.2% for EBT3 film and TLDs respectively. The AgX-100 I-125 seed was a suitable replacement for the 6711 I-125 seed. Due to the introduction of the stainless-steel backscatter factor in PS v6.4.6, the department has decided to report both the homogenous dose and heterogeneity corrected dose for each eye plaque patient.
Comment: =Verification
=BT
BibTeX:
@article{Pagulayan2019,
  author = {Pagulayan, Claire and Heng, Soo Min and Corde, Stephanie},
  title = {Dosimetric validation of the Theragenics AgX-100® I-125 seed for ROPES eye plaque brachytherapy.},
  journal = {Australasian physical & engineering sciences in medicine},
  year = {2019},
  volume = {42},
  pages = {599--609},
  doi = {https://doi.org/10.1007/s13246-019-00761-6}
}
Nolan, M.W., Kelsey, K.L., Enomoto, M., Ru, H., Gieger, T.L. and Lascelles, B.D.X. Pet Dogs with Subclinical Acute Radiodermatitis Experience Widespread Somatosensory Sensitization 2019 Radiation Research
Vol. 193(3), pp. 241 
article DOI  
Abstract: Radiation-induced dermatitis (RID) is a common andpainful complication of radiotherapy. When severe, radi-ation-associated pain (RAP) can reduce the efficacy ofradiotherapy by limiting the radiation dose given, and/ornecessitating breaks in treatment. Current RAP mitigationstrategies are of limited efficacy. Our long-term goal is todevelop a comparative oncology model, in which novelanalgesic interventions for RAP can be evaluated. The aimof this study was to validate quantitative end pointsindicative of RAP in pet dogs with subclinical and low-grade RID. Extremity soft tissue sarcomas were treatedwith post-operative treatment (54 Gy in 18 fractions).Visual toxicity scores, questionnaire-based pain instru-ments and objective algometry [mechanical quantitativesensory testing (mQST)], were evaluated regularly. Breed-matched control populations were also evaluated toaddress the effect of potential confounders. Skin biopsiesfrom within the irradiated field were collected at baselineand after 24 Gy irradiation, for analysis of pain-relatedgenes using the nanoString nCounter platform. Relative tocontrol populations, mechanical thresholds decreased inirradiated test subjects as the total radiation doseincreased, with the most pronounced effect at the irradi-ated site. This was accompanied by increased mRNAexpression of GFRa3, TNFa, TRPV2 and TRPV4. In aseparate set of dogs with moderate-to-severe RID, serumconcentrations of artemin (the ligand for GFRa3) wereelevated relative to controls (P¼0.015). Progressivereduction in mechanical thresholds, both locally andremotely, indicates widespread somatosensory sensitizationduring radiaiton treatment. mQST in pet dogs undergoing radiation treatment represents an innovative tool forpreclinical evaluation of novel analgesics.
Comment: =Verification
=Linac
BibTeX:
@article{Nolan2019,
  author = {Michael W. Nolan and Krista L. Kelsey and Masataka Enomoto and Hongyu Ru and Tracy L. Gieger and B. Duncan X. Lascelles},
  title = {Pet Dogs with Subclinical Acute Radiodermatitis Experience Widespread Somatosensory Sensitization},
  journal = {Radiation Research},
  publisher = {Radiation Research Society},
  year = {2019},
  volume = {193},
  number = {3},
  pages = {241},
  doi = {https://doi.org/10.1667/rr15468.1}
}
Mundayadan, C., Venning, A., Hodgson, A., Chick, B. and Waller, B. Flattening Filter Free Beams for 3DCRT: Is Shape of the Beam Profile an Added Advantage 2019 Clin Oncol Res J: CORJ-100003
Vol. 1 
article DOI  
Abstract: Megavoltage radiotherapy has proven to be highly effective for the treatment of basal cell carcinoma (BCC) of the nose. A common treatment technique has been 3D conformal, half-beam blocked, lateral, parallel opposed, 6 MV flat beams, using a sym-metric wax block to provide uniform dosimetry across the treatment region. One issue we identified with the wax block method is the significant time overhead involved to manufacture and fit the block to the patient’s nose. In this study, we investigated the use of flattening filter free (FFF) beams with thermoplastic bolus used as an alternative to the wax block method, exploiting the wedged shape of a half-beam blocked FFF field. The use of thermoplastic bolus significantly reduces the manufacturing overheads and time required for simulation setup, while improving the patient’s comfort and experience. We acquired a cohort of 10 patient plans for the two techniques, with each plan assessed and approved by a radiation oncologist. We subsequently applied a range of plan evaluation metrics to compare the two techniques for various dosimetric end points. We found that, for the metrics applied, there was no statisti-cally significant difference between the two planning methods. In conclusion, it was found that using 3D conformal FFF planning with thermoplastic bolus provides an efficient method in terms of simulation, maintenance of hygiene, patient comfort, time and cost effectiveness.
Comment: =Verification
=Linac
BibTeX:
@article{Mundayadan2019,
  author = {Mundayadan, CM and Venning, A and Hodgson, A and Chick, B and Waller, B},
  title = {Flattening Filter Free Beams for 3DCRT: Is Shape of the Beam Profile an Added Advantage},
  journal = {Clin Oncol Res J: CORJ-100003},
  year = {2019},
  volume = {1},
  doi = {No DOI}
}
Graves, S.A., Snyder, J.E., Boczkowski, A., St-Aubin, J., Wang, D., Yaddanapudi, S. and Hyer, D.E. Commissioning and performance evaluation of RadCalc for the Elekta unity MRI-linac. 2019 Journal of applied clinical medical physics
Vol. 20, pp. 54-62 
article DOI  
Abstract: Recent availability of MRI-guided linear accelerators has introduced a number of clinical challenges, particularly in the context of online plan adaptation. Paramount among these is verification of plan quality prior to patient treatment. Currently, there are no commercial products available for monitor unit verification that fully support the newly FDA cleared Elekta Unity 1.5 T MRI-linac. In this work, we investigate the accuracy and precision of RadCalc for this purpose, which is a software package that uses a Clarkson integration algorithm for point dose calculation. To this end, 18 IMRT patient plans (186 individual beams) were created and used for RadCalc point dose calculations. In comparison with the primary treatment planning system (Monaco), mean point dose deviations of 0.0 ± 1.0% (n = 18) and 1.7 ± 12.4% (n = 186) were obtained on a per-plan and per-beam basis, respectively. The dose plane comparison functionality within RadCalc was found to be highly inaccurate, however, modest improvements could be made by artificially shifting jaws and multi leaf collimator positions to account for the dosimetric shift due to the magnetic field (67.3% vs 96.5% mean 5%/5 mm gamma pass rate).
Comment: =Evaluation
=Linac
=MR
BibTeX:
@article{Graves2019,
  author = {Graves, Stephen A. and Snyder, Jeffrey E. and Boczkowski, Amanda and St-Aubin, Joël and Wang, Dongxu and Yaddanapudi, Sridhar and Hyer, Daniel E.},
  title = {Commissioning and performance evaluation of RadCalc for the Elekta unity MRI-linac.},
  journal = {Journal of applied clinical medical physics},
  year = {2019},
  volume = {20},
  pages = {54--62},
  doi = {https://doi.org/10.1002/acm2.12760}
}
Bhagroo, S., French, S.B., Mathews, J.A. and Nazareth, D.P. Secondary monitor unit calculations for VMAT using parallelized Monte Carlo simulations 2019 Journal of applied clinical medical physics
Vol. 20(6), pp. 60-69 
article DOI  
Abstract: We have developed a fast and accurate in-house Monte Carlo (MC) secondary monitor unit (MU) check method, based on the EGSnrc system, for independent verification of volumetric modulated arc therapy (VMAT) treatment planning system dose calculations, in accordance with TG-114 recommendations. For a VMAT treatment plan created for a Varian Trilogy linac, DICOM information was exported from Eclipse. An open-source platform was used to generate input files for dose calculations using the EGSnrc framework. The full VMAT plan simulation employed 107 histories, and was parallelized to run on a computer cluster. The resulting 3ddose matrices were converted to the DICOM format using CERR and imported into Eclipse. The method was evaluated using 35 clinical VMAT plans of various treatment sites. For each plan, the doses calculated with the MC approach at four three-dimensional reference points were compared to the corresponding Eclipse calculations, as well as calculations performed using the clinical software package, MUCheck. Each MC arc simulation of 107 particles required 13?25 min of total time, including processing and calculation. The average discrepancies in calculated dose values between the MC method and Eclipse were 2.03% (compared to 3.43% for MUCheck) for prostate cases, 2.45% (3.22% for MUCheck) for head and neck cases, 1.7% (5.51% for MUCheck) for brain cases, and 2.84% (5.64% for MUCheck) for miscellaneous cases. Of 276 comparisons, 201 showed greater agreement between the treatment planning system and MC vs MUCheck. The largest discrepancies between MC and MUCheck were found in regions of high dose gradients and heterogeneous densities. By parallelizing the calculations, point-dose accuracies of 2-7%, sufficient for clinical secondary checks, can be achieved in a reasonable amount of time. As computer clusters and/or cloud computing become more widespread, this method will be useful in most clinical setups.
Comment: =Promotion
=Linac
=MC
BibTeX:
@article{Bhagroo2019,
  author = {Bhagroo, Stephen and French, Samuel B. and Mathews, Joshua A. and Nazareth, Daryl P.},
  title = {Secondary monitor unit calculations for VMAT using parallelized Monte Carlo simulations},
  journal = {Journal of applied clinical medical physics},
  publisher = {John Wiley & Sons, Ltd},
  year = {2019},
  volume = {20},
  number = {6},
  pages = {60--69},
  doi = {https://doi.org/10.1002/acm2.12605}
}
Bertelsen, A.S., Schytte, T., Møller, P.K., Mahmood, F., Riis, H.L., Gottlieb, K.L., Agergaard, S.N., Dysager, L., Hansen, O., Gornitzka, J., Veldhuizen, E., ODwyer, D.B., Christiansen, R.L., Nielsen, M., Jensen, H.R., Brink, C. and Bernchou, U. First clinical experiences with a high field 1.5 T MR linac 2019 Acta Oncologica
Vol. 58(10), pp. 1352-1357 
article DOI  
Abstract: A 1.5 T MR Linac (MRL) has recently become available. MRL treatment workflows (WF) include online plan adaptation based on daily MR images (MRI). This study reports initial clinical experiences after five months of use in terms of patient compliance, cases, WF timings, and dosimetric accuracy. Method and materials: Two different WF were used dependent on the clinical situation of the day; Adapt To Position WF (ATP) where the reference plan position is adjusted rigidly to match the position of the targets and the OARs, and Adapt To Shape WF (ATS), where a new plan is created to match the anatomy of the day, using deformable image registration. Both WFs included three 3D MRI scans for plan adaptation, verification before beam on, and validation during IMRT delivery. Patient compliance and WF timings were recorded. Accuracy in dose delivery was assessed using a cylindrical diode phantom. Results: Nineteen patients have completed their treatment receiving a total of 176 fractions. Cases vary from prostate treatments (60Gy/20F) to SBRT treatments of lymph nodes (45 Gy/3F) and castration by ovarian irradiation (15 Gy/3F). The median session time (patient in to patient out) for 127 ATPs was 26 (21–78) min, four fractions lasted more than 45 min due to additional plan adaptation. For the 49 ATSs a median time of 12 (1–24) min was used for contouring resulting in a total median session time of 42 (29–91) min. Three SBRT fractions lasted more than an hour. The time on the MRL couch was well tolerated by the patients. The median gamma pass rate (2 mm,2% global max) for the adapted plans was 99.2 (93.4–100)%, showing good agreement between planned and delivered dose. Conclusion: MRL treatments, including daily MRIs, plan adaptation, and accurate dose delivery, are possible within a clinically acceptable timeframe and well tolerated by the patients.
Comment: =Verification
=Linac
=MR
=MC
BibTeX:
@article{Bertelsen2019,
  author = {Anders S. Bertelsen and Tine Schytte and Pia K. Møller and Faisal Mahmood and Hans L. Riis and Karina L. Gottlieb and Søren N. Agergaard and Lars Dysager and Olfred Hansen and Janne Gornitzka and Elisabeth Veldhuizen and Dean B. ODwyer and Rasmus L. Christiansen and Morten Nielsen and Henrik R. Jensen and Carsten Brink and Uffe Bernchou},
  title = {First clinical experiences with a high field 1.5 T MR linac},
  journal = {Acta Oncologica},
  publisher = {Informa UK Limited},
  year = {2019},
  volume = {58},
  number = {10},
  pages = {1352--1357},
  doi = {https://doi.org/10.1080/0284186x.2019.1627417}
}
Tuazon, B., Narayanasamy, G., Papanikolaou, N., Kirby, N., Mavroidis, P. and Stathakis, S. Evaluation and comparison of second-check monitor unit calculation software with Pinnacle treatment planning system. 2018 Physica medica
Vol. 45, pp. 186-191 
article DOI  
Abstract: The purpose of this study was to evaluate and compare the accuracy of dose calculations in second check softwares (Diamond, IMSure, MuCheck, and RadCalc) against the Phillips Pinnacle treatment planning system. Eighteen previously treated patients' treatment planning files consisting of a total of 204 beams were exported from the Pinnacle TPS to each of the four second check software. Of these beams, 145 of the beams used were IMRT plans while 59 were VMAT arcs. The values were represented as a percent difference between primary and secondary calculations and used for statistical analysis. Box plots, Pearson Correlation, and Bland-Altman analysis were performed in MedCalc. The mean percent difference in calculated dose for Diamond, IMSure, MuCheck, and RadCalc from Pinnacle were -0.67%, 0.31%, 1.51% and -0.36%, respectively. The corresponding variances were calculated to be 0.07%, 0.13%, 0.08%, and 0.03%; and the largest percent differences were -7.9%, 9.70%, 9.39%, and 5.45%. The dose differences of each of the second check software in this study can vary considerably and VMAT plans have larger differences than IMRT. Among the four second check softwares, RadCalc values has shown a high agreement on average with low variation, and had the smallest percent range from Pinnacle values. The closest in average percent difference from the Pinnacle data was the IMSure software, but suffered from significantly larger variance and percent range. The values reported by Diamond and MuCheck had significantly high percent differences with TPS values.
Comment: =Evaluation
=Linac
BibTeX:
@article{Tuazon2018,
  author = {Tuazon, B. and Narayanasamy, G. and Papanikolaou, N. and Kirby, N. and Mavroidis, P. and Stathakis, S.},
  title = {Evaluation and comparison of second-check monitor unit calculation software with Pinnacle treatment planning system.},
  journal = {Physica medica},
  year = {2018},
  volume = {45},
  pages = {186--191},
  doi = {https://doi.org/10.1016/j.ejmp.2017.12.004}
}
Takahashi, R., Kamima, T., Itano, M., Yamazaki, T., Ishibashi, S., Higuchi, Y., Shimizu, H., Yamamoto, T., Yamashita, M., Baba, H., Sugawara, Y., Sato, A., Nishiyama, S., Kawai, D., Miyaoka, S. and Tachibana, H. A multi-institutional study of secondary check of treatment planning using Clarkson-based dose calculation for three-dimensional radiotherapy 2018 Physica medica
Vol. 49, pp. 19-27 
article DOI  
Abstract: As there have been few reports on quantitative analysis of inter-institutional results for independentmonitor unit (MU) verification, we performed a multi-institutional study of verification to show the feasibility ofapplying the 3–5% action levels used in the U.S. and Europe, and also to show the results of inter-institutionalcomparisons.Methods:A total of 5936fields were collected from 12 institutions. We used commercial software employing theClarkson algorithm for verification after a validation study of measurement and software comparisons wasperformed. The doses generated by the treatment planning systems (TPSs) were retrospectively analyzed usingthe verification software.Results:Mean ± two standard deviations of all locations were 1.0 ± 3.6%. There were larger differences forbreast (4.0 ± 4.0%) and for lung (2.5 ± 5.8%). A total of 80% of thefields with differences over 5% of theaction level involved breast and lung targets, with 7.2 ± 5.4%. Inter-institutional comparisons showed varioussystematic differences forfield shape for breast and differences in thefields were attributable to differences inreference point placement for lung. The large differences for breast and lung are partially attributable to dif-ferences in the methods used to correct for heterogeneity.Conclusions:The 5% action level may be feasible for verification; however, an understanding of larger differ-ences in breast and lung plans is important in clinical practice. Based on the inter-institutional comparisons, caremust be taken when determining an institution-specific action level from plans with differentfield shape settingsand incorrectly placed reference points.
Comment: =Evaluation
=Linac
BibTeX:
@article{Takahashi2018,
  author = {Takahashi, Ryo and Kamima, Tatsuya and Itano, Masanobu and Yamazaki, Takeshi and Ishibashi, Satoru and Higuchi, Yoshihiro and Shimizu, Hiroyuki and Yamamoto, Toshijiro and Yamashita, Mikiko and Baba, Hiromi and Sugawara, Yasuharu and Sato, Aya and Nishiyama, Shiro and Kawai, Daisuke and Miyaoka, Satoshi and Tachibana, Hidenobu},
  title = {A multi-institutional study of secondary check of treatment planning using Clarkson-based dose calculation for three-dimensional radiotherapy},
  journal = {Physica medica},
  publisher = {Elsevier},
  year = {2018},
  volume = {49},
  pages = {19--27},
  doi = {https://doi.org/10.1016/j.ejmp.2018.04.394}
}
Miguel-Chumacero, E., Currie, G., Johnston, A. and Currie, S. Effectiveness of Multi-Criteria Optimization-based Trade-Off exploration in combination with RapidPlan for head & neck radiotherapy planning. 2018 Radiation Oncology
Vol. 13, pp. 229 
article DOI  
Abstract: A new strategy is introduced combining the use of Multi-Criteria Optimization-based Trade-Off Exploration (TO) and RapidPlan™ (RP) for the selection of optimisation parameters that improve the trade-off between sparing of organs at risk (OAR) and target coverage for head and neck radiotherapy planning. Using both approaches simultaneously; three different workflows were proposed for the optimisation process of volumetric-modulated arc therapy (VMAT) plans. The generated plans were compared to the clinical plans and the plans that resulted using RP and TO individually. Twenty clinical VMAT plans previously administered were selected. Five additional plans were created for each patient: a clinical plan further optimised with TO (Clin+TO); two plans generated by in-house built RP models, RP_1 with the model built with VMAT clinical plans and RP_TO with the model built with VMAT plans optimised by TO. Finally, these last two plans were additionally optimised with TO for the creation of the plans RP_1 + TO and RP_TO respectively. The TO management was standardised to maximise the sparing of the parotid glands without compromising a clinically acceptable PTV coverage. Resulting plans were inter-compared based on dose-volume parameters for OAR and PTVs, target homogeneity, conformity, and plans complexity and deliverability. The plans optimised using TO in combination with RP showed significantly improved OAR sparing while maintaining comparable target dose coverage to the clinical plans. The largest OAR sparing compared to the clinical plans was achieved by the RP_TO plans, which reported a mean parotid dose average of 15.0 ± 4.6 Gy vs 22.9 ± 5.5 Gy (left) and 17.1 ± 5.0 Gy vs 24.8 ± 5.8 Gy (right). However, at the same time, RP_TO showed a slight dose reduction for the 99% volume of the nodal PTV and an increase for the 95% (when comparing to the clinical plans 76.0 ± 1.2 vs 77.4 ± 0.6 and 80.9 ± 0.9 vs 79.7 ± 0.4) but remained within clinical acceptance. Plans optimised with RP and TO combined, showed an increase in complexity but were proven to be deliverable. The use of TO combined with RP during the optimisation of VMAT plans enhanced plan quality the most. For the RP_TO plans, acceptance of a slight deterioration in nodal PTV allowed the largest reduction in OAR dose to be achieved.
Comment: =Verification
=Linac
BibTeX:
@article{MiguelChumacero2018,
  author = {Miguel-Chumacero, Eliane and Currie, Garry and Johnston, Abigail and Currie, Suzanne},
  title = {Effectiveness of Multi-Criteria Optimization-based Trade-Off exploration in combination with RapidPlan for head & neck radiotherapy planning.},
  journal = {Radiation Oncology},
  year = {2018},
  volume = {13},
  pages = {229},
  doi = {https://doi.org/10.1186/s13014-018-1175-y}
}
Le, A.H., Stojadinovic, S., Timmerman, R., Choy, H., Duncan, R.L., Jiang, S.B. and Pompos, A. Real-Time Whole-Brain Radiation Therapy: A Single-Institution Experience. 2018 International Journal of Radiation Oncology Biology Physics
Vol. 100(5), pp. 1280-1288 
article DOI  
Abstract: To demonstrate the feasibility of a real-time whole-brain radiation therapy (WBRT) workflow, taking advantage of contemporary radiation therapy capabilities and seeking to optimize clinical workflow for WBRT. METHODS AND MATERIALS: We developed a method incorporating the linear accelerator's on-board imaging system for patient simulation, used cone-beam computed tomography (CBCT) data for treatment planning, and delivered the first fraction of prescribed therapy, all during the patient's initial appointment. Simulation was performed in the linear accelerator vault. An acquired CBCT data set was used for scripted treatment planning protocol, providing inversely planned, automated treatment plan generation. The osseous boundaries of the brain were auto-contoured to create a target volume. Two parallel-opposed beams using field-in-field intensity modulate radiation therapy covered this target to the user-defined inferior level (C1 or C2). The method was commissioned using an anthropomorphic head phantom and verified using 100 clinically treated patients. RESULTS: Whole-brain target heterogeneity was within 95%-107% of the prescription dose, and target coverage compared favorably to standard, manually created 3-dimensional plans. For the commissioning CBCT datasets, the secondary monitor unit verification and independent 3-dimensional dose distribution comparison for computed and delivered doses were within 2% agreement relative to the scripted auto-plans. On average, time needed to complete the entire process was 35.1 ± 10.3 minutes from CBCT start to last beam delivered. CONCLUSIONS: The real-time WBRT workflow using integrated on-site imaging, planning, quality assurance, and delivery was tested and deemed clinically feasible. The design necessitates a synchronized team consisting of physician, physicist, dosimetrist, and therapists. This work serves as a proof of concept of real-time planning and delivery for other treatment sites.
Comment: =Verification
=Linac
BibTeX:
@article{Le2018,
  author = {Le, Anh H. and Stojadinovic, Strahinja and Timmerman, Robert and Choy, Hak and Duncan, Romona L. and Jiang, Steve B. and Pompos, Arnold},
  title = {Real-Time Whole-Brain Radiation Therapy: A Single-Institution Experience.},
  journal = {International Journal of Radiation Oncology Biology Physics},
  publisher = {Elsevier},
  year = {2018},
  volume = {100},
  number = {5},
  pages = {1280--1288},
  doi = {https://doi.org/10.1016/j.ijrobp.2017.12.282}
}
Kamima, T., Baba, H., Takahashi, R., Yamashita, M., Sugawara, Y., Kawai, D., Yamamoto, T., Satou, A. and Tachibana, H. Multi-institutional comparison of computer-based independent dose calculation for intensity modulated radiation therapy and volumetric modulated arc therapy 2018 Physica medica
Vol. 45, pp. 72-81 
article DOI  
Abstract: No multi-institutional studies of computer-based independent dose calculation have addressed thediscrepancies among radiotherapy treatment planning systems (TPSs) and the verification programs for intensitymodulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). We conducted a multi-institutional study to investigate whether ± 5% is a reasonable action level for independent dose calculation forIMRT/VMAT.Methods:In total, 477 IMRT/VMAT plans for prostate or head and neck (H&N) malignancies were retro-spectively analyzed using a modified Clarkson-based commercial verification program. The doses from the TPSs and verification programs were compared using the mean ± 1 standard deviation (SD).Results:In the TPS-calculated dose comparisons for prostate and H&N malignancies, the sliding window (SW)technique (−2.5 ± 1.8% and−5.3 ± 2.6%) showed greater negative systematic differences than the step-and-shoot (S&S) technique (−0.3 ± 2.2% and−0.8 ± 2.2%). The VMAT dose differences for prostate and H&Nmalignancies were 0.9 ± 1.8% and 1.1 ± 3.3%, respectively. The SDs were larger for the H&N plans than forthe prostate plans in both IMRT and VMAT. Such plans including more out-of-field control points showed greatersystematic differences and SDs.Conclusions:This study will help individual institutions to establish an action level for agreement betweenprimary calculations and verification for IMRT/VMAT. A local dose difference of ± 5% at a point within theplanning target volume (above−350 HU) may be a reasonable action level.
Comment: =Evaluation
=Linac
BibTeX:
@article{Kamima2018,
  author = {Kamima, Tatsuya and Baba, Hiromi and Takahashi, Ryo and Yamashita, Mikiko and Sugawara, Yasuharu and Kawai, Daisuke and Yamamoto, Toshijiro and Satou, Aya and Tachibana, Hidenobu},
  title = {Multi-institutional comparison of computer-based independent dose calculation for intensity modulated radiation therapy and volumetric modulated arc therapy},
  journal = {Physica medica},
  publisher = {Elsevier},
  year = {2018},
  volume = {45},
  pages = {72--81},
  doi = {https://doi.org/10.1016/j.ejmp.2017.10.024}
}
Hand, C., Fitzherbert, C., Zhou, F. and Irmen, P. Clinical Implementation and End‐To‐End Testing of Varian SRS Cones 2018 Journal of Applied Clinical Medical Physics
Vol. 19(3), pp. 370-407 
conference DOI  
Abstract: Due to limited industry guidelines for small field dosimetry, this study will demonstrate the clinical implementation and end‐to‐end testing of Varian SRS cones. Methods: 6 MV and 6 FFF plans were created for each of the Varian SRS cones (17.5 mm, 15 mm, 12.5 mm, 10 mm, 7.5 mm, 5 mm, and 4 mm) in Eclipse Cone Planning. Each plan consisted of a 50° and 80° arc. A water phantom was used for calculation at 95 cm SSD. Point doses were calculated on the central axis at 5 cm depth. Point doses were measured and verified using a PTW 60012 in a Sun Nuclear 1D SCANNER water tank and a Sun Nuclear EDGE detector in both a solid water phantom and 1D SCANNER water tank. In addition, independent MU and dose verification was performed using RadCalc® software for each plan. Results: For the EDGE detector, the maximum difference between the planned point dose and the measured point dose was 3.19% and 1.26% for 6 MV and 6 FFF energies, respectively, using a solid water phantom and 6.77% and 3.72% for 6 MV and 6 FFF energies, respectively, using a water tank. For the PTW 60012, the maximum difference between the planned point dose and the measured point dose was 2.38% and 6.92% for 6 MV and 6 FFF energies, respectively. The RadCalc® software showed agreement within 1.29% for MU and 1.28% for point dose calculations for 6 MV energy plans and 0.67% for MU and 0.67% for point dose calculations for 6 FFF energy plans. Conclusion: Recently published MPPG 9a is currently the only guideline specific to SRS/SBRT treatment but gives no detailed instruction to small field considerations. IAEA TRS 498 is referenced but is currently unpublished. This experience provides a model for successfully implementing Varian SRS cones for clinical use and developing a second independent MU and dose verification method utilizing the widely used RadCalc® software.
Comment: =Verification
=Linac
BibTeX:
@conference{Hand2018,
  author = {Hand, C and Fitzherbert, C and Zhou, F and Irmen, P},
  title = {Clinical Implementation and End‐To‐End Testing of Varian SRS Cones},
  journal = {Journal of Applied Clinical Medical Physics},
  publisher = {John Wiley & Sons, Ltd},
  year = {2018},
  volume = {19},
  number = {3},
  pages = {370--407},
  doi = {https://doi.org/10.1002/acm2.12334}
}
Gopan, O., Smith, W.P., Chvetsov, A., Hendrickson, K., Kalet, A., Kim, M., Nyflot, M., Phillips, M., Young, L., Novak, A., Zeng, J. and Ford, E. Utilizing simulated errors in radiotherapy plans to quantify the effectiveness of the physics plan review. 2018 Medical Physics
Vol. 45, pp. 5359-5365 
article DOI  
Abstract: The review of a radiation therapy plan by a physicist prior to treatment is a standard tool for ensuring the quality of treatments. However, little is known about how well this task is performed in practice. The goal of this study is to present a novel method to measure the effectiveness of physics plan review by introducing simulated errors into computerized "mock" treatment charts and measuring the performance of plan review by physicists. We generated six simulated treatment charts containing multiple errors. To select errors, we compiled a list based on events from a departmental incident learning system and an international incident learning system (SAFRON). Seventeen errors with the highest scores for frequency and severity were included in the simulations included six mock treatment charts. Eight physicists reviewed the simulated charts as they would a normal pretreatment plan review, with each chart being reviewed by at least six physicists. There were 113 data points for evaluation. Observer bias was minimized using a simple error vs hidden error approach, using detectability scores for stratification. The confidence interval for the proportion of errors detected was computed using the Wilson score interval. Simulated errors were detected in 67% of reviews [58-75%] (95% confidence interval [CI] in brackets). Of the errors included in the simulated plans, the following error scenarios had the highest detection rates: an incorrect isocenter in DRR (93% [70-99%]), a planned dose different from the prescribed dose (92% [67-99%]) and invalid QA (85% [58-96%]). Errors with low detection rates included incorrect CT dataset (0%, [0-39%]) and incorrect isocenter localization in planning system (38% [18-64%]). Detection rates of errors from simulated charts were compared against observed detection rates of errors from a departmental incident learning system. It has been notoriously difficult to quantify error and safety performance in oncology. This study uses a novel technique of simulated errors to quantify performance and suggests that the pretreatment physics plan review identifies some errors with high fidelity while other errors are more challenging to detect. These data will guide future work on standardization and automation. The example process studied here was physics plan review, but this approach of simulated errors may be applied in other contexts as well and may also be useful for training and education purposes.
Comment: =Verification
=Linac
BibTeX:
@article{Gopan2018a,
  author = {Gopan, Olga and Smith, Wade P. and Chvetsov, Alexei and Hendrickson, Kristi and Kalet, Alan and Kim, Minsun and Nyflot, Matthew and Phillips, Mark and Young, Lori and Novak, Avrey and Zeng, Jing and Ford, Eric},
  title = {Utilizing simulated errors in radiotherapy plans to quantify the effectiveness of the physics plan review.},
  journal = {Medical Physics},
  year = {2018},
  volume = {45},
  pages = {5359--5365},
  doi = {https://doi.org/10.1002/mp.13242}
}
Cai, B., Green, O.L., Kashani, R., Rodriguez, V.L., Mutic, S. and Yang, D. A practical implementation of physics quality assurance for photon adaptive radiotherapy. 2018 Zeitschrift für Medizinische Physik
Vol. 28, pp. 211-223 
article DOI  
Abstract: The fast evolution of technology in radiotherapy (RT) enabled the realization of adaptive radiotherapy (ART). However, the new characteristics of ART pose unique challenges for efficiencies and effectiveness of quality assurance (QA) strategies. In this paper, we discuss the necessary QAs for ART and introduce a practical implementation. A previously published work on failure modes and effects analysis (FMEA) of ART is introduced first to explain the risks associated with ART sub-processes. After a brief discussion of QA challenges, we review the existing QA strategies and tools that might be suitable for each ART step. By introducing the MR-guided online ART QA processes developed at our institute, we demonstrate a practical implementation. The limitations and future works to develop more robust and efficient QA strategies are discussed at the end.
Comment: =Promotion
=Linac
BibTeX:
@article{Cai2018,
  author = {Cai, Bin and Green, Olga L. and Kashani, Rojano and Rodriguez, Vivian L. and Mutic, Sasa and Yang, Deshan},
  title = {A practical implementation of physics quality assurance for photon adaptive radiotherapy.},
  journal = {Zeitschrift für Medizinische Physik},
  year = {2018},
  volume = {28},
  pages = {211--223},
  doi = {https://doi.org/10.1016/j.zemedi.2018.02.002}
}
Yamazaki, T., Itano, M., Ishibashi, S., Higuchi, Y., Yamashita, M., Kosaka, M., Kobayashi, N. and Tachibana, H. Impact of Different Independent Dose Verification Software Programs for Secondary Check. 2017 Japanese journal of medical physics
Vol. 36, pp. 197-206 
article DOI  
Abstract: A multi-institutional study was performed to identify the impact of different independent dose verification programs on independent dose verification software program. Data for 1,543 treatment fields were collected in three institutions. RADCALC and Simple MU Analysis (Simple MU) using the Clarkson-based algorithm were used. RADCALC needs the input of radiological path length (RPL) from radiotherapy treatment planning systems (RTPSs) (Eclipse or Pinnacle ). The Simple MU computes the RPL using CT images independently from the RTPSs. Ion-chamber measurements were performed for commissioning the two programs and the RTPSs. Next, the results of the two programs were compared to the RTPSs obtained in the clinically-approved plans in all three institutions. The commissioning results showed ±1.5% variation in the ion-chamber measurements and there was slight difference between the institutions. The RADCALC (0.9±2.2%) and the Simple MU (1.7±2.1%) results showed a slight systematic difference. Pinnacle computed longer RPLs because it used CT-physical density tables. Thus, there was an impact on the accuracy in the treatment plans involving bone and other high-density materials. Dose calculation algorithms in different dose verification programs provided similar results. However, care must be taken because different RPL calculation methods in the RTPSs may affect dose difference between different independent dose verification programs by 1%.
Comment: =Evaluation
=Linac
BibTeX:
@article{Yamazaki2017,
  author = {Yamazaki, Takeshi and Itano, Masanobu and Ishibashi, Satoru and Higuchi, Yoshihiro and Yamashita, Mikiko and Kosaka, Megumi and Kobayashi, Nozomi and Tachibana, Hidenobu},
  title = {Impact of Different Independent Dose Verification Software Programs for Secondary Check.},
  journal = {Japanese journal of medical physics},
  year = {2017},
  volume = {36},
  pages = {197--206},
  doi = {https://doi.org/10.11323/jjmp.36.4_197}
}
Yamashita, M., Takahashi, R., Kokubo, M., Takayama, K., Tanabe, H., Sueoka, M., Ishii, M. and Tachibana, H. A feasibility study of independent verification of dose calculation for Vero 4DRT using a Clarkson-based algorithm 2017 Medical Dosimetry
Vol. 44(1), pp. 20-25 
article DOI  
Abstract: Dose verification for a gimbal-mounted image-guided radiotherapy system, Vero4DRT (Mitsubishi Heavy Industries Ltd., Tokyo, Japan) is usually carried out by pretreatment measurement. Independent verification calculations using Monte Carlo methods for Vero4DRT have been published. As the Clarkson method is faster and easier to use than measurement and Monte Carlo methods, we evaluated the accuracy of an independent calculation verification program and its feasibility as a secondary check for Vero4DRT. Computed tomography (CT)-based dose calculation was performed using a modified Clarkson-based algorithm. In this study, 120 patients' treatment plans were collected in our institute. The treatments were performed using conventional irradiation for lung and prostate, 3-dimensional (3D) conformal stereotactic body radiotherapy (SBRT) for the lung, and intensity-modulated radiation therapy (IMRT) for the prostate. Differences between the treatment planning system (TPS) and the Clarkson-based independent dose verification software were computed, and confidence limits (CLs, mean?±?2 standard deviation %) for Vero4DRT were compared with the CLs for the C-arms linear accelerators in the previous study. The results of the CLs, the conventional irradiation, SBRT, and IMRT showed 2.2?±?3.5% (CL of the C-arms linear accelerators: 2.4?±?5.3%), 1.1?±?1.7% (?0.3?±?2.0%), 4.8?±?3.7% (5.4?±?5.3%), and ?0.5?±?2.5% (?0.1?±?3.6%) differences, respectively. The dose disagreement between the TPS and CT-based independent dose verification software was less than the 5% action level of American Association of Physicists in Medicine (AAPM) Task Group 114 (TG114). The CLs for the gimbal-mounted Vero4DRT were similar to the deviations for C-arms linear accelerators.
Comment: =Promotion
=Linac
=Vero
=MC
BibTeX:
@article{Yamashita2017,
  author = {Yamashita, Mikiko and Takahashi, Ryo and Kokubo, Masaki and Takayama, Kenji and Tanabe, Hiroaki and Sueoka, Masaki and Ishii, Masao and Tachibana, Hidenobu},
  title = {A feasibility study of independent verification of dose calculation for Vero 4DRT using a Clarkson-based algorithm},
  journal = {Medical Dosimetry},
  publisher = {Elsevier},
  year = {2017},
  volume = {44},
  number = {1},
  pages = {20--25},
  doi = {https://doi.org/10.1016/j.meddos.2017.12.007}
}
Squires, M., Hu, Y., Byrne, M., Archibald-Heeren, B., Cheers, S., Bosco, B., Teh, A. and Fong, A. Static beam tomotherapy as an optimisation method in whole-breast radiation therapy (WBRT) 2017 Journal of Medical Radiation Sciences
Vol. 64(4), pp. 281-289 
article DOI  
Abstract: TomoTherapy (Accuray, Sunnyvale, CA) has recently introduced a static form of tomotherapy: TomoDirect™ (TD). This study aimed to evaluate TD against a contemporary intensity modulated radiation therapy (IMRT) alternative through comparison of target and organ at risk (OAR) doses in breast cancer cases. A secondary objective was to evaluate planning efficiency by measuring optimisation times. Methods Treatment plans of 27 whole‐breast radiation therapy (WBRT) patients optimised with a tangential hybrid IMRT technique were replanned using TD. Parameters included a dynamic field width of 2.5 cm, a pitch of 0.251 and a modulation factor of 2.000; 50 Gy in 25 fractions was prescribed and planning time recorded. The planning metrics used in analysis were ICRU based, with the mean PTV minimum (D99) used as the point of comparison. Results: Both modalities met ICRU50 target heterogeneity objectives (TD D99 = 48.0 Gy vs. IMRT = 48.1 Gy, P = 0.26; TD D1 = 53.5 Gy vs. IMRT = 53.0 Gy, P = 0.02; Homogeneity index TD = 0.11 vs. IMRT = 0.10, P = 0.03), with TD plans generating higher median doses (TD D50 = 51.1 Gy vs. IMRT = 50.9 Gy, P = 0.03). No significant difference was found in prescription dose coverage (TD V50 = 85.5% vs. IMRT = 82.0%, P = 0.09). TD plans produced a statistically significant reduction in V5 ipsilateral lung doses (TD V5 = 23.2% vs. IMRT = 27.2%, P = 0.04), while other queried OARs remained comparable (TD ipsilateral lung V20 = 13.2% vs. IMRT = 14.6%, P = 0.30; TD heart V5 = 2.7% vs. IMRT = 2.8%, P = 0.47; TD heart V10 = 1.7% vs. IMRT = 1.8%, P = 0.44). TD reduced planning time considerably (TD = 9.8 m vs. IMRT = 27.6 m, P < 0.01), saving an average planning time of 17.8 min per patient. Conclusions: TD represents a suitable WBRT treatment approach both in terms of plan quality metrics and planning efficiency.
Comment: =Verification
=TT
BibTeX:
@article{Squires2017,
  author = {Matthew Squires and Yunfei Hu and Mikel Byrne and Ben Archibald-Heeren and Sonja Cheers and Bruno Bosco and Amy Teh and Andrew Fong},
  title = {Static beam tomotherapy as an optimisation method in whole-breast radiation therapy (WBRT)},
  journal = {Journal of Medical Radiation Sciences},
  publisher = {Wiley},
  year = {2017},
  volume = {64},
  number = {4},
  pages = {281--289},
  doi = {https://doi.org/10.1002/jmrs.232}
}
Santos, T., Ventura, T., Mateus, J., Capela, M. and Lopes, M. A comparison of tools for Delivery Quality Assurance in TomoTherapy 2017 Radiotherapy and Oncology
Vol. 123, pp. S964 
conference DOI  
Abstract: A TomoTherapy HD unit has recently been installed in our hospital. The purpose of the present work is to establish an accurate and efficient method of patient specific delivery quality assurance (DQA). Four available tools (EBT3 Grafchromic film, Dosimetry Check –DC –, ArcCHECKTMand RadCalc®) have been tested and compared.Material and MethodsStandard patient plan verification in TomoTherapy is done through film dosimetry in the Cheese Virtual WaterTMphantom. Also point dose measurements can be performed inserting ionization chambers in this phantom. A well-established film absolute dosimetry methodology using EBT3 Gafchromic film and applying a multichannel correction method was developed in-house, adapting the standard approach in the DQA Tomo station. The treatment plans of the first 21 patients were retrospectively verified using also Dosimetry Check software (Math Resolutions, LLC) and ArcCHECKTM(Sun Nuclear). A beta version of RadCalc®6.3 (LifeLine Software Inc.) for TomoTherapy has been used for independent treatment time calculation. DC uses the MVCT detector sinogram to reconstruct the 3D dose distribution. In this work it was used in pre-treatment mode with the couch out of the bore. The transit dose mode where the patient delivered dose reconstruction is obtained was not assessed in this work. ArcCHECKTMrecords the signal of 1386 diodes embedded as a helical grid on a cylindrical phantom, enabling 4D volumetric measurements. The Gamma passing rate acceptance limit was 95% using a 3%/3 mm criterion in all cases. ResultsAll the used QA tools showed a good agreement between measured and planned doses. Film and DC achieved similar results with mean Gamma passing rates of 98.8±1.6% (1SD) for EBT3 film and 97.9±1.6% (1SD) for DC. Moreover, a correlation was found between those results:when passing rates using film were poorer (<97%), the same happened with DC, while passing rates over 97% for DC corresponded to the same range using film. This correspondence was not verified with ArcCHECKTMwhere Gamma passing rates were always close to 100% (99.6±0.7% (1SD)). Concerning the independent treatment time verification with Radcalc®, the percentage difference to the Tomo TPS calculation was 0.2±2.5% (1SD), on average.ConclusionDC and ArcCHECKTMallow volumetric dose comparisons betweencalculated and measured doses. Moreover DC displays DVHs and isodose lines for the considered structures in the plan while 3D-DVH in ArcCHECKTMis not available for TomoTherapy. DC seems to be a valuable tool for performing patient-specific DQA however,considering the present Pencil Beam algorithm and its known limitations, a verification using film dosimetry and ionization chamber measurements should be done in case of any significant discrepancy. Concerning the beta version for TomoTherapy in RadCalc® software, it seems to be a valid tool for independent treatment time verification, easily incorporable in routine treatment workflow.
Comment: =Verification
=TT
BibTeX:
@conference{Santos2017,
  author = {T. Santos and T. Ventura and J. Mateus and M. Capela and M.D.C. Lopes},
  title = {A comparison of tools for Delivery Quality Assurance in TomoTherapy},
  journal = {Radiotherapy and Oncology},
  publisher = {Elsevier BV},
  year = {2017},
  volume = {123},
  pages = {S964},
  doi = {https://doi.org/10.1016/s0167-8140(17)32114-x}
}
Pogson, E.M., Aruguman, S., Hansen, C.R., Currie, M., Oborn, B.M., Blake, S.J., Juresic, J., Ochoa, C., Yakobi, J., Haman, A., Trtovac, A., Carolan, M., Holloway, L. and Thwaites, D.I. Multi-institutional comparison of simulated treatment delivery errors in ssIMRT, manually planned VMAT and autoplan-VMAT plans for nasopharyngeal radiotherapy 2017 Physica medica
Vol. 42, pp. 55-66 
article DOI  
Abstract: To quantify the impact of simulated errors for nasopharynx radiotherapy across multiple insti-tutions and planning techniques (auto-plan generated Volumetric Modulated Arc Therapy (ap-VMAT),manually planned VMAT (mp-VMAT) and manually planned step and shoot Intensity ModulatedRadiation Therapy (mp-ssIMRT)).Methods:Ten patients were retrospectively planned with VMAT according to three institution’s proto-cols. Within one institution two further treatment plans were generated using differing treatment plan-ning techniques. This resulted in mp-ssIMRT, mp-VMAT, and ap-VMAT plans. Introduced treatmenterrors included Multi Leaf Collimator (MLC) shifts, MLC field size (MLCfs), gantry and collimator errors.A change of more than 5% in most selected dose metrics was considered to have potential clinical impact.The original patient plan total Monitor Units (MUs) were correlated to the total number of dose metricsexceeded.Results:The impact of different errors was consistent, with ap-VMAT plans (two institutions) showinglarger dose deviations than mp-VMAT created plans (one institution). Across all institutions’ VMAT plansthe significant errors included; ±5°for the collimator angle, ±5 mm for the MLC shift and +1, ±2 and±5 mm for the MLC field size. The total number of dose metrics exceeding tolerance was positively cor-related to the VMAT total plan MUs (r = 0.51, p < 0.001), across all institutions and techniques.Conclusions:Differences in VMAT robustness to simulated errors across institutions occurred due to plan-ning method differences. Whilst ap-VMAT was most sensitive to MLC errors, it also produced the bestquality treatment plans. Mp-ssIMRT was most robust to errors. Higher VMAT treatment plan complexityled to less robust plans.
Comment: =Verification
=Linac
BibTeX:
@article{Pogson2017,
  author = {Pogson, Elise M. and Aruguman, Sankar and Hansen, Christian R. and Currie, Michael and Oborn, Bradley M. and Blake, Samuel J. and Juresic, Josip and Ochoa, Cesar and Yakobi, Jim and Haman, Alicia and Trtovac, Admir and Carolan, Martin and Holloway, Lois and Thwaites, David I.},
  title = {Multi-institutional comparison of simulated treatment delivery errors in ssIMRT, manually planned VMAT and autoplan-VMAT plans for nasopharyngeal radiotherapy},
  journal = {Physica medica},
  publisher = {Elsevier},
  year = {2017},
  volume = {42},
  pages = {55--66},
  doi = {https://doi.org/10.1016/j.ejmp.2017.08.008}
}
Nolan, M., Arkans, M., LaVine, D., DeFrancesco, T., Myers, J., Griffith, E., Posner, L., Keene, B., Tou, S. and Gieger, T. Pilot study to determine the feasibility of radiation therapy for dogs with right atrial masses and hemorrhagic pericardial effusion 2017 Journal of Veterinary Cardiology
Vol. 19(2), pp. 132-143 
article DOI  
Abstract: To determine the short-term safety and biologic activity of radiation therapy (RT) for presumptive cardiac hemangiosarcoma in pet dogs. Six dogs with echocardiographic evidence of a right atrial/auricular mass, and hemorrhagic pericardial effusion, were enrolled in a prospective, single-arm clinical trial. Methods: A single fraction of 12 Gy was delivered using conformal external beam irradiation. Serum cardiac troponin I and plasma concentrations of vascular endothelial growth factor were quantified before, 4 and 24 h after RT. The frequency of required pericardiocenteses (quantified as the number of pericardiocenteses per week) before RT was compared to that after treatment. Overall survival time was determined. Results: No treatment-related complications were observed. Pericardiocentesis was performed an average of 0.91 times per week before RT, and an average of 0.21 times per week after RT; this difference was statistically significant (p=0.03, as compared using a Wilcoxon signed-rank test of paired data). Pre- and post-treatment plasma vascular endothelial growth factor concentrations were not significantly different at any time point; there was a statistically significant (p=0.04; Friedman's test for non-parametric repeated measures) increase in cardiac troponin concentrations 4 h after irradiation. Median overall survival time was 79 days. Conclusions: In this population of dogs, RT was delivered without complication, and appears to have reduced the frequency of periacardial tamponade that necessitated pericardiocentesis. Serum cardiac troponin levels are altered after RT. RT alone, or in combination with chemotherapy, may provide clinical benefit to dogs with presumptive diagnoses of cardiac hemangiosarcoma.
Comment: =Verification
=Linac
BibTeX:
@article{Nolan2017,
  author = {M.W. Nolan and M.M. Arkans and D. LaVine and T. DeFrancesco and J.A. Myers and E.H. Griffith and L.P. Posner and B.W. Keene and S.P. Tou and T.L. Gieger},
  title = {Pilot study to determine the feasibility of radiation therapy for dogs with right atrial masses and hemorrhagic pericardial effusion},
  journal = {Journal of Veterinary Cardiology},
  publisher = {Elsevier BV},
  year = {2017},
  volume = {19},
  number = {2},
  pages = {132--143},
  doi = {https://doi.org/10.1016/j.jvc.2016.12.001}
}
Chang, I.C.F., Chen, J. and Yartsev, S. Performance Characteristics of an Independent Dose Verification Program for Helical Tomotherapy. 2017 Journal of Medical Physics
Vol. 42, pp. 156-162 
article DOI  
Abstract: Helical tomotherapy with its advanced method of intensity-modulated radiation therapy delivery has been used clinically for over 20 years. The standard delivery quality assurance procedure to measure the accuracy of delivered radiation dose from each treatment plan to a phantom is time-consuming. RadCalc , a radiotherapy dose verification software, has released specifically for beta testing a module for tomotherapy plan dose calculations. RadCalc 's accuracy for tomotherapy dose calculations was evaluated through examination of point doses in ten lung and ten prostate clinical plans. Doses calculated by the TomoHDA™ tomotherapy treatment planning system were used as the baseline. For lung cases, RadCalc overestimated point doses in the lung by an average of 13%. Doses within the spinal cord and esophagus were overestimated by 10%. Prostate plans showed better agreement, with overestimations of 6% in the prostate, bladder, and rectum. The systematic overestimation likely resulted from limitations of the pencil beam dose calculation algorithm implemented by RadCalc . Limitations were more severe in areas of greater inhomogeneity and less prominent in regions of homogeneity with densities closer to 1 g/cm . Recommendations for RadCalc dose calculation algorithms and anatomical representation were provided based on the results of the study.
Comment: =Evaluation
=TT
BibTeX:
@article{Chang2017,
  author = {Chang, Isaac C. F. and Chen, Jeff and Yartsev, Slav},
  title = {Performance Characteristics of an Independent Dose Verification Program for Helical Tomotherapy.},
  journal = {Journal of Medical Physics},
  year = {2017},
  volume = {42},
  pages = {156--162},
  doi = {https://doi.org/10.4103/jmp.JMP_48_17}
}
Brown, R., Howie, A., Enari, K., Peters, I., Cutajar, D., Poder, J., Bece, A. and Bucci, J. Implementation and validation of a real-time prostate HDR brachytherapy system: dosimetric verification and use of FMEA in the developmentof a QA program 2017 Australasian Physical & Engineering Sciences in Medicine
Vol. 41(1), pp. 245-355 
conference DOI  
Abstract: The aim of this project was to implement real-time HDR prostate brachytherapy at St George Cancer Care Centre using the treatment planning system (TPS) Oncentra Prostate (OCP) v4.2.2 (Elekta AB, Stockholm, Sweden). AAPM TG53 [1] and IAEA TRS430 [2] were utilised as guides in the formation of a commissioning and QA plan tailored for real-time HDR. AAPM TG100 [3] describes the principles of failure mode and effects analysis (FMEA), which were used to review the QA program. Method Commissioning testing was performed on OCP (TPS, stepper, encoder, template) as well as the brachytherapy module of RadCalc v6.3.2 (LifeLine Software Inc, USA). End-to-end testing involved real time dose verification measurements in a prostate phantom using MOSkin dosimeters. Before clinical release, a multidisciplinary risk assessment was performed and extensive documentation formulated (workflow guidelines, checklists). A process map of the workflow was developed, failure modes identified and risk priority numbers (RPNs) calculated for each failure mode and averaged across the team. Results Initial geometric accuracy tests within OCP revealed a 10% discrepancy, requiring ultrasound recalibration within the software. Final end-to-end testing on a prostate phantom with dosimetric verification yielded point dose measurements in agreement with OCP by less than 3.7%, and validation of the plan in RadCalc exhibited maximum point dose differences of 0.1% (Table 1). FMEA analysis revealed 46 possible fault modes in the workflow, with the top 10 highest scoring faults listed in Table 2. Conclusion Accuracy of ultrasound calibration in the ultrasound system and in OCP is essential for providing accurate patient treatment. End-to-end testing verified, through phantom measurement and TPS comparisons, that the set up and calibrations were correct, and that the technique was safe for clinical use. FMEA was effective in identifying possible failure modes and useful for optimisation of an ongoing QA program.
Comment: =Verification
=BT
BibTeX:
@conference{Brown2017,
  author = {Brown, R and Howie, A and Enari, K and Peters, I and Cutajar, D and Poder, J and Bece, A and Bucci, J},
  title = {Implementation and validation of a real-time prostate HDR brachytherapy system: dosimetric verification and use of FMEA in the developmentof a QA program},
  journal = {Australasian Physical & Engineering Sciences in Medicine},
  publisher = {Springer Science and Business Media LLC},
  year = {2017},
  volume = {41},
  number = {1},
  pages = {245--355},
  doi = {https://doi.org/10.1007/s13246-017-0614-7}
}
Thøgersen, E. and Holm, A. Evaluation of conventional versus IMRT based Prophylactic Cranial Irradiation treatment planning 2016 Radiotherapy and Oncology
Vol. 119, pp. S978-S979 
conference DOI  
Abstract: Patients with Small-Cell Lung Cancer (SCLC) have a high risk of developing brain metastasis. Prophylactic Cranial Irradiation (PCI), is applied to SCLC patients that response to chemotherapy. It is well known that PCI is associated with an increase in median overall survival. There are approximately 84 incidences per year in central region DK. Radiotherapy (RT) to this group of patients is conventionally performed using opposed MLC defined static fields. However, treatment planning can be time consuming. The aim of this study is to evaluate time-effectiveness, by changing the treatment technique from conventional to IMRT based treatment planning of PCI patients. Material and Methods: This retrospective study included twenty SCLC patients, all treated with conventional planned PCI. Each patient received 25 Gray in 10 fractions. An IMRT template was made (Eclipse Version 11.0, Varian Medical Systems, Palo Alto, CA) and for each patient an IMRT plan was generated by one IMRT optimization. One intermediate dose calculation was performed during optimization before the final dose calculation. The contoured structures used for comparison between IMRT and conventional planning were: ITV, PTV and left/right lens. The plans were evaluated and compared on; max- and minimum doses, the mean/maximum doses to the lenses, and the homogeneity index (HI). The HI was defined by D5%/D95%. Quality assurance of the IMRT plans was performed by recording Portal Dosimetry Images (PDI) for ten of the plans, and by independent dose calculation checks using RadCalc (RadCalc Version 6.2, LifeLine Software Inc, Tyler, USA). Results: The observed differences between the conventional and the IMRT plans were limited. In average the maximum dose was 0.3 percentage points (pp) lower for IMRT than for conventional plans. The ITV coverage was better for the IMRT plans, with an average ITV minimum dose of 95.9 % compared to 94.1% (+1.8 pp). However, the PTV coverage was slightly worse for the IMRT plans, a decrease of 0.4 pp in V95%. The only relevant organs at risk are the lenses, were the maximum dose on average were lowered 0.3 Gray and the mean dose on average was lowered 0.1 Gray. The average HI for the IMRT plans was 4.0 while 5.1 for the conventional plans. The 10 PDI measurements were all accepted with a reference gamma index value of 5% dose agreement within 3 mm distance to agreement, and no further measurements were performed. Independent dose calculation checks were performed for QA. The time spend on treatment planning was approximately 20 minutes for IMRT plans and could easily be up to 3 hours when using the conventional technique. Conclusion: It was possible to significantly reduce the time spend on dose planning by changing the treatment technique from conventional to IMRT for PCI patients while attaining comparable dosimetric quality of the treatment plans. Furthermore, both the treatment time and the time spend on quality assurances are comparable for the two techniques.
Comment: =Verification
=Linac
BibTeX:
@conference{Thogersen2016,
  author = {E.H. Thøgersen and A.I.S. Holm},
  title = {Evaluation of conventional versus IMRT based Prophylactic Cranial Irradiation treatment planning},
  journal = {Radiotherapy and Oncology},
  publisher = {Elsevier BV},
  year = {2016},
  volume = {119},
  pages = {S978--S979},
  doi = {https://doi.org/10.1016/s0167-8140(16)33326-6}
}
Su, Z., Mamalui, M. and Li, Z. 3 Year Experience of Treatment Plan Quality Assurance for Vero SBRT Patients 2016 Medical Physics
Vol. 43(6Part22), pp. 3593-3593 
conference DOI  
Abstract: To verify treatment plan monitor units from iPlan treatment planning system for Vero Stereotactic Body Radiotherapy (SBRT) treatment using both software-based and (homogeneous and heterogeneous) phantom-based approaches. Methods: Dynamic conformal arcs (DCA) were used for SBRT treatment of oligometastasis patients using Vero linear accelerator. For each plan, Monte Carlo calculated treatment plans MU (prescribed dose to water with 1% variance) is verified first by RadCalc software with 3% difference threshold. Beyond 3% differences, treatment plans were copied onto (homogeneous) Scanditronix phantom for non-lung patients and copied onto (heterogeneous) CIRS phantom for lung patients and the corresponding plan dose was measured using a cc01 ion chamber. The difference between the planed and measured dose was recorded. For the past 3 years, we have treated 180 patients with 315 targets. Out of these patients, 99 targets treatment plan RadCalc calculation exceeded 3% threshold and phantom based measurements were performed with 26 plans using Scanditronix phantom and 73 plans using CIRS phantom. Mean and standard deviation of the dose differences were obtained and presented. Results: For all patient RadCalc calculations, the mean dose difference is 0.76% with a standard deviation of 5.97%. For non-lung patient plan Scanditronix phantom measurements, the mean dose difference is 0.54% with standard deviation of 2.53%; for lung patient plan CIRS phantom measurements, the mean dose difference is −0.04% with a standard deviation of 1.09%; The maximum dose difference is 3.47% for Scanditronix phantom measurements and 3.08% for CIRS phantom measurements. Conclusion: Limitations in secondary MU check software lead to perceived large dose discrepancies for some of the lung patient SBRT treatment plans. Homogeneous and heterogeneous phantoms were used in plan quality assurance for non-lung patients and lung patients, respectively. Phantom based QA showed the relative good agreement between iPlan calculated dose and measured dose.
Comment: =Verification
=Linac
=Vero
=MC
BibTeX:
@conference{Su2016,
  author = {Su, Z and Mamalui, M and Li, Z},
  title = {3 Year Experience of Treatment Plan Quality Assurance for Vero SBRT Patients},
  journal = {Medical Physics},
  year = {2016},
  volume = {43},
  number = {6Part22},
  pages = {3593-3593},
  doi = {https://doi.org/10.1118/1.4956749}
}
Soldner, A., Fitzherbert, C., Zhou, F. and Hand, C. Implementation of the RadCalc Image Analysis Tool for IMRT QA 2016 Medical Physics
Vol. 43(6Part17), pp. 3532-3532 
conference DOI  
Abstract: To assess RadCalc as a means for analyzing fluence maps of IMRT QA patient plans. Eclipse generated fluence maps were compared to RadCalc fluence maps generated from both Eclipse parameters and from dynalog trajectory files. Methods: Six IMRT plans consisting of fifty individual fields were compared both field-by-field and as composite plans. These plans were exported from Eclipse to RadCalc. Each plan was then delivered in QA mode on a Varian Clinac iX, while recording and saving the dynalog trajectory files. These files were then imported into RadCalc, providing three sources of generating fluence maps: Eclipse, RadCalc, and dynalog files. Using the image analysis tool in RadCalc, a gamma analysis was then performed as a point-by-point comparison for each IMRT field. The Eclipse fluence map was used as the baseline for each comparison. Results: Based on the manufacturer's recommendations, all fields were normalized to the maximum pixel value within each Eclipse field. All data was analyzed using a gamma index of 3mm/3% with passing criteria of 90%. For both dynalog analysis and RadCalc fluence analysis, 48/50 created fluence maps passed at greater than 90% when compared with the Eclipse baseline. In analyzing the composite of each of the six patients’ plans, all plans passed over 90%. Conclusion: Using the dynalog trajectory files in combination with RadCalc Version 6.3 image analysis is a promising metric for verifying IMRT QA passing rates. Notably, if a field failed, it did so for both dynalog and RadCalc compared to Eclipse. This suggests RadCalc can accurately simulate fluence maps, with similar results to dynalog comparisons. Limitations within the RadCalc software were discovered in the analytical process such as pixel resolution and the inability to set minimum threshold values. Comparisons could be extended to include dose map and distance to agreement analysis by expanding software capabilities.
Comment: =Evaluation
=Linac
BibTeX:
@conference{Soldner2016,
  author = {Soldner, A and Fitzherbert, C and Zhou, F and Hand, C},
  title = {Implementation of the RadCalc Image Analysis Tool for IMRT QA},
  journal = {Medical Physics},
  year = {2016},
  volume = {43},
  number = {6Part17},
  pages = {3532-3532},
  doi = {https://doi.org/10.1118/1.4956487}
}
Richmond, N., Tulip, R. and Walker, C. Empirical determination of collimator scatter data for use in Radcalc commercial monitor unit calculation software: Implication for prostate volumetric modulated-arc therapy calculations. 2016 Medical Dosimetry
Vol. 41, pp. 53-58 
article DOI  
Abstract: The aim of this work was to determine, by measurement and independent monitor unit (MU) check, the optimum method for determining collimator scatter for an Elekta Synergy linac with an Agility multileaf collimator (MLC) within Radcalc, a commercial MU calculation software package. The collimator scatter factors were measured for 13 field shapes defined by an Elekta Agility MLC on a Synergy linac with 6MV photons. The value of the collimator scatter associated with each field was also calculated according to the equation Sc=Sc(mlc)+Sc(corr)(Sc(open)-Sc(mlc)) with Sc(corr) varied between 0 and 1, where Sc(open) is the value of collimator scatter calculated from the rectangular collimator-defined field and Sc(mlc) the value using only the MLC-defined field shape by applying sector integration. From this the optimum value of the correction was determined as that which gives the minimum difference between measured and calculated Sc. Single (simple fluence modulation) and dual-arc (complex fluence modulation) treatment plans were generated on the Monaco system for prostate volumetric modulated-arc therapy (VMAT) delivery. The planned MUs were verified by absolute dose measurement in phantom and by an independent MU calculation. The MU calculations were repeated with values of Sc(corr) between 0 and 1. The values of the correction yielding the minimum MU difference between treatment planning system (TPS) and check MU were established. The empirically derived value of Sc(corr) giving the best fit to the measured collimator scatter factors was 0.49. This figure however was not found to be optimal for either the single- or dual-arc prostate VMAT plans, which required 0.80 and 0.34, respectively, to minimize the differences between the TPS and independent-check MU. Point dose measurement of the VMAT plans demonstrated that the TPS MUs were appropriate for the delivered dose. Although the value of Sc(corr) may be obtained by direct comparison of calculation with measurement, the efficacy of the value determined for VMAT-MU calculations are very much dependent on the complexity of the MLC delivery.
Comment: =Evaluation
=Linac
BibTeX:
@article{Richmond2016,
  author = {Richmond, Neil and Tulip, Rachael and Walker, Chris},
  title = {Empirical determination of collimator scatter data for use in Radcalc commercial monitor unit calculation software: Implication for prostate volumetric modulated-arc therapy calculations.},
  journal = {Medical Dosimetry},
  year = {2016},
  volume = {41},
  pages = {53--58},
  doi = {https://doi.org/10.1016/j.meddos.2015.08.002}
}
Poder, J., Morales, J., Hil, R. and Butson, M Development of a patient specific quality assurance technique for the Brainlab Multi-Metastasestreatment planning system 2016 Australasian Physical & Engineering Sciences in Medicine
Vol. 39(4), pp. 1045-1190 
conference DOI  
Abstract: Linear accelerator based stereotactic radiosurgery (SRS) is used to treat brain metastases in the Department of Radiation Oncology, Chris O’Brien Lifehouse. Traditionally, the SRS program was limited to treating multiple lesions with multiple isocentres, and patients with more than 3 brain metastases were treated using whole brain radiation therapy. The Brainlab Elements Multiple Metastases (BEMM) (v1.0.1.97, Brainlab AG, Feldkirchen, Germany) module was recently commissioned in Lifehouse. The development of a patient specific quality assurance technique for BEMM treatments is described. Method The lack of a dedicated physics quality assurance (QA) module in BEMM required the use of third party systems to develop a patient specific QA protocol. The Radcalc MU check program Lifeline Software) and the Varian Portal Dosimetry (Varian Medical Systems) were commissioned to achieve this purpose. BEMM arcs were planned on a slab phantom geometry with field sizes ranging from 6–30 mm, number of metastases ranging from 2–10 and off axis distances of 2–6 cm. The dose to each metastasis was individually checked in Radcalc using an independent dose calculation and fluence checks were analysed in Portal Dosimetry using gamma analysis. Subsets of these plans were then calculated on an anthropomorphic phantom and the process repeated. Results Mean dose differences between BEMM and Radcalc for the slab geometries was 0.4% (max 13.3%, min -4.9%) where as for the anthropomorphic cases, the mean difference was 2.8% (max 11.6%, min -0.6%). Fluence checks using Portal Dosimetry yielded an average pass rate of 98% for a gamma criteria of 3%/3 mm and 96.5% for 2%/2 mm. Conclusion Despite the limitations of the BEMM v1.0.1.97 for physics QA, a patient specific QA protocol has been developed using both independent dose calculations and fluence measurements with an electronic portal imager.
Comment: =Verification
=Linac
BibTeX:
@conference{Poder2016a,
  author = {Poder, J and Morales, J and Hil, R and Butson M},
  title = {Development of a patient specific quality assurance technique for the Brainlab Multi-Metastasestreatment planning system},
  journal = {Australasian Physical & Engineering Sciences in Medicine},
  publisher = {Springer Science and Business Media LLC},
  year = {2016},
  volume = {39},
  number = {4},
  pages = {1045--1190},
  doi = {https://doi.org/10.1007/s13246-016-0494-2}
}
Pearson, D., Gill, S.K., Campbell, N. and Reddy, K. Dosimetric and volumetric changes in the rectum and bladder in patients receiving CBCT-guided prostate IMRT: analysis based on daily CBCT dose calculation 2016 Journal of Applied Clinical Medical Physics
Vol. 17(6), pp. 107-117 
article DOI  
Abstract: Delivered dose can be calculated by transferring the planned treatment beams onto the daily CBCT. Bladder and rectum volumetric doses were calculated and correlated to the daily bladder and rectum fullness. Patients for this study underwent hypofractionated prostate IMRT to 70 Gy in 28 fractions. Daily CBCT was utilized for image guidance. A clinically acceptable plan was created using a CTV-to-PTV uniform margin of 5 mm. Image fusion was performed to transfer the bladder and rectum contours onto each CBCT. Contours were then edited to match the anatomy of each CBCT. Using the daily treatment isocenter, the planned beams were transferred onto the CBCT and daily and cumulative DVHs calculated. For the results a total of 168 daily CBCTs were evaluated. The bladder was found to be smaller for 74.7% of the 168 daily CBCTs accessed in this study. This reduction in volume correlated to an increase in the cumulative bladder V70 Gy from 9.47% on the planning CT to 10.99% during treatment. V70Gy for the rectum was 7.27% on the planning CT, when all six patients were averaged, and increased to 11.56% on the average of all daily treatment CBCTs. Increases in volumetric rectum dose correlated with increases in rectal volume. For one patient, the rectum and bladder absolute V70 Gy, averaged over the course of treatment, increased by 295% and 61%, respectively. Larger variations in the daily bladder and rectal volume were observed and these correlated to large deviations from the volumetric dose received by these structures. In summary, bladder and rectum volume changes during treatment have an effect on the cumulative dose received by these organs. It was observed that the volumetric dose received by the bladder decreases as the volume of the bladder increases. The inverse was true for the rectum.
Comment: =Verification
=Linac
BibTeX:
@article{Pearson2016,
  author = {Pearson, David and Gill, Sukhdeep K. and Campbell, Nina and Reddy, Krishna},
  title = {Dosimetric and volumetric changes in the rectum and bladder in patients receiving CBCT-guided prostate IMRT: analysis based on daily CBCT dose calculation},
  journal = {Journal of Applied Clinical Medical Physics},
  publisher = {John Wiley & Sons, Ltd},
  year = {2016},
  volume = {17},
  number = {6},
  pages = {107--117},
  doi = {https://doi.org/10.1120/jacmp.v17i6.6207}
}
Palmer, A.L., Pearson, M., Whittard, P., McHugh, K.E. and Eaton, D.J. Current status of kilovoltage (kV) radiotherapy in the UK: installed equipment, clinical workload, physics quality control and radiation dosimetry 2016 The British Journal of Radiology
Vol. 89(1068), pp. 20160641 
article DOI  
Abstract: To assess the status and practice of kilo-voltage (kV) radiotherapy in the UK.Methods:96% of the radiotherapy centres in the UKresponded to a comprehensive survey. An analysis of theinstalled equipment base, patient numbers, clinical treat-ment sites, quality control (QC) testing and radiationdosimetry processes were undertaken.Results:73% of UK centres have at least one kV treatmentunit, with 58 units installed across the UK. Although 35%of units are over 10 years old, 39% units have beeninstalled in the last 5 years. Approximately 6000 patientsare treated with kV units in the UK each year, the mostcommon site (44%) being basal cell carcinoma. Abenchmark of QC practice in the UK is presented, againstwhich individual centres can compare their procedures,frequency of testing and acceptable tolerance values.We propose the use of internal“notification”and“suspension”levels for analysis. All surveyed centreswere using recommended Codes of Practice for kVdosimetry in the UK; approximately the same numberusing in-air and in-water methodologies for mediumenergy, with two-thirds of all centres citing“clinicalrelevance”as the reason for choice of code. 64% ofcentres had hosted an external dosimetry audit within thelast 3 years, with only one centre never being indepen-dently audited. The majority of centres use locallymeasured applicator factors and published backscatterfactors for treatments. Monitor unit calculations areperformed using software in only 36% of centres.Conclusion:A comprehensive review of current kVpractice in the UK is presented.Advances in knowledge:Data and discussion on con-temporary kV radiotherapy in the UK, with a particularfocus on physics aspects.
Comment: =Verification
=Linac
BibTeX:
@article{Palmer2016,
  author = {Antony L Palmer and Michael Pearson and Paul Whittard and Katie E McHugh and David J Eaton},
  title = {Current status of kilovoltage (kV) radiotherapy in the UK: installed equipment, clinical workload, physics quality control and radiation dosimetry},
  journal = {The British Journal of Radiology},
  publisher = {British Institute of Radiology},
  year = {2016},
  volume = {89},
  number = {1068},
  pages = {20160641},
  doi = {https://doi.org/10.1259/bjr.20160641}
}
Nyathi, T., Colyer, C., Bhardwaj, A.K., Rijken, J. and Morton, J. Post-upgrade testing on a radiotherapy oncology information system with an embedded record and verify system following the IAEA Human Health Report No. 7 recommendations 2016 Physica medica
Vol. 32(6), pp. 854-858 
article DOI  
Abstract: Record and verify (R&V) systems have proven that their application in radiotherapy clinics leads to a significant reduction in mis-treatments of patients. The purpose of this technical note is to share our experience of acceptance testing, commissioning and setting up a quality assurance programme for the MOSAIQ oncology information system and R&V system after upgrading from software version 2.41 to 2.6 in a multi-vendor, multi-site environment. Testing was guided primarily by the IAEA HumanReport No. 7 recommendations, but complemented by other departmental workflow specific tests. To the best of our knowledge, this is the first time successful implementation of the IAEA Human HealthReport Series No. 7 recommendations have been reported in the literature.
Comment: =Verification
=Linac
BibTeX:
@article{Nyathi2016,
  author = {Nyathi, Thulani and Colyer, Christopher and Bhardwaj, Anup Kumar and Rijken, James and Morton, Jason},
  title = {Post-upgrade testing on a radiotherapy oncology information system with an embedded record and verify system following the IAEA Human Health Report No. 7 recommendations},
  journal = {Physica medica},
  publisher = {Elsevier},
  year = {2016},
  volume = {32},
  number = {6},
  pages = {854--858},
  doi = {https://doi.org/10.1016/j.ejmp.2016.05.061}
}
Mohlapholi, M., Mkhize, T. and Moalosi, T. Monitor units comparison between TPS and independent software verification system 2016 Physica medica
Vol. 32, pp. 144 
conference DOI  
Abstract: IntroductionIn radiation therapy, the treatment planning system (TPS) is used to calculate the monitor units (MUs) needed to deliver a prescribed dose. To avoid any potential errors prior to the start of treatment, quality assurance is performed to verify the MUs with an independent verification system. Commercial MU independent check software such as RadCalc (Lifeline Software Inc., v6.2 Build 5.3) can be used to perform independent MU checks for TPS plans. In this study, we compared MUs calculated with the CMS XiO TPS (v5.1) to the MUs calculated by commercial software RadCalc. IntroductionIn radiation therapy, the treatment planning system (TPS) is used to calculate the monitor units (MUs) needed to deliver a prescribed dose. To avoid any potential errors prior to the start of treatment, quality assurance is performed to verify the MUs with an independent verification system. Commercial MU independent check software such as RadCalc (Lifeline Software Inc., v6.2 Build 5.3) can be used to perform independent MU checks for TPS plans. In this study, we compared MUs calculated with the CMS XiO TPS (v5.1) to the MUs calculated by commercial software RadCalc.
Comment: =Evaluation
=Linac
BibTeX:
@conference{Mohlapholi2016,
  author = {Mohlapholi, M. and Mkhize, T. and Moalosi, T.},
  title = {Monitor units comparison between TPS and independent software verification system},
  journal = {Physica medica},
  publisher = {Elsevier},
  year = {2016},
  volume = {32},
  pages = {144},
  doi = {https://doi.org/10.1016/j.ejmp.2016.07.020}
}
Kosztyla, R., Pierce, G., Ploquin, N., Roumeliotis, M. and Schinkel, C. Verification of Monitor Unit Calculations for Breast Field-In-Field Three-Dimensional Conformal Radiotherapy Plans 2016 Medical Physics
Vol. 43(8Part2), pp. 4940-4941 
conference DOI  
Abstract: To determine the source of systematic monitor unit (MU) calculation discrepancies between RadCalc and Eclipse treatment planning software for three-dimensional conformal radiotherapy field-in-field breast treatments. Methods: Data were reviewed for 28 patients treated with a field-in-field breast technique with MU calculations from RadCalc that were larger than MU calculations from Eclipse for at least one field. The distance of the calculation point from the jaws was measured in each field's beam's-eye-view and compared with the percentage difference in MU (%ΔMU) between RadCalc and Eclipse. 10×10, 17×13 and 20×20 cm2 beam profiles were measured using the Profiler 2 diode array for 6-MV photon beams and compared with profiles calculated with Eclipse and RadCalc using a gamma analysis (3%, 3 mm). Results: The mean %ΔMU was 1.3%±0.3%. There was a statistically-significant correlation between %ΔMU and the distance of the calculation point from the Y jaw (r=−0.43, p<0.001). RadCalc profiles differed from measured profiles, especially near the jaws. The gamma pass rate for 6-MV fields of 17×13 cm2 field size was 95%±1% for Eclipse-generated profiles and 53%±20% for RadCalc-generated profiles (p=0.01). Conclusions: Calculations using RadCalc for field-in-field breast plans resulted in MUs that were larger than expected from previous clinical experience with wedged plans with calculation points far from the jaws due to the position of the calculation point near the jaws in the beam's-eye-view of each field.
Comment: =Evaluation
=Linac
BibTeX:
@conference{Kosztyla2016,
  author = {Kosztyla, Robert and Pierce, Greg and Ploquin, Nicolas and Roumeliotis, Michael and Schinkel, Colleen},
  title = {Verification of Monitor Unit Calculations for Breast Field-In-Field Three-Dimensional Conformal Radiotherapy Plans},
  journal = {Medical Physics},
  year = {2016},
  volume = {43},
  number = {8Part2},
  pages = {4940-4941},
  doi = {https://doi.org/10.1118/1.4961795}
}
Kainz, K., Prah, D., Ahunbay, E. and Li, X.A. Clinical experience with planning, quality assurance, and delivery of burst-mode modulated arc therapy 2016 Journal of Applied Clinical Medical Physics
Vol. 17(5), pp. 47-59 
article DOI  
Abstract: "Burst-mode" modulated arc therapy (hereafter referred to as (mARC) is a form of volumetric-modulated arc therapy characterized by variable gantry rotation speed, static MLCs while the radiation beam is on, and MLC repositioning while the beam is off. We present our clinical experience with the planning techniques and plan quality assurance measurements of mARC delivery. Clinical mARC plans for five representative cases (prostate, low-dose-rate brain, brain with partial-arc vertex fields, pancreas, and liver SBRT) were generated using a Monte Carlo?based treatment planning system. A conventional-dose-rate flat 6 MV and a high-dose-rate non-flat 7 MV beam are available for planning and delivery. mARC plans for intact-prostate cases can typically be created using one 360° arc, and treatment times per fraction seldom exceed 6 min using the flat beam; using the nonflat beam results in slightly higher MU per fraction, but also in delivery times less than 4 min and with reduced mean dose to distal organs at risk. mARC also has utility in low-dose-rate brain irradiation; mARC fields can be designed which deliver a uniform 20 cGy dose to the PTV in approximately 3-minute intervals, making it a viable alternative to conventional 3D CRT. For brain cases using noncoplanar arcs, delivery time is approximately six min using the nonflat beam. For pancreas cases using the nonflat beam, two overlapping 360° arcs are required, and delivery times are approximately 10 min. For liver SBRT, the time to deliver 800 cGy per fraction is at least 12 min. Plan QA measurements indicate that the mARC delivery is consistent with the plan calculation for all cases. mARC has been incorporated into routine practice within our clinic; currently, on average approximately 15 patients per day are treated using mARC; and with the exception of LDR brain cases, all are treated using the nonflat beam.
Comment: =Verification
=Linac
=MC
BibTeX:
@article{Kainz2016,
  author = {Kainz, Kristofer and Prah, Douglas and Ahunbay, Ergun and Li, X. Allen},
  title = {Clinical experience with planning, quality assurance, and delivery of burst-mode modulated arc therapy},
  journal = {Journal of Applied Clinical Medical Physics},
  publisher = {John Wiley & Sons, Ltd},
  year = {2016},
  volume = {17},
  number = {5},
  pages = {47--59},
  doi = {https://doi.org/10.1120/jacmp.v17i5.6253}
}
Hu, Y., Lambert, J.A. and Wang, Y. Comparison of two programs in calculating electron output factors at extended source-surface distances. 2016 Journal of Medical Physics
Vol. 41, pp. 58-64 
article DOI  
Abstract: Monitor units (MUs) calculated by radiotherapy treatment planning systems need to be verified independently. At extended source-surface distances (SSDs), different output factors (OFs) can be given by different independent MU checking packages due to the calculation methods used and assumptions made within them. The accuracy of two software packages - RadCalc(®) (LifeLine Software Inc., Austin, USA) and eDatabook (Y. Wang, Radiation Oncology Institute, Sydney, AUS) - was determined by comparing the calculated OFs directly to measured OFs for a series of standard electron cutouts on an Elekta Synergy linear accelerator at standard and extended SSDs (100 cm and above). For the majority of the measurements made, eDatabook provided OFs closer to the measured value than RadCalc; however, in two cases, eDatabook was unable to provide a factor. RadCalc failed to calculate the OFs accurately at extended SSDs as its calculation is based on the assumption that the established effective-SSD curve can accurately predict the data where there are no measurements available. The accuracy of eDatabook is due to its use of a linear interpolation to determine the OF at an extended SSD when there are no measurement data available.
Comment: =Evaluation
=Linac
BibTeX:
@article{Hu2016a,
  author = {Hu, Yunfei and Lambert, Jonathan Andrew and Wang, Yang},
  title = {Comparison of two programs in calculating electron output factors at extended source-surface distances.},
  journal = {Journal of Medical Physics},
  year = {2016},
  volume = {41},
  pages = {58--64},
  doi = {https://doi.org/10.4103/0971-6203.177283}
}
Hu, Y., Archibald-Heeren, B., Byrne, M. and Wang, Y. An assessment on the use of RadCalc to verify Raystation Electron Monte Carlo plans. 2016 Australasian physical & engineering sciences in medicine
Vol. 39, pp. 735-745 
article DOI  
Abstract: Large differences in monitor units have been observed when RadCalc, a pencil-beam-algorithm based software, is used to verify clinical electron plans from Raystation, a Monte-Carlo-algorithm based planning system. To investigate the problem, a number of clinical plans as well as test plans were created and calculated in both systems, with the resultant monitor units compared. The results revealed that differences between the two systems are significant when the geometry includes inhomogeneities and curved surfaces. The RadCalc pencil-beam-algorithm fails to handle such complexities, particularly in the presence of surface curvature. The error is not negligible and cannot be easily corrected for. It is concluded that RadCalc is not adequate to verify electron Monte Carlo plans from Raystation when complex geometry is involved and alternative methods should be developed.
Comment: =Evaluation
=Linac
=MC
BibTeX:
@article{Hu2016,
  author = {Hu, Yunfei and Archibald-Heeren, Ben and Byrne, Mikel and Wang, Yang},
  title = {An assessment on the use of RadCalc to verify Raystation Electron Monte Carlo plans.},
  journal = {Australasian physical & engineering sciences in medicine},
  year = {2016},
  volume = {39},
  pages = {735--745},
  doi = {https://doi.org/10.1007/s13246-016-0470-x}
}
Hardin, M., To, D., Giaddui, T., Li, J., Yu, Y. and Harrison, A. Analysis of Three QA Methods for Predicting Dose Deviation Pass Percentage for Lung SBRT VMAT Plans 2016 Medical Physics
Vol. 43(6Part19), pp. 3552-3552 
conference DOI  
Abstract: To investigate the significance of using pinpoint ionization chambers (IC) and RadCalc (RC) in determining the quality of lung SBRT VMAT plans with low dose deviation pass percentage (DDPP) as reported by ScandiDos Delta4 (D4). To quantify the relationship between DDPP and point dose deviations determined by IC (ICDD), RadCalc (RCDD), and median dose deviation reported by D4 (D4DD). Methods: Point dose deviations and D4 DDPP were compiled for 45 SBRT VMAT plans. Eighteen patients were treated on Varian Truebeam linear accelerators (linacs); the remaining 27 were treated on Elekta Synergy linacs with Agility collimators. A one-way analysis of variance (ANOVA) was performed to determine if there were any statistically significant differences between D4DD, ICDD, and RCDD. Tukey's test was used to determine which pair of means was statistically different from each other. Multiple regression analysis was performed to determine if D4DD, ICDD, or RCDD are statistically significant predictors of DDPP. Results: Median DDPP, D4DD, ICDD, and RCDD were 80.5% (47.6%–99.2%), −0.3% (−2.0%–1.6%), 0.2% (−7.5%–6.3%), and 2.9% (−4.0%–19.7%), respectively. The ANOVA showed a statistically significant difference between D4DD, ICDD, and RCDD for a 95% confidence interval (p < 0.001). Tukey's test revealed a statistically significant difference between two pairs of groups, RCDD-D4DD and RCDD-ICDD (p < 0.001), but no difference between ICDD-D4DD (p = 0.485). Multiple regression analysis revealed that ICDD (p = 0.04) and D4DD (p = 0.03) are statistically significant predictors of DDPP with an adjusted r2 of 0.115. Conclusion: This study shows ICDD predicts trends in D4 DDPP; however this trend is highly variable as shown by our low r2. This work suggests that ICDD can be used as a method to verify DDPP in delivery of lung SBRT VMAT plans. RCDD may not validate low DDPP discovered in D4 QA for small field SBRT treatments.
Comment: =Evaluation
=Linac
BibTeX:
@conference{Hardin2016,
  author = {Hardin, M and To, D and Giaddui, T and Li, J and Yu, Y and Harrison, A},
  title = {Analysis of Three QA Methods for Predicting Dose Deviation Pass Percentage for Lung SBRT VMAT Plans},
  journal = {Medical Physics},
  year = {2016},
  volume = {43},
  number = {6Part19},
  pages = {3552-3552},
  doi = {https://doi.org/10.1118/1.4956571}
}
Hardcastle, N., Oborn, B.M. and Haworth, A. On the use of a convolution-superposition algorithm for plan checking in lung stereotactic body radiation therapy. 2016 Journal of applied clinical medical physics
Vol. 17, pp. 99-110 
article DOI  
Abstract: Stereotactic body radiation therapy (SBRT) aims to deliver a highly conformal ablative dose to a small target. Dosimetric verification of SBRT for lung tumors presents a challenge due to heterogeneities, moving targets, and small fields. Recent software (M3D) designed for dosimetric verification of lung SBRT treatment plans using an advanced convolution-superposition algorithm was evaluated. Ten lung SBRT patients covering a range of tumor volumes were selected. 3D CRT plans were created using the XiO treatment planning system (TPS) with the superposition algorithm. Dose was recalculated in the Eclipse TPS using the AAA algorithm, M3D verification software using the collapsed-cone-convolution algorithm, and in-house Monte Carlo (MC). Target point doses were calculated with RadCalc software. Near-maximum, median, and near-minimum target doses, conformity indices, and lung doses were compared with MC as the reference calculation. M3D 3D gamma passing rates were compared with the XiO and Eclipse. Wilcoxon signed-rank test was used to compare each calculation method with XiO with a threshold of significance of p < 0.05. M3D and RadCalc point dose calculations were greater than MC by up to 7.7% and 13.1%, respectively, with M3D being statistically significant (s.s.). AAA and XiO calculated point doses were less than MC by 11.3% and 5.2%, respectively (AAA s.s.). Median and near-minimum and near-maximum target doses were less than MC when calculated with AAA and XiO (all s.s.). Near-maximum and median target doses were higher with M3D compared with MC (s.s.), but there was no difference in near-minimum M3D doses compared with MC. M3D-calculated ipsilateral lung V20 Gy and V5 Gy were greater than that calculated with MC (s.s.); AAA- and XiO-calculated V20 Gy was lower than that calculated with MC, but not statistically different to MC for V5 Gy. Nine of the 10 plans achieved M3D gamma passing rates greater than 95% and 80%for 5%/1 mm and 3%/1 mm criteria, respectively. M3D typically calculated a higher target and lung dose than MC for lung SBRT plans. The results show a range of calculated doses with different algorithms and suggest that M3D is in closer agree-ment with Monte Carlo, thus discrepancies between the TPS and M3D software will be observed for lung SBRT plans. M3D provides a useful supplement to verification of lung SBRT plans by direct measurement, which typically excludes patient specific heterogeneities.
Comment: =Evaluation
=Linac
=MC
BibTeX:
@article{Hardcastle2016,
  author = {Hardcastle, Nicholas and Oborn, Bradley M. and Haworth, Annette},
  title = {On the use of a convolution-superposition algorithm for plan checking in lung stereotactic body radiation therapy.},
  journal = {Journal of applied clinical medical physics},
  year = {2016},
  volume = {17},
  pages = {99--110},
  doi = {https://doi.org/10.1120/jacmp.v17i5.6186}
}
Goyal, U., Locke, A., Smith-Raymond, L. and Georgiev, G.N. Simple shielding reduces dose to the contralateral breast during prone breast cancer radiotherapy 2016 Medical Dosimetry
Vol. 41(2), pp. 159-165 
article DOI  
Abstract: Our goal was to design a prone breast shield for the contralateral breast and study its efficacy in decreasing scatter radiation to the contralateral breast in a prone breast phantom setup receiving radiation therapy designed for breast cancer. We constructed a prone breast phantom setup consisting of (1) A thermoplastic mask with a left-sided depression created by a water balloon for a breast shape; (2) 2 plastic bags to hold water in the thermoplastic mask depression; (3) 2000mL of water to fill the thermoplastic mask depression to create a water-based false breast; (4) 1-cm thick bolus placed in the contralateral breast holder; (5) 2 lead (Pb) sheets, each 0.1-cm thick for blocking scatter radiation in the contralateral bolus-based false breast; (6) a prone breast board to hold the thermoplastic mask, water, bolus, and lead; (7) 9cm solid water on top of the breast board to simulate body; (8) a diode was used to verify dose for each treatment field of the treated water-based breast; (9) metal?oxide?semiconductor-field effect transistor (MOSFET) dosimeters to measure dose to the contralateral bolus-based breast. The phantom prone breast setup was CT simulated and treatment was designed with 95% isodose line covering the treated breast. The maximum dose was 107.1%. Megavoltage (MV) port images ensured accurate setup. Measurements were done using diodes on the treated water-based breast and MOSFET dosimeters at the medial and lateral sides of the contralateral bolus-based breast without and with the Pb shield. Five treatments were done for each of the 3 data sets and recorded individually for statistical purposes. All treatments were completed with 6MV photons at 200cGy per treatment. The dose contributions from each of the 3 data sets including 15 treatments total without and with the prone lead shield to the medial and lateral portions of contralateral bolus-based breast were averaged individually. Unshielded dose means were 37.11 and 2.94cGy, and shielded dose means were 12.68 and 1.54cGy, respectively. When comparing medial and lateral portions of the contralateral bolus-based doses without and with Pb, the shield significantly reduced dose to both sides of the contralateral breast (medial p = 2.64 ? 10?14, lateral p = 4.91 ? 10?6). The prone 0.2-cm Pb shield significantly reduced scatter dose to the contralateral breast on the order of 2 to 3 times. Reductions may be clinically relevant for women younger than 45 years by decreasing the risk of contralateral radiation-induced breast cancer in patients receiving radiation therapy for breast cancer. This shield is simple as it would be a part of the prone breast board during treatments, but future studies are warranted for safety and efficacy clinically.
Comment: =Verification
=Linac
BibTeX:
@article{Goyal2016,
  author = {Goyal, Uma and Locke, Angela and Smith-Raymond, Lexie and Georgiev, Georgi N.},
  title = {Simple shielding reduces dose to the contralateral breast during prone breast cancer radiotherapy},
  journal = {Medical Dosimetry},
  publisher = {Elsevier},
  year = {2016},
  volume = {41},
  number = {2},
  pages = {159--165},
  doi = {https://doi.org/10.1016/j.meddos.2015.12.001}
}
Gillespie, S. and Woulfe, P. Commissioning an Elekta Versa HD linear accelerator 2016 Physica medica
Vol. 32(7), pp. 954 
conference DOI  
Abstract: The Versa HD not only brought kV image guided radiotherapy to our department, it also enabled the department to offer VMAT and high dose-rate (FFF) treatments. This study describes the dosimetric aspects of commissioning performed on an Elekta Versa HD for both flattened & FFF photon modes. Photon PDD & profiles agreed well with expected values as per the acceptance testing protocol/literature. The PDDs of 6 MV FFF and 10 MV FFF beams show deeper dmax and steeper falloff with depth than the corresponding flattened beams. While flatness values of 6 MV FFF and 10 MV FFF profiles were expectedly higher than the corresponding flattened beams while the symmetry values were remained similar. Photon data was modelled in Pinnacle TPS. Verification consisted of point dose measurements, profile analysis using PTW?s 2D Array/Verisoft software and a phantom study (solid, air and lung inserts). Two interdepartmental independent dose audits were carried out along with an alanine postal audit (NPL) and MD Anderson Prostate & Head SRS audits for extended verification of the pinnacle models. 6MV VMAT planning was investigated using Pinnacle?s Smartarc solution which yielded at least equivalent if not more favourable results whilst reducing treatment time. Patient Specific VMAT QA of treatment plans were carried out with PTW OCTAVIUS 4D/Verisoft Software in conjunction with Radcalc Monitor Unit Calculation Software. All planning/delivery combinations showed good agreement with >95% pixels passing ?<1 at 3%/3mm. Similar results in terms of planning/verification agreement were obtained with 6MV FFF VMAT plans.
Comment: =Verification
=Linac
BibTeX:
@conference{Gillespie2016,
  author = {Gillespie, Sean and Woulfe, Peter},
  title = {Commissioning an Elekta Versa HD linear accelerator},
  journal = {Physica medica},
  publisher = {Elsevier},
  year = {2016},
  volume = {32},
  number = {7},
  pages = {954},
  doi = {https://doi.org/10.1016/j.ejmp.2016.05.031}
}
Deufel, C.L., Furutani, K.M., Dahl, R.A. and Haddock, M.G. Automated construction of an intraoperative high-dose-rate treatment plan library for the Varian brachytherapy treatment planning system 2016 Brachytherapy
Vol. 15(4), pp. 531-536 
article DOI  
Abstract: The ability to create treatment plans for intraoperative high-dose-rate (IOHDR) brachytherapy is limited by lack of imaging and time constraints. An automated method for creation of a library of high-dose-rate brachytherapy plans that can be used with standard planar applicators in the intraoperative setting is highly desirable. METHODS AND MATERIALS: Nonnegative least squares algebraic methods were used to identify dwell time values for flat, rectangular planar applicators. The planar applicators ranged in length and width from 2 cm to 25 cm. Plans were optimized to deliver an absorbed dose of 10 Gy to three different depths from the patient surface: 0 cm, 0.5 cm, and 1.0 cm. Software was written to calculate the optimized dwell times and insert dwell times and positions into a .XML plan template that can be imported into the Varian brachytherapy treatment planning system. The user may import the .XML template into the treatment planning system in the intraoperative setting to match the patient applicator size and prescribed treatment depth. RESULTS: A total of 1587 library plans were created for IOHDR brachytherapy. Median plan generation time was approximately 1 minute per plan. Plan dose was typically 100% ± 1% (mean, standard deviation) of the prescribed dose over the entire length and width of the applicator. Plan uniformity was best for prescription depths of 0 cm and 0.5 cm from the patient surface. CONCLUSIONS: An IOHDR plan library may be created using automated methods. Thousands of plan templates may be optimized and prepared in a few hours to accommodate different applicator sizes and treatment depths and reduce treatment planning time. The automated method also enforces dwell time symmetry for symmetrical applicator geometries, which simplifies quality assurance.
Comment: =Promotion
=BT
BibTeX:
@article{Deufel2016,
  author = {Christopher L. Deufel and Keith M. Furutani and Robert A. Dahl and Michael G. Haddock},
  title = {Automated construction of an intraoperative high-dose-rate treatment plan library for the Varian brachytherapy treatment planning system},
  journal = {Brachytherapy},
  publisher = {Elsevier BV},
  year = {2016},
  volume = {15},
  number = {4},
  pages = {531--536},
  doi = {https://doi.org/10.1016/j.brachy.2016.04.001}
}
Béliveau-Nadeau, D., Callejo, S. and Roberge, D. Technique for Robotic Stereotactic Irradiation of Choroidal Melanoma 2016 Cureus  article DOI  
Abstract: Radiotherapy has a long history in the organ-sparing management of choroidal melanoma. Joining plaque radiotherapy and proton irradiation, stereotactic robotic photon irradiation is a new tool in the radiation oncologist’s armamentarium for ocular tumors. The non-coplanar fields with steep dose gradients are well suited to spare uninvolved retina, anterior chamber, and the optic nerve. In our practice, it is the preferred treatment for melanomas that are non-amenable to standard plaque brachytherapy. Since late 2010, we have treated more than 40 patients with our robotic linear accelerator. This case-based technical note outlines the technique used at the University of Montreal, Montreal, Canada.
Comment: =Verification
=CK
BibTeX:
@article{BeliveauNadeau2016,
  author = {Dominic Béliveau-Nadeau and Sonia Callejo and David Roberge},
  title = {Technique for Robotic Stereotactic Irradiation of Choroidal Melanoma},
  journal = {Cureus},
  publisher = {Cureus, Inc.},
  year = {2016},
  doi = {https://doi.org/10.7759/cureus.582}
}
Ates, O., Ahunbay, E., Chen, G., Lawton, C. and Li, X. Clinical Implementation of An Online Replanning Process 2016 Medical Physics
Vol. 43(6Part38), pp. 3786-3786 
conference DOI  
Abstract: The purpose of this study is to report the clinical implementation of an online replanning process with CT-on-Rails to address daily interfractional variations. Methods: A treatment planning package (MONACO/ADMIRE/MOSAIQ, Elekta) is used to perform online adaptive replanning, using segment aperture morphing (SAM) algorithm implemented in MONACO, based on daily CTs acquired from a CT-on-Rails (ARTISTE, Siemens). The online replanning is implemented in prostate RT in the following workflow:(1) Generating a target contour based on the image of the day, using ADMIRE deformable image registration software with manual editing if necessary; (2) Automatically modifying segment apertures from the original plan using the SAM algorithm to account for the changes in the target from planning to daily CTs including deformation; (3) Calculating the dose distribution for the new apertures with the same MUs as in the original plan;(4) Transferring the new plan into MOSAIQ Record & Verify system;(5) Performing a pre-delivery QA using both our home-grown and RADCALC software (LifeLine);(6) Delivering the adaptive plan for the fraction.The entire workflow takes <10 min. using a 16-CPU hardware. Results: The online adaptive replanning process was successfully applied during RT for prostate cancers. The adaptive plan significantly improved the plan quality in both target coverage and organs-at-risk (OAR) sparing when compared to the current standard of practice; IGRT repositioning plan. For the average of 10 prostate cases, PTV-V100, Rectum-V70, and Bladder-V45 (%) coverages were (92.84 ± 1.61/97.61 ± 1.45/98.85 ± 1.13), (6.76 ± 2.37/5.40 ± 2.61/3.52 ± 0.94) and (8.20 ± 3.55/5.72 ± 2.61/6.68 ± 3.21) for the IGRT, online SAM, and reoptimization plans, respectively. Conclusion: The online adaptive replanning workflow is clinically practical for prostate RT and can quickly generate adaptive plans with superior plan qualities when compared to the repositioning plans, improving the management of interfractional variations. This study was partially supported by Elekta Inc.
Comment: =Verification
=Linac
BibTeX:
@conference{Ates2016,
  author = {Ates, O and Ahunbay, E and Chen, G and Lawton, C and Li, X},
  title = {Clinical Implementation of An Online Replanning Process},
  journal = {Medical Physics},
  year = {2016},
  volume = {43},
  number = {6Part38},
  pages = {3786-3786},
  doi = {https://doi.org/10.1118/1.4957701}
}
AlMohammed, H. Pretreatment Dose Verification for Squamous Cell carcinoma of The Tongue 2016 Journal of Nuclear Medicine & Radiation Therapy
Vol. 07(01) 
article DOI  
Abstract: The aim of this study is to assess and to evaluate the significant of performing patient’s specification qualityassurance (QA) for patients diagnosed with squamous cell carcinoma of the tongue (SCC) whom treated withintensity modulated radiation therapy (IMRT). The study was done in ten pre- treatment’s plans that been preparedfor patients. All the ten selected plans are going to be treated with split-field (SF) technique for intensity modulatedradiation therapy (IMRT) planning using 10 MV beams and a prescribed dose between 66Gy and 74 Gy. For qualityassurance protocol we are using the two-dimensional ionization-chamber array. The study showed that anagreement between the measured dose and the pre-planned dose using the treatment planning system. All theplans passed >95% Gamma with the pixels that within 5% distance to agreement of 5 mm for IMRT patient-specificquality assurance (QA). It concludes that intensity modulated radiation therapy (IMRT) has the ability to deliver ahighly conformal dose distribution to the planning target volume (PTV) while sparing the organs at risk in thesurrounding area. The result showed a very good agreement between measurements dose and calculations dosewhich proven that the IMRT patient-specific quality assurance (QA) that we used is accurate and sophisticated to beused.
Comment: =Verification
=Linac
BibTeX:
@article{AlMohammed2016,
  author = {Huda AlMohammed},
  title = {Pretreatment Dose Verification for Squamous Cell carcinoma of The Tongue},
  journal = {Journal of Nuclear Medicine & Radiation Therapy},
  publisher = {OMICS Publishing Group},
  year = {2016},
  volume = {07},
  number = {01},
  doi = {https://doi.org/10.4172/2155-9619.1000279}
}
Tuazon, B., Narayanasamy, G., Kirby, N., Mavroidis, P., Papanikolaou, N. and Stathakis, S. Evaluation and Comparison of Second-Check Monitor Unit Calculation Software with Pinnacle Treatment Planning System 2015 Medical Physics
Vol. 42(6Part17), pp. 3419-3419 
conference DOI  
Abstract: The purpose of this study was to evaluate and compare the accuracy of dose calculation algorithms in the second check software programs Radcalc, Diamond, IMSure, and MUcheck, against the Pinnacle3 treatment planning system (TPS). Methods: Baseline accuracy of the second check software was established by comparison against Pinnacle TPS data using open square fields of 5, 10, 20, 30 and 40cm in a SAD setup. 18 previously treated patients’ files were exported from the Pinnacle3 TPS to each of the four second check softwares, consisting of 146 step and shoot intensity modulated radiotherapy (IMRT) beams and 60 Smart Arcs. Monitor unit (MU) calculated in each of the software were compared with the TPS and the values were represented as a percent difference. Open fields were calculated as a baseline for each software's accuracy using 5×5, 10×10, 20×20, 30×30, and 40×40 fields. Box plots, Pearson correlation, and Bland-Altman analysis were used for comparison of the results. Results: The baseline accuracy was established to within 0.6%, −1.4%, −0.2%, and −1.0% for Diamond, IMSure,MUcheck, and Radcalc, respectively. In the clinical data, the dose difference represented as mean ± 1 standard deviation were 0.7%±0.1%, −0.3%±0.1%, −1.5%±0.1%, and 0.4%±0.0% for Diamond, IMSure, MUcheck, and Radcalc, respectively Conclusion: The implementation of Clarkson algorithm for the dose calculation between each of the software in question can vary considerably. The currently used second check software, Radcalc has shown the best agreement on average, variance, and smallest percent range from Pinnacle3 TPS values. The closest in average percent difference from the TPS data was the IMSure software, but has significantly larger variance and percent range. The mean percent differences in Diamond and MUcheck were significantly larger than Radcalc and IMSure.
Comment: =Evaluation
=Linac
BibTeX:
@conference{Tuazon2015,
  author = {Tuazon, B and Narayanasamy, G and Kirby, N and Mavroidis, P and Papanikolaou, N and Stathakis, S},
  title = {Evaluation and Comparison of Second-Check Monitor Unit Calculation Software with Pinnacle Treatment Planning System},
  journal = {Medical Physics},
  year = {2015},
  volume = {42},
  number = {6Part17},
  pages = {3419-3419},
  doi = {https://doi.org/10.1118/1.4924733}
}
Park, J.C., Li, J.G., Arhjoul, L., Yan, G., Lu, B., Fan, Q. and Liu, C. Adaptive beamlet-based finite-size pencil beam dose calculation for independent verification of IMRT and VMAT 2015 Medical Physics
Vol. 42(4), pp. 1836-1850 
article DOI  
Abstract: The use of sophisticated dose calculation procedure in modern radiation therapy treatment planning is inevitable in order to account for complex treatment fields created by multileaf collimators (MLCs). As a consequence, independent volumetric dose verification is time consuming, which affects the efficiency of clinical workflow. In this study, the authors present an efficient adaptive beamlet-based finite-size pencil beam (AB-FSPB) dose calculation algorithm that minimizes the computational procedure while preserving the accuracy. METHODS: The computational time of finite-size pencil beam (FSPB) algorithm is proportional to the number of infinitesimal and identical beamlets that constitute an arbitrary field shape. In AB-FSPB, dose distribution from each beamlet is mathematically modeled such that the sizes of beamlets to represent an arbitrary field shape no longer need to be infinitesimal nor identical. As a result, it is possible to represent an arbitrary field shape with combinations of different sized and minimal number of beamlets. In addition, the authors included the model parameters to consider MLC for its rounded edge and transmission. RESULTS: Root mean square error (RMSE) between treatment planning system and conventional FSPB on a 10 × 10 cm(2) square field using 10 × 10, 2.5 × 2.5, and 0.5 × 0.5 cm(2) beamlet sizes were 4.90%, 3.19%, and 2.87%, respectively, compared with RMSE of 1.10%, 1.11%, and 1.14% for AB-FSPB. This finding holds true for a larger square field size of 25 × 25 cm(2), where RMSE for 25 × 25, 2.5 × 2.5, and 0.5 × 0.5 cm(2) beamlet sizes were 5.41%, 4.76%, and 3.54% in FSPB, respectively, compared with RMSE of 0.86%, 0.83%, and 0.88% for AB-FSPB. It was found that AB-FSPB could successfully account for the MLC transmissions without major discrepancy. The algorithm was also graphical processing unit (GPU) compatible to maximize its computational speed. For an intensity modulated radiation therapy (∼12 segments) and a volumetric modulated arc therapy fields (∼90 control points) with a 3D grid size of 2.0 × 2.0 × 2.0 mm(3), dose was computed within 3-5 and 10-15 s timeframe, respectively. CONCLUSIONS: The authors have developed an efficient adaptive beamlet-based pencil beam dose calculation algorithm. The fast computation nature along with GPU compatibility has shown better performance than conventional FSPB. This enables the implementation of AB-FSPB in the clinical environment for independent volumetric dose verification.
Comment: =Promotion
=Linac
BibTeX:
@article{Park2015,
  author = {Justin C. Park and Jonathan G. Li and Lahcen Arhjoul and Guanghua Yan and Bo Lu and Qiyong Fan and Chihray Liu},
  title = {Adaptive beamlet-based finite-size pencil beam dose calculation for independent verification of IMRT and VMAT},
  journal = {Medical Physics},
  publisher = {Wiley},
  year = {2015},
  volume = {42},
  number = {4},
  pages = {1836--1850},
  doi = {https://doi.org/10.1118/1.4914858}
}
Monroe, J. and Bull, C. Study of Dosimetric Leaf Gap and Transmission Factor Variations Affecting Common Clinical QA Tools 2015 Medical Physics
Vol. 42(6Part23), pp. 3500-3500 
conference DOI  
Abstract: To determine if clinical variations in the Dosimetric Leaf Gap (DLG) or Transmission Factor (TF) are detectable in a 3D secondary calculation, 1D secondary calculation, log file-based analysis or hardware-based quality assurance of realistic patient plans. Methods: DLG values and TF values were selected based on clinical surveys of 17 clinics. The minimum, maximum, and representative values were used in the generation of 30 6MV plans. Six patients were created in Eclipse 11 and planned for three sites: SBRT Lung, Prostate, and Prostate with Lymph Nodes(P/S/L). Each site was planned utilizing two different techniques: IMRT and VMAT. Variations in the DLG used were 0.02cm, 0.1748cm, 0.17208cm (SBRT), and 0.2cm while holding the TF at 0.015 and 0.0148 (SBRT). The TF values used were 0.0135, 0.015, 0.0148 (SBRT), and 0.0215 while holding the DLG at 0.1748cm or 0.17208cm(SBRT).Plans used the Analytic Anisotropic Algorithm. Consistency in planning included controlling objectives, iterations, priorities, and normalizations. Plans were delivered on a Varian Trilogy with Millennium 120 MLCs. Plans were analyzed with: Mobius3D using Collapsed Cone Convolution/Superposition Algorithm (CCCS) reference beam model, RadCalc using a modified Clarkson scatter integration lookup tables, a gantry-mounted MapCHECK2 using a 2-D diode array, and MobiusFX log file-based CCCS analysis. Gamma analysis in Mobius3D, MobiusFX, and MapCHECK2 used a gamma criteria of 95%/3%/3mm. No efforts were made to improve any outcome by searching for improved agreement. Results: The prostate IMRT plans were not affected by any variation. IMRT Lung showed mixed results. VMAT Prostate plans were not affected. The VMAT P/S/L was flagged by Mobius3D and Fx, while the VMAT Lung DLG 0.02cm was flagged by RadCalc as well as the IMRT Lung TF=0.0215. Conclusion: The variations in clinical DLG values and TF values were only detectable in extreme cases (DLG=0.02cm or TF=0.0215) in a few select plan variations tested here. Mobius Systems supplied by Mobius Medical, LP. C Bull is an employee of Mobius Medical, LP
Comment: =Verification
=Linac
BibTeX:
@conference{Monroe2015,
  author = {Monroe, J and Bull, C},
  title = {Study of Dosimetric Leaf Gap and Transmission Factor Variations Affecting Common Clinical QA Tools},
  journal = {Medical Physics},
  year = {2015},
  volume = {42},
  number = {6Part23},
  pages = {3500-3500},
  doi = {https://doi.org/10.1118/1.4925074}
}
Loria, D., Mzenda, B. and Sims R Hutton, D. Commissioning and clinical implementation of raystation v4.0.3.4 electron Monte Carlo 2015 Australasian Physical & Engineering Sciences in Medicine
Vol. 39(1), pp. 259-354 
conference DOI  
Abstract: Currently, our electron patients are treated based on the square root cutout factor method in RadCalc. This method predicts output factors of the rectangular fields from the measured square field output factors. Although this method was shown to be accurate for rectangular fields, this is not CT-based to account for density variations or inhomogeneities and does not give any dose distribution information. Raystation TPS uses Electron Monte Carlo (EMC) calculation on image based datasets. To assess the EMC beam model, several tests were performed based on TG252 for 6, 9, and 12 MeV for 3 matched Elekta machines at 100 cm and 110 cm SSD. The mechanical jaw parameters were verified against the reference machine. The output factors, PDDs and profiles for open and irregular fields as well as oblique incidence were compared to water tank measurements. The TPS dose for several bolus setups, inhomogeneities and clinical plans were compared to diode measurements. Photon-electron junctions were compared using film dosimetry. Gamma analysis was done using MartriXX 2D array for all profiles and clinical plans then further analyzed with an in-house 1D spreadsheet. Transfer of TPS plans to Mosaiq and RadCalc was successful with acceptable workarounds. All point dose comparisons at dmax were within 5 % tolerance. All 2D gamma analyses measured at dmax were[95 %. Some profiles, particularly for large fields, will require improvement in subsequent model revisions due to penumbral mismatches as found in the 1D gamma analysis. The Electron Monte Carlo module within Raystation v.4.0.3.4 is acceptable for clinical use with minor issues that has been reported to Raysearch for future version enhancements.
Comment: =Verification
=Linac
=MC
BibTeX:
@conference{Loria2015b,
  author = {Loria, D and Mzenda, B and Sims, R Hutton, D},
  title = {Commissioning and clinical implementation of raystation v4.0.3.4 electron Monte Carlo},
  journal = {Australasian Physical & Engineering Sciences in Medicine},
  publisher = {Springer Science and Business Media LLC},
  year = {2015},
  volume = {39},
  number = {1},
  pages = {259--354},
  doi = {https://doi.org/10.1007/s13246-015-0410-1}
}
Itano, M., Yamazaki, T., Yamashita, M., Ishibashi, S., Higuchi, Y., Kosaka, M., Kobayashi, N. and Tachibana, H. Impact of Different Independent Dose Verification Software Programs for Secondary Check 2015 Medical Physics
Vol. 42(6Part19), pp. 3439-3439 
conference DOI  
Abstract: There have been many reports for different dose calculation algorithms for treatment planning system (TPS). Independent dose verification program (IndpPro) is essential to verify clinical plans from the TPS. However, the accuracy of different independent dose verification programs was not evident. We conducted a multi-institutional study to reveal the impact of different IndpPros using different TPSs. Methods: Three institutes participated in this study. They used two different IndpPros (RADCALC and Simple MU Analysis (SMU), which implemented the Clarkson algorithm. RADCALC needed the input of radiological path length (RPL) computed by the TPSs (Eclipse or Pinnacle3). SMU used CT images to compute the RPL independently from TPS). An ion-chamber measurement in water-equivalent phantom was performed to evaluate the accuracy of two IndpPros and the TPS in each institute. Next, the accuracy of dose calculation using the two IndpPros compared to TPS was assessed in clinical plan. Results: The accuracy of IndpPros and the TPSs in the homogenous phantom was +/−1% variation to the measurement. 1543 treatment fields were collected from the patients treated in the institutes. The RADCALC showed better accuracy (0.9 ± 2.2 %) than the SMU (1.7 ± 2.1 %). However, the accuracy was dependent on the TPS (Eclipse: 0.5%, Pinnacle3: 1.0%). The accuracy of RADCALC with Eclipse was similar to that of SMU in one of the institute. Conclusion: Depending on independent dose verification program, the accuracy shows systematic dose accuracy variation even though the measurement comparison showed a similar variation. The variation was affected by radiological path length calculation. IndpPro with Pinnacle3 has different variation because Pinnacle3 computed the RPL using physical density. Eclipse and SMU uses electron density, though.
Comment: =Evaluation
=Linac
BibTeX:
@conference{Itano2015,
  author = {Itano, M and Yamazaki, T and Yamashita, M and Ishibashi, S and Higuchi, Y and Kosaka, M and Kobayashi, N and Tachibana, H},
  title = {Impact of Different Independent Dose Verification Software Programs for Secondary Check},
  journal = {Medical Physics},
  year = {2015},
  volume = {42},
  number = {6Part19},
  pages = {3439-3439},
  doi = {https://doi.org/10.1118/1.4924817}
}
Held, M., Sneed, P.K., Fogh, S.E., Pouliot, J. and Morin, O. Feasibility of MV CBCT-based treatment planning for urgent radiation therapy: dosimetric accuracy of MV CBCT-based dose calculations 2015 Journal of Applied Clinical Medical Physics
Vol. 16(6), pp. 458-471 
article DOI  
Abstract: Unlike scheduled radiotherapy treatments, treatment planning time and resources are limited for emergency treatments. Consequently, plans are often simple 2D image-based treatments that lag behind technical capabilities available for nonurgent radiotherapy. We have developed a novel integrated urgent workflow that uses onboard MV CBCT imaging for patient simulation to improve planning accuracy and reduce the total time for urgent treatments. This study evaluates both MV CBCT dose planning accuracy and novel urgent workflow feasibility for a variety of anatomic sites. We sought to limit local mean dose differences to less than 5% compared to conventional CT simulation. To improve dose calculation accuracy, we created separate Hounsfield unit?to?density calibration curves for regular and extended field-of-view (FOV) MV CBCTs. We evaluated dose calculation accuracy on phantoms and four clinical anatomical sites (brain, thorax/spine, pelvis, and extremities). Plans were created for each case and dose was calculated on both the CT and MV CBCT. All steps (simulation, planning, setup verification, QA, and dose delivery) were performed in one 30 min session using phantoms. The monitor units (MU) for each plan were compared and dose distribution agreement was evaluated using mean dose difference over the entire volume and gamma index on the central 2D axial plane. All whole-brain dose distributions gave gamma passing rates higher than 95% for criteria, and pelvic sites ranged between 90% and 98% for criteria. However, thoracic spine treatments produced gamma passing rates as low as 47% for criteria. Our novel MV CBCT-based dose planning and delivery approach was feasible and time-efficient for the majority of cases. Limited MV CBCT FOV precluded workflow use for pelvic sites of larger patients and resulted in image clearance issues when tumor position was far off midline. The agreement of calculated MU on CT and MV CBCT was acceptable for all treatment sites.
Comment: =Verification
=Linac
BibTeX:
@article{Held2015,
  author = {Held, Mareike and Sneed, Penny K. and Fogh, Shannon E. and Pouliot, Jean and Morin, Olivier},
  title = {Feasibility of MV CBCT-based treatment planning for urgent radiation therapy: dosimetric accuracy of MV CBCT-based dose calculations},
  journal = {Journal of Applied Clinical Medical Physics},
  publisher = {John Wiley & Sons, Ltd},
  year = {2015},
  volume = {16},
  number = {6},
  pages = {458--471},
  doi = {https://doi.org/10.1120/jacmp.v16i6.5625}
}
Hardcastle, N., Oborn, B. and Haworth, A. Lung SABR dose calculation verification usinga convolution superposition algorithm 2015 Australasian Physical & Engineering Sciences in Medicine
Vol. 39(1), pp. 259-354 
conference DOI  
Abstract: Stereotactic Ablative Body Radiotherapy (SABR) is an established treatment technique for primary lung tumours and metastases. SABR aims to deliver an ablative, highly conformal dose to the tumour in five or fewer fractions. Dose calculation and subsequent verification in lung SABR is challenging due to large tissue density variations and small fields. A new software (Mobius3D) designed to perform dose calculation verification using an advanced dose calculation algorithm is evaluated for lung SABR. Method Ten lung SABR plans spanning a range of treatment volumes and locations were selected. The treated 3D conformal treatment plans were performed in the XiO treatment planning system (TPS) using the superposition algorithm. Verification of the planned dose was performed with Mobius3D. For comparison, the plans were recalculated in Eclipse TPS using the AAA algorithm, as well as an in-house BEAMnrc Monte Carlo algorithm. Dosimetric parameters relating to target and organ at risk dose were compared between the calculation algorithms. A Wilcoxon signed-rank test was used to compare each method with a threshold of significance of p0.05. Results Calculated point doses in the tumour were greater with Mobius3D, Monte Carlo and RadCalc compared with XiO by up to 12.5, 5.5 and 18.0 % respectively. Near minimum target doses were greater with AAA, Mobius3D and MC compared with XiO by up to 8 %, and near maximum doses were greater than XiO by 11.0 % an 6.5 %respectively. AAA, Mobius3D andMCall calculated higher lung V5 Gy and V20 Gy. All stated results were statistically significant. Conclusion In the ten lung SABR cases considered, significant differences between the TPS and alternate calculation methods were identified. Identifying the true dose in these situations is challenging and clinical judgement is required to evaluate the comparison of results of the TPS and plan verification software.
Comment: =Verification
=Linac
=MC
BibTeX:
@conference{Hardcastle2015,
  author = {Hardcastle, N and Oborn, B and Haworth, A},
  title = {Lung SABR dose calculation verification usinga convolution superposition algorithm},
  journal = {Australasian Physical & Engineering Sciences in Medicine},
  publisher = {Springer Science and Business Media LLC},
  year = {2015},
  volume = {39},
  number = {1},
  pages = {259--354},
  doi = {https://doi.org/10.1007/s13246-015-0410-1}
}
Sashin, V. Dynalog data tool for IMRT plan verification 2014 The Royal Australian and New Zealand College of Radiologists  article DOI  
Abstract: The complexity of IMRT treatments demands a comprehensive quality assurance (QA) program that includes checks and tests performed at different stages of the treatment: simulation, planning and dose delivery. An important component of this QA program is the verification of MLC leaf positions during the plan data transfer and delivery. The developed software tool performs the following tasks: Checks the data transfer of the MLC leaf positions by comparing the actual coordinates against the planned ones; Estimates fluence delivery errors arising from positional and fractional MU deviations; Facilitates choosing a ‘good’ QA point for reliable dose verification; Performs several axillary functions to ensure quality and the safe delivery of IMRT plans.
Comment: =Verification
=Linac
BibTeX:
@article{Sashin2014,
  author = {Sashin, Vladimir},
  title = {Dynalog data tool for IMRT plan verification},
  journal = {The Royal Australian and New Zealand College of Radiologists},
  publisher = {The Royal Australian and New Zealand College of Radiologists},
  year = {2014},
  doi = {https://doi.org/10.1594/RANZCR2014/R-0051}
}
Noel, C.E., Santanam, L., Parikh, P.J. and Mutic, S. Process-based quality management for clinical implementation of adaptive radiotherapy 2014 Medical Physics
Vol. 41(8Part1), pp. 081717 
article DOI  
Abstract: Intensity-modulated adaptive radiotherapy (ART) has been the focus of considerable research and developmental work due to its potential therapeutic benefits. However, in light of its unique quality assurance (QA) challenges, no one has described a robust framework for its clinical implementation. In fact, recent position papers by ASTRO and AAPM have firmly endorsed pretreatment patient-specific IMRT QA, which limits the feasibility of online ART. The authors aim to address these obstacles by applying failure mode and effects analysis (FMEA) to identify high-priority errors and appropriate risk-mitigation strategies for clinical implementation of intensity-modulated ART. METHODS: An experienced team of two clinical medical physicists, one clinical engineer, and one radiation oncologist was assembled to perform a standard FMEA for intensity-modulated ART. A set of 216 potential radiotherapy failures composed by the forthcoming AAPM task group 100 (TG-100) was used as the basis. Of the 216 failures, 127 were identified as most relevant to an ART scheme. Using the associated TG-100 FMEA values as a baseline, the team considered how the likeliness of occurrence (O), outcome severity (S), and likeliness of failure being undetected (D) would change for ART. New risk priority numbers (RPN) were calculated. Failures characterized by RPN ≥ 200 were identified as potentially critical. RESULTS: FMEA revealed that ART RPN increased for 38% (n = 48/127) of potential failures, with 75% (n = 36/48) attributed to failures in the segmentation and treatment planning processes. Forty-three of 127 failures were identified as potentially critical. Risk-mitigation strategies include implementing a suite of quality control and decision support software, specialty QA software/hardware tools, and an increase in specially trained personnel. CONCLUSIONS: Results of the FMEA-based risk assessment demonstrate that intensity-modulated ART introduces different (but not necessarily more) risks than standard IMRT and may be safely implemented with the proper mitigations.
Comment: =Promotion
=Linac
BibTeX:
@article{Noel2014,
  author = {Camille E. Noel and Lakshmi Santanam and Parag J. Parikh and Sasa Mutic},
  title = {Process-based quality management for clinical implementation of adaptive radiotherapy},
  journal = {Medical Physics},
  publisher = {Wiley},
  year = {2014},
  volume = {41},
  number = {8Part1},
  pages = {081717},
  doi = {https://doi.org/10.1118/1.4890589}
}
Narayanasamy, G., Cruz, W., Breton, C., Gutierrez, A., Mavroidis, P., Papanikolaou, N. and Stathakis, S. Comparison of Measured Tissue Phantom Ratios (TPR) Against Calculated From Percent Depth Doses (PDD) with and Without Peak Scatter Factor (PSF) in 6MV Open Beam 2014 Medical Physics
Vol. 41(6Part19), pp. 341-341 
conference DOI  
Abstract: To examine the accuracy of measured tissue phantom ratios (TPR) values with TPR calculated from percentage depth dose (PDD) with and without peak scatter fraction (PSF) correction. Methods: For 6MV open beam, TPR and PDD values were measured using PTW Semiflex (31010) ionization field and reference chambers (0.125cc volume) in a PTW MP3-M water tank. PDD curves were measured at SSD of 100cm for 7 square fields from 3cm to 30cm. The TPR values were measured up to 22cm depth for the same fields by continuous water draining method with ionization chamber static at 100cm from source. A comparison study was performed between the (a) measured TPR, (b) TPR calculated from PDD without PSF, (c) TPR calculated from PDD with PSF and (d) clinical TPR from RadCalc (ver 6.2, Sun Nuclear Corp). Results: There is a field size, depth dependence on TPR values. For 10cmx10cm, the differences in surface dose (DDs), dose at 10cm depth (DD10) <0.5%; differences in dmax (Ddmax) <2mm for the 4 methods. The corresponding values for 30cmx30cm are DDs, DD10 <0.2% and Ddmax<3mm. Even though for 3cmx3cm field, DDs and DD10 <1% and Ddmax<1mm, the calculated TPR values with and without PSF correction differed by 2% at >20cm depth. In all field sizes at depths>28cm, (d) clinical TPR values are larger than that from (b) and (c) by >3%. Conclusion: Measured TPR in method (a) differ from calculated TPR in methods (b) and (c) to within 1% for depths < 28cm in all 7 fields in open 6MV beam. The dmax values are within 3mm of each other. The largest deviation of >3% was observed in clinical TPR values in method (d) for all fields at depths < 28cm.
Comment: =Verification
=Linac
BibTeX:
@conference{Narayanasamy2014,
  author = {Narayanasamy, G and Cruz, W and Breton, C and Gutierrez, Alonso and Mavroidis, Panayiotis and Papanikolaou, N and Stathakis, S},
  title = {Comparison of Measured Tissue Phantom Ratios (TPR) Against Calculated From Percent Depth Doses (PDD) with and Without Peak Scatter Factor (PSF) in 6MV Open Beam},
  journal = {Medical Physics},
  year = {2014},
  volume = {41},
  number = {6Part19},
  pages = {341-341},
  doi = {https://doi.org/10.1118/1.4888832}
}
Krigsfeld, G., Shah, J., Sanzari, J., Lin, L. and Kennedy, A. Evidence of disseminated intravascular coagulation in a porcine model following radiation exposure 2014 Life Sciences in Space Research
Vol. 3, pp. 1-9 
article DOI  
Abstract: Recent evidence has suggested that disseminated intravascular coagulation (DIC) plays an integral role in death at the LD50 dose of either gamma or solar particle event (SPE)-like proton radiation in ferrets. In these studies, Yucatan minipigs were evaluated to determine whether they were susceptible to the development of radiation induced DIC. Yucatan minipigs were exposed to a dose of 2.5 Gray (Gy) with x-rays and monitored over the course of 30 days. Evidence of DIC was evaluated by way of thromboelastometry parameters, platelet counts, fibrinogen concentration, and the d-dimer assay. Pigs exposed to x-rays developed signs of DIC within 2 days post-irradiation. The development of DIC was exacerbated over the course of the studies, and one of the pigs died at day 14 and another had to be euthanized on day 16 post-irradiation. For both of these pigs, DIC was evident at the time of death. The following observations were indicated or were suggestive of DIC: whole blood clotting was impaired (as evidenced by thromboelastometry alterations), there were decreased platelet counts, elevated d-dimer concentrations in the blood, and/or hemorrhaging and the presence of fibrin in tissues observed during post-mortem examination. The extrapolation of data from these studies, in combination with other published data, have led to the hypothesis that there could be a correlation between the propensity to develop DIC, as indicated by hemorrhaging at death at relatively low doses of radiation, and the LD50 for a particular species. Our data suggest that the development of DIC may contribute to death at the LD50 dose in large mammals.
Comment: =Verification
=Linac
BibTeX:
@article{Krigsfeld2014,
  author = {G.S. Krigsfeld and J.B. Shah and J.K. Sanzari and L. Lin and A.R. Kennedy},
  title = {Evidence of disseminated intravascular coagulation in a porcine model following radiation exposure},
  journal = {Life Sciences in Space Research},
  publisher = {Elsevier BV},
  year = {2014},
  volume = {3},
  pages = {1--9},
  doi = {https://doi.org/10.1016/j.lssr.2014.07.001}
}
Khan, R.F., Villarreal-Barajas, E., Lau, H. and Liu, H.-W. Effect of Acuros XB algorithm on monitor units for stereotactic body radiotherapy planning of lung cancer. 2014 Medical Dosimetry
Vol. 39, pp. 83-87 
article DOI  
Abstract: Stereotactic body radiotherapy (SBRT) is a curative regimen that uses hypofractionated radiation-absorbed dose to achieve a high degree of local control in early stage non-small cell lung cancer (NSCLC). In the presence of heterogeneities, the dose calculation for the lungs becomes challenging. We have evaluated the dosimetric effect of the recently introduced advanced dose-calculation algorithm, Acuros XB (AXB), for SBRT of NSCLC. A total of 97 patients with early-stage lung cancer who underwent SBRT at our cancer center during last 4 years were included. Initial clinical plans were created in Aria Eclipse version 8.9 or prior, using 6 to 10 fields with 6-MV beams, and dose was calculated using the anisotropic analytic algorithm (AAA) as implemented in Eclipse treatment planning system. The clinical plans were recalculated in Aria Eclipse 11.0.21 using both AAA and AXB algorithms. Both sets of plans were normalized to the same prescription point at the center of mass of the target. A secondary monitor unit (MU) calculation was performed using commercial program RadCalc for all of the fields. For the planning target volumes ranging from 19 to 375cm(3), a comparison of MUs was performed for both set of algorithms on field and plan basis. In total, variation of MUs for 677 treatment fields was investigated in terms of equivalent depth and the equivalent square of the field. Overall, MUs required by AXB to deliver the prescribed dose are on an average 2% higher than AAA. Using a 2-tailed paired t-test, the MUs from the 2 algorithms were found to be significantly different (p < 0.001). The secondary independent MU calculator RadCalc underestimates the required MUs (on an average by 4% to 5%) in the lung relative to either of the 2 dose algorithms.
Comment: =Evaluation
=Linac
BibTeX:
@article{Khan2014,
  author = {Khan, Rao F. and Villarreal-Barajas, Eduardo and Lau, Harold and Liu, Hong-Wei},
  title = {Effect of Acuros XB algorithm on monitor units for stereotactic body radiotherapy planning of lung cancer.},
  journal = {Medical Dosimetry},
  year = {2014},
  volume = {39},
  pages = {83--87},
  doi = {https://doi.org/10.1016/j.meddos.2013.10.003}
}
Halabi, T. and Lu, H.-M. Automating checks of plan check automation 2014 Journal of Applied Clinical Medical Physics
Vol. 15(4), pp. 1-8 
article DOI  
Abstract: While a few physicists have designed new plan check automation solutions for their clinics, fewer, if any, managed to adapt existing solutions. As complex and varied as the systems they check, these programs must gain the full confidence of those who would run them on countless patient plans. The present automation effort, planCheck, therefore focuses on versatility and ease of implementation and verification. To demonstrate this, we apply planCheck to proton gantry, stereotactic proton gantry, stereotactic proton fixed beam (STAR), and IMRT treatments.
Comment: =Verification
=Linac
BibTeX:
@article{Halabi2014,
  author = {Halabi, Tarek and Lu, Hsiao-Ming},
  title = {Automating checks of plan check automation},
  journal = {Journal of Applied Clinical Medical Physics},
  publisher = {John Wiley & Sons, Ltd},
  year = {2014},
  volume = {15},
  number = {4},
  pages = {1--8},
  doi = {https://doi.org/10.1120/jacmp.v15i4.4889}
}
Evans, A.J., Lee, D.Y., Jain, A.K., Razi, S.S., Park, K., Schwartz, G.S., Trichter, F., Ostenson, J., Sasson, J.R. and Bhora, F.Y. The effect of metallic tracheal stents on radiation dose in the airway and surrounding tissues. 2014 The Journal of surgical research
Vol. 189, pp. 1-6 
article DOI  
Abstract: Metallic airway stents are often used in the management of central airway malignancies. The presence of a metallic foreign body may affect radiation dose in tissue. We studied the effect of a metallic airway stent on radiation dose delivery in a phantom and an in vivo porcine model. A metallic tracheal stent was fitted onto a support in a water phantom. Point dosimeters were positioned in the phantom around the support and the stent. Irradiation was then performed on a linear accelerator with and without the stent. Metallic tracheal stents were deployed in the trachea of three pigs. Dosimeters were implanted in the tissues near (Group 1) and away (Group 2) from the stent. The pigs were then irradiated, and the dose perturbation factor was calculated by comparing the actual dose detected by the dosimeters versus the planned dose. The difference in the dose detected by the dosimeters and the planned dose ranged from 1.8% to 6.1% for the phantom with the stent and 0%-5.3% for the phantom without the stent. These values were largely within the manufacturer's specified error of 5%. No significant difference was observed in the dose perturbation factor for Group 1 and Group 2 dosimeters (0.836 ± 0.058 versus 0.877 ± 0.088, P = 0.220) in all the three pigs. Metallic airway stents do not significantly affect radiation dose in the airway and surrounding tissues in a phantom and porcine model. Radiation treatment planning systems can account for the presence of the stent. External beam radiation can be delivered without concern for significant dose perturbation.
Comment: =Verification
=Linac
BibTeX:
@article{Evans2014,
  author = {Evans, Andrew J. and Lee, David Y. and Jain, Anudh K. and Razi, Syed S. and Park, Koji and Schwartz, Gary S. and Trichter, Frieda and Ostenson, Jason and Sasson, Jordan R. and Bhora, Faiz Y.},
  title = {The effect of metallic tracheal stents on radiation dose in the airway and surrounding tissues.},
  journal = {The Journal of surgical research},
  year = {2014},
  volume = {189},
  pages = {1--6},
  doi = {https://doi.org/10.1016/j.jss.2014.01.013}
}
Deufel, C.L. and Furutani, K.M. Quality assurance for high dose rate brachytherapy treatment planning optimization: using a simple optimization to verify a complex optimization. 2014 Physics in Medicine and Biology
Vol. 59, pp. 525-540 
article DOI  
Abstract: As dose optimization for high dose rate brachytherapy becomes more complex, it becomes increasingly important to have a means of verifying that optimization results are reasonable. A method is presented for using a simple optimization as quality assurance for the more complex optimization algorithms typically found in commercial brachytherapy treatment planning systems. Quality assurance tests may be performed during commissioning, at regular intervals, and/or on a patient specific basis. A simple optimization method is provided that optimizes conformal target coverage using an exact, variance-based, algebraic approach. Metrics such as dose volume histogram, conformality index, and total reference air kerma agree closely between simple and complex optimizations for breast, cervix, prostate, and planar applicators. The simple optimization is shown to be a sensitive measure for identifying failures in a commercial treatment planning system that are possibly due to operator error or weaknesses in planning system optimization algorithms. Results from the simple optimization are surprisingly similar to the results from a more complex, commercial optimization for several clinical applications. This suggests that there are only modest gains to be made from making brachytherapy optimization more complex. The improvements expected from sophisticated linear optimizations, such as PARETO methods, will largely be in making systems more user friendly and efficient, rather than in finding dramatically better source strength distributions.
Comment: =Promotion
=BT
BibTeX:
@article{Deufel2014,
  author = {Deufel, Christopher L. and Furutani, Keith M.},
  title = {Quality assurance for high dose rate brachytherapy treatment planning optimization: using a simple optimization to verify a complex optimization.},
  journal = {Physics in Medicine and Biology},
  year = {2014},
  volume = {59},
  pages = {525--540},
  doi = {https://doi.org/10.1088/0031-9155/59/3/525}
}
Allen, C., Sansourekidou, P. and Pavord, D. Raystation Electron Monte Carlo Commissioning and Clinical Implementation 2014 Medical Physics
Vol. 41(6Part15), pp. 287-287 
conference DOI  
Abstract: To evaluate the Raystation v4.0 Electron Monte Carlo algorithm for an Elekta Infinity linear accelerator and commission for clinical use. Methods: A total of 199 tests were performed (75 Export and Documentation, 20 PDD, 30 Profiles, 4 Obliquity, 10 Inhomogeneity, 55 MU Accuracy, and 5 Grid and Particle History). Export and documentation tests were performed with respect to MOSAIQ (Elekta AB) and RadCalc (Lifeline Software Inc). Mechanical jaw parameters and cutout magnifications were verified. PDD and profiles for open cones and cutouts were extracted and compared with water tank measurements. Obliquity and inhomogeneity for bone and air calculations were compared to film dosimetry. MU calculations for open cones and cutouts were performed and compared to both RadCalc and simple hand calculations. Grid size and particle histories were evaluated per energy for statistical uncertainty performance. Acceptability was categorized as follows: performs as expected, negligible impact on workflow, marginal impact, critical impact or safety concern, and catastrophic impact of safety concern. Results: Overall results are: 88.8% perform as expected, 10.2% negligible, 2.0% marginal, 0% critical and 0% catastrophic. Results per test category are as follows: Export and Documentation: 100% perform as expected, PDD: 100% perform as expected, Profiles: 66.7% perform as expected, 33.3% negligible, Obliquity: 100% marginal, Inhomogeneity 50% perform as expected, 50% negligible, MU Accuracy: 100% perform as expected, Grid and particle histories: 100% negligible. To achieve distributions with satisfactory smoothness level, 5,000,000 particle histories were used. Calculation time was approximately 1 hour. Conclusion: Raystation electron Monte Carlo is acceptable for clinical use. All of the issues encountered have acceptable workarounds. Known issues were reported to Raysearch and will be resolved in upcoming releases.
Comment: =Verification
=Linac
=MC
BibTeX:
@conference{Allen2014,
  author = {Allen, C and Sansourekidou, P and Pavord, D},
  title = {Raystation Electron Monte Carlo Commissioning and Clinical Implementation},
  journal = {Medical Physics},
  year = {2014},
  volume = {41},
  number = {6Part15},
  pages = {287-287},
  doi = {https://doi.org/10.1118/1.4888608}
}
Zhou, P., Kiszka, D., Zhang, H., Jia, Y. and Desrosiers, C. Evaluation of Total Body Irradiation Technique Using 20 Diodes In-Vivo Dosimetry System 2013 Medical Physics
Vol. 40(6Part15), pp. 278-278 
conference DOI  
Abstract: To evaluate a new Total Body Irradiation (TBI) technique using CT planning by 20 diodes real time in-vivo dosimetry system.Material and Methods: TBI treatment is typically performed at extended SSD ( 3 to 4 meters) under high energy x-rays (6 MV). Lateral treatment results in a more convenient setup but less dose uniformity as compared with AP/PA treatment. This study evaluated a new TBI treatment which is performed at 2 meter distance, AP/PA. Matched oblique field plan was created by Eclipse TPS with CT simulated data from PIXY phantom; using MLC for lung blocking. Field in Field technique was applied to improve dose uniformity. A steel attenuator with transmission factor 0.55 for 6MV photon field is used to reduce dose rate to 5–20 cGy/min while a 5mm thick Lexan sheet is placed about 20 cm above patient to increase skin dose. Patients will lay supine and prone on a movable bed. Three AP and PA fields were used to deliver prescribed dose. A 20-diodes SunNuclear in-vivo dosimetry system was used for monitoring dose at different sites. Diodes were calibrated with attenuator to accommodate energy spectrum change. SSD, dose rate, angular dependence of diodes were measured. RadCalc MU verification software was also tested for agreement with TPS and measured data. Results: Attenuator could reduce the dose rate to about 13 cGy/min. By averaging the entrance and exit reading, the doses at patients anatomical mid-line were measured and found to have good agreement with TPS (within 7% difference). Two dry-runs have demonstrated that the TBI plan can achieve and intended dose uniformity better than 10%. The RadCalc verification program agreed with TPS on average within 3%. Conclusion: CT-image based and TPS generated TBI plan is feasible. Diodes are suitable for both the TBI technique testing and dose monitoring.
Comment: =Verification
=Linac
BibTeX:
@conference{Zhou2013,
  author = {Zhou, P and Kiszka, D and Zhang, H and Jia, Y and Desrosiers, C},
  title = {Evaluation of Total Body Irradiation Technique Using 20 Diodes In-Vivo Dosimetry System},
  journal = {Medical Physics},
  year = {2013},
  volume = {40},
  number = {6Part15},
  pages = {278-278},
  doi = {https://doi.org/10.1118/1.4814756}
}
Steciw, S., Rathee, S. and Warkentin, B. Modulation factors calculated with an EPID-derived MLC fluence model to streamline IMRT/VMAT second checks 2013 Journal of Applied Clinical Medical Physics
Vol. 14(6), pp. 62-81 
article DOI  
Abstract: This work outlines the development of a robust method of calculating modulation factors used for the independent verification of MUs for IMRT and VMAT treatments, to replace onerous ion chamber measurements. Two-dimensional fluence maps were calculated for dynamic MLC fields that include MLC interleaf leakage, transmission, and tongue-and-groove effects, as characterized from EPID-acquired images. Monte Carlo-generated dose kernels were then used to calculate doses for a modulated field and that field with the modulation removed at a depth specific to the calculation point in the patient using in-house written software, Mod_Calc. The ratio of these two doses was taken to calculate modulation factors. Comparison between Mod_Calc calculation and ion chamber measurement of modulation factors for 121 IMRT fields yielded excellent agreement, where the mean difference between the two was . This validated use of Mod_Calc clinically. Analysis of 5,271 dynamic fields from clinical use of Mod_Calc gave a mean difference of between Mod_Calc and Eclipse-generated factors. In addition, 99.3% and 96.5% fields pass 5% and 2% criteria, respectively, for agreement between these two predictions. The development and use of Mod_Calc at our clinic has considerably streamlined our QA process for IMRT and RapidArc fields, compared to our previous method based on ion chamber measurements. As a result, it has made it feasible to maintain our established and trusted current in-house method of MU verification, without resorting to commercial software alternatives. PACS numbers: 87.55.km, 87.55.Qr, 87.55.kd, 87.57.uq
Comment: =Promotion
=Linac
=MC
BibTeX:
@article{Steciw2013,
  author = {Steciw, Stephen and Rathee, Satyapal and Warkentin, Brad},
  title = {Modulation factors calculated with an EPID-derived MLC fluence model to streamline IMRT/VMAT second checks},
  journal = {Journal of Applied Clinical Medical Physics},
  publisher = {John Wiley & Sons, Ltd},
  year = {2013},
  volume = {14},
  number = {6},
  pages = {62--81},
  doi = {https://doi.org/10.1120/jacmp.v14i6.4274}
}
Poder, J. and Corde, S. I-125 ROPES eye plaque dosimetry: validation of a commercial 3D ophthalmic brachytherapy treatment planning system and independent dose calculation software with GafChromic® EBT3 films. 2013 Medical Physics
Vol. 40, pp. 121709 
article DOI  
Abstract: The purpose of this study was to measure the dose distributions for different Radiation Oncology Physics and Engineering Services, Australia (ROPES) type eye plaques loaded with I-125 (model 6711) seeds using GafChromic(®) EBT3 films, in order to verify the dose distributions in the Plaque Simulator™ (PS) ophthalmic 3D treatment planning system. The brachytherapy module of RADCALC(®) was used to independently check the dose distributions calculated by PS. Correction factors were derived from the measured data to be used in PS to account for the effect of the stainless steel ROPES plaque backing on the 3D dose distribution. Using GafChromic(®) EBT3 films inserted in a specially designed Solid Water™ eye ball phantom, dose distributions were measured three-dimensionally both along and perpendicular to I-125 (model 6711) loaded ROPES eye plaque's central axis (CAX) with 2 mm depth increments. Each measurement was performed in full scatter conditions both with and without the stainless steel plaque backing attached to the eye plaque, to assess its effect on the dose distributions. Results were compared to the dose distributions calculated by Plaque Simulator™ and checked independently with RADCALC(®). The EBT3 film measurements without the stainless steel backing were found to agree with PS and RADCALC(®) to within 2% and 4%, respectively, on the plaque CAX. Also, RADCALC(®) was found to agree with PS to within 2%. The CAX depth doses measured using EBT3 film with the stainless steel backing were observed to result in a 4% decrease relative to when the backing was not present. Within experimental uncertainty, the 4% decrease was found to be constant with depth and independent of plaque size. Using a constant dose correction factor of T = 0.96 in PS, where the calculated dose for the full water scattering medium is reduced by 4% in every voxel in the dose grid, the effect of the plaque backing was accurately modeled in the planning system. Off-axis profiles were also modeled in PS by taking into account the three-dimensional model of the plaque backing. The doses calculated by PS and RADCALC(®) for uniformly loaded ROPES plaques in full and uniform scattering conditions were validated by the EBT3 film measurements. The stainless steel plaque backing was observed to decrease the measured dose by 4%. Through the introduction of a scalar correction factor (0.96) in PS, the dose homogeneity effect of the stainless steel plaque backing was found to agree with the measured EBT3 film measurements.
Comment: =Evaluation
=BT
BibTeX:
@article{Poder2013,
  author = {Poder, Joel and Corde, Stéphanie},
  title = {I-125 ROPES eye plaque dosimetry: validation of a commercial 3D ophthalmic brachytherapy treatment planning system and independent dose calculation software with GafChromic® EBT3 films.},
  journal = {Medical Physics},
  year = {2013},
  volume = {40},
  pages = {121709},
  doi = {https://doi.org/10.1118/1.4828786}
}
Poder, J., Annabell, N., Geso, M., Alqathami, M. and Corde, S. ROPES eye plaque dosimetry: commissioning and verification of an ophthalmic brachytherapy treatment planning system 2013 Journal of Physics
Vol. 444, pp. 012102 
article DOI  
Abstract: In this study, the Plaque SimulatorTM eye plaque brachytherapy planning system was commissioned for ROPES eye plaques and Amersham Health model 6711 Iodine 125 seeds, using TG43-UI data. The brachytherapy module of the RADCALC® independent checking program was configured to allow verification of the accuracy of the dose calculated by Plaque SimulatorTM. Central axis depth dose distributions were compared and observed to agree to within 2% for all ROPES plaque models and depths of interest. Experimental measurements were performed with a customized PRESAGEm 3-D type dosimeter to validate the calculated depth dose distributions. Preliminary results have shown the effect of the stainless steel plaque backing decreases the measured fluorescence intensity by up to 25%, and 40% for the 15 mm and 10 mm diameter ROPES plaques respectively. This effect, once fully quantified should be accounted for in the Plaque SimulatorTM eye plaque brachytherapy planning system.
Comment: =Verification
=BT
BibTeX:
@article{Poder2013a,
  author = {J Poder and N Annabell and M Geso and M Alqathami and S Corde},
  title = {ROPES eye plaque dosimetry: commissioning and verification of an ophthalmic brachytherapy treatment planning system},
  journal = {Journal of Physics},
  publisher = {IOP Publishing},
  year = {2013},
  volume = {444},
  pages = {012102},
  doi = {https://doi.org/10.1088/1742-6596/444/1/012102}
}
Morales-Paliza, M. and Ding, G. An Evaluation of RadCal Software in Its Monitor Unit Calculation Accuracy for Small Dynamic Fields Using HDMLC 2013 Medical Physics
Vol. 40(6Part10), pp. 205-206 
conference DOI  
Abstract: To investigate the accuracy of an independent monitor unit (MU) verification program for small fields used in dynamically modulated highdefinition multileaf-collimator (HDMLC)-based stereotatic radiosurgery (SRS). Methods: HDMLC-SRS patient-treatment plans were calculated using the BrainLab-pencil beam dose-calculation algorithm implemented in the BrainLab-iPlan treatment planning system (TPS) (v.4.1.2) for the Novalis-TX 6X-SRS beam. Percent depth doses, beam profiles and output tables from this clinical beam were utilized to commission the RadCalc software (v.6.2) for independent MU verification. The MU difference between the MU calculation of the treatment planning system and the independent MU verification program for 187 dynamic arcs and 44 intensity modulated beams corresponding to 41 intracranial lesions from 35 patients was calculated. Field sizes of the arcs and beams studied ranged from 15 to 34 mm in their longest extension. Results: The average difference in the MUs with one standard deviation was −0.1% +/− 1.0% for the dynamic arcs and −0.0%+/− 2.7% for the intensity-modulated beams. The intensity modulated beams verifications showed a much higher spread in the difference compared to the non-modulated dynamic arcs; however, the average results can be considered clinically acceptable. The MU difference correlated inversely with the lesion size, indicating the limitation of the TPS algorithm with smaller field sizes. Conclusion: Use of the RadCalc software as an independent monitor unit verification system for both modulated and non-modulated small fields based on high-definition multileaf collimation is adequate to independently validate the point dose calculation accuracy. The system can be utilized as a part of the SRS quality assurance program.
Comment: =Evaluation
=Linac
BibTeX:
@conference{Morales-Paliza2913,
  author = {Morales-Paliza, M and Ding, G},
  title = {An Evaluation of RadCal Software in Its Monitor Unit Calculation Accuracy for Small Dynamic Fields Using HDMLC},
  journal = {Medical Physics},
  year = {2013},
  volume = {40},
  number = {6Part10},
  pages = {205-206},
  doi = {https://doi.org/10.1118/1.4814447}
}
McKinsey, R., Qiu, Y., Stathakis, S., Esquivel, C., Papanikolaou, N. and Mavroidis, P. Comparison of Different Commercial MU Verification Software in Terms of Accuracy and Performance 2013 Medical Physics
Vol. 40(6Part10), pp. 204-204 
conference DOI  
Abstract: All radiation therapy departments have a need for a quick and accurate verification of their treatment plans ranging from conventional, brachytherapy, to IMRT. The aim of this study is to perform an inter-comparison of different commercially available Monitor Unit (MU) secondary/independent software. Methods: In this study, four independent MU verification software were examined (IMSure, DIAMOND, MuCheck, and Radcalc) as quality assurance tools for RTP systems. An inter-comparison of the treatment plans of 13 patients was performed using those MU verification software. All the plans were generated using the Pinnacle v9.2 treatment planning system. The treatment techniques include VMAT, MLC-based step-and-shoot IMRT and Conventional Conformal plans for different treatment sites (breast, head and neck, chest, pelvis, abdomen, and brain). The parameters that had to be adjusted after importing the treatment plans into the different software were the average SSD and effective depth. Results: The average percent differences between the MUs provided by the Pinnacle and the RadCalc, ImSure and DIAMOND software were found to be −1.7%, −1.9% and 3.4%, respectively. The variation of the percent differences among the individual patients were 2.9% (−7.2 − 2.5), 3.7% (−7.2 − 3.7) and 7.0% (−9.9 – 16.2) for RadCalc, ImSure and DIAMOND, respectively. Conclusion: Importing the files from the Pinnacle RTP system was equally easy for all the software. It was found that Radcalc was the software that required the minimum changes/interventions when inserting the average SSD and effective depth. However, the Radcalc was the slower among the examined software in computing the MUs of the different beams for the VMAT technique. Overall, the variation of the MU calculations between the examined software was found to be very similar indicating that their ability to be used as quality assurance tools of the calculations provided by the RTP systems is equivalent.
Comment: =Verification
=BT
=Linac
BibTeX:
@conference{McKinsey2013,
  author = {McKinsey, R and Qiu, Y and Stathakis, S and Esquivel, C and Papanikolaou, N and Mavroidis, P},
  title = {Comparison of Different Commercial MU Verification Software in Terms of Accuracy and Performance},
  journal = {Medical Physics},
  year = {2013},
  volume = {40},
  number = {6Part10},
  pages = {204-204},
  doi = {https://doi.org/10.1118/1.4814440}
}
Lu, L., Yembi-Goma, G., Wang, J.Z., Gupta, N., Huang, Z., Lo, S.S., Martin, D. and Mayr, N. A Practical Method to Evaluate and Verify Dose Calculation Algorithms in the Treatment Planning System of Radiation Therapy 2013 International Journal of Medical Physics, Clinical Engineering and Radiation Oncology
Vol. 02(03), pp. 76-87 
article DOI  
Abstract: To introduce a practical method of usingan Electron Density Phantom (EDP) to evaluate different dose cal- culation algorithms for photon beams in a treatment planning system (TPS) and to commission the Anisotropic Ana- lytical Algorithm (AAA) with inhomogeneity correction in Varian Eclipse TPS. Methods and Materials: The same EDP with various tissue-equivalent plugs (water, lung exhale, lung inhale, liver, breast, muscle, adipose, dense bone, trabecular bone) used to calibrate the computed tomography (CT) simulator was adopted to evaluate different dose cal- culation algorithms in a TPS by measuring the actual dose delivered to the EDP. The treatment plans with a 6-Megavolt (MV) single field of 20 × 20, 10 × 10, and 4 × 4 cm2 field sizes were created based on the CT images of the EDP. A dose of 200 cGy was prescribed to the exhale-lung insert. Dose calculations were performed with AAA with inhomo- geneity correction, Pencil Beam Convolution (PBC), and AAA without inhomogeneity correction. The plans were de- livered and the actual doses were measured using radiation dosimetry devices MapCheck, EDR2-film, and ionization chamber respectively. Measured doses were compared with the calculated doses from the treatment plans. Results: The calculated dose using the AAA with inhomogeneity correction was most consistent with the measured dose. The dose discrepancy for all types of tissues covered by beam fields is at the level of 2%. The effect of AAA inhomogeneity cor- rection for lung tissues is over 14%. Conclusions: The use of EDP and Map Check to evaluate and commission the dose calculation algorithms in a TPS is practical. In Varian Eclipse TPS, the AAA with inhomogeneity correction should be used for treatment planning especially when lung tissues are involved in a small radiation field.
Comment: =Promotion
=Linac
BibTeX:
@article{Lu2013,
  author = {Lanchun Lu and Guy Yembi-Goma and Jian Z. Wang and Nilendu Gupta and Zhibin Huang and Simon S. Lo and Douglas Martin and Nina Mayr},
  title = {A Practical Method to Evaluate and Verify Dose Calculation Algorithms in the Treatment Planning System of Radiation Therapy},
  journal = {International Journal of Medical Physics, Clinical Engineering and Radiation Oncology},
  publisher = {Scientific Research Publishing, Inc.},
  year = {2013},
  volume = {02},
  number = {03},
  pages = {76--87},
  doi = {https://doi.org/10.4236/ijmpcero.2013.23011}
}
Lu, L. Dose calculation algorithms in external beam photon radiation therapy 2013 International Journal of Cancer Therapy and Oncology
Vol. 1(2) 
article DOI  
Abstract: The ultimate goal of radiation therapy is to deliver a prescribed dose to a tumor precisely while minimizing dose to the critical structures. Radiation dose is the core of the regime, which also includes dose calculation and delivery of radiation beam. The former is the key component of a treatment planning system. Its accuracy directly impacts the quality of a treatment while its speed heavily affects the clinical flow. This review is focused on photon beam dose calculation algorithms, although some basic concepts can also be applied to other beam modalities.
Comment: =Promotion
=Linac
BibTeX:
@article{Lu2013a,
  author = {Lanchun Lu},
  title = {Dose calculation algorithms in external beam photon radiation therapy},
  journal = {International Journal of Cancer Therapy and Oncology},
  publisher = {International Journal of Cancer Therapy and Oncology},
  year = {2013},
  volume = {1},
  number = {2},
  doi = {https://doi.org/10.14319/ijcto.0102.5}
}
Curtis, H., Richmond, N., Burke, K. and Walker, C. Determination of monitor unit check tolerances based on a comparison with measurement and treatment planning system data 2013 Medical Dosimetry
Vol. 38(1), pp. 81-87 
article DOI  
Abstract: This work describes the experimental validation of treatment planning system monitor unit (MU) calculations against measurement for a range of scenarios. This, together with a comparison of treatment planning system MUs and an independent MU check method, allows the derivation of confidence intervals for the check process. Data were collected for open and 60° motorized wedge fields using an Elekta Synergy linac at 6 and 8MV using homogeneous and heterogeneous phantoms. Masterplan (Version 4.0) pencil-beam and collapsed cone algorithms were used for the primary MU calculations with full inhomogeneity correction. Results show that both algorithms agree with measurement to acceptable tolerance levels in the majority of the cases studied. The confidence interval for the pencil-beam algorithm MU against an independent check was determined as + 1.6% to ?3.4%. This is modified to + 2.3% to ?2.5% when data collected with low-density heterogeneities are removed as this algorithm is not used clinically for these cases. The corresponding interval for the collapsed cone algorithm was + 1.2% to ?4.3%, indicating that an offset tolerance for the independent check is appropriate. Analysis of clinical conformal treatment plan data generated using the pencil-beam algorithm (1393 beams) returned 93% of beams within the independent check tolerance. Similarly, using the collapsed cone algorithm as the primary MU calculation, 77% (of 1434 beams) were within the confidence interval.
Comment: =Evaluation
=Linac
BibTeX:
@article{Curtis2013,
  author = {Curtis, Helen and Richmond, Neil and Burke, Kevin and Walker, Chris},
  title = {Determination of monitor unit check tolerances based on a comparison with measurement and treatment planning system data},
  journal = {Medical Dosimetry},
  publisher = {Elsevier},
  year = {2013},
  volume = {38},
  number = {1},
  pages = {81--87},
  doi = {https://doi.org/10.1016/j.meddos.2012.07.005}
}
Arumugam, S., Xing, A., Jameson, M. and Holloway, L. An algorithm to calculate a collapsed arc dose matrix in volumetric modulated arc therapy 2013 Medical Physics
Vol. 40(7), pp. 071724 
article DOI  
Abstract: The delivery of volumetric modulated arc therapy (VMAT) is more complex than otherconformal radiotherapy techniques. In this work, the authors present the feasibility of performingroutine verification of VMAT delivery using a dose matrix measured by a gantry mounted 2D ionchamber array and corresponding dose matrix calculated by an inhouse developed algorithm.Methods:Pinnacle, v9.0, treatment planning system (TPS) was used in this study to generate VMATplans for a 6 MV photon beam from an Elekta-Synergy linear accelerator. An algorithm was de-veloped and implemented with inhouse computer code to calculate the dose matrix resulting froma VMAT arc in a plane perpendicular to the beam at isocenter. The algorithm was validated usingmeasurement of standard patterns and clinical VMAT plans with a 2D ion chamber array. The clini-cal VMAT plans were also validated using ArcCHECK measurements. The measured and calculateddose matrices were compared using gamma (γ) analysis with 3%/3 mm criteria andγtolerance of 1.Results:The dose matrix comparison of standard patterns has shown excellent agreement with themeanγpass rate 97.7 (σ=0.4)%. The validation of clinical VMAT plans using the dose matrixpredicted by the algorithm and the corresponding measured dose matrices also showed good agree-ment with the meanγpass rate of 97.6 (σ=1.6)%. The validation of clinical VMAT plans usingArcCHECK measurements showed a mean pass rate of 95.6 (σ=1.8)%.Conclusions:The developed algorithm was shown to accurately predict the dose matrix, in aplane perpendicular to the beam, by considering all possible leaf trajectories in a VMAT delivery.This enables the verification of VMAT delivery using a 2D array detector mounted on a treatmenthead.
Comment: =Verification
=Linac
BibTeX:
@article{Arumugam2013,
  author = {Sankar Arumugam and Aitang Xing and Michael Jameson and Lois Holloway},
  title = {An algorithm to calculate a collapsed arc dose matrix in volumetric modulated arc therapy},
  journal = {Medical Physics},
  publisher = {Wiley},
  year = {2013},
  volume = {40},
  number = {7},
  pages = {071724},
  doi = {https://doi.org/10.1118/1.4810964}
}
Agapito, J. On the possible benefits of a hybrid VMAT technique in the treatment of non&#x2013;small cell lung cancer 2013 Medical Dosimetry
Vol. 38(4), pp. 460-466 
article DOI  
Abstract: To assess, using clinical cases, the potential of a hybrid technique for the treatment of non?small cell lung cancer (NSCLC)-blending volumetric-modulated arc therapy (VMAT) and conformal radiation therapy (CRT) fields, and to consider potential issues with implementation of such a technique. Eight clinical cases already treated with CRT were used for a planning study comparing target coverage and organs at risk (OAR) sparing between CRT and hybrid VMAT (VMATh). Quality assurance (QA) implications of the resultant hybrid plans are discussed. The hybrid technique resulted in superior target conformity or improved sparing of OAR or both. The hybrid technique shows promise, but the QA implications of motion at treatment need careful consideration.
Comment: =Verification
=Linac
BibTeX:
@article{Agapito2013,
  author = {Agapito, John},
  title = {On the possible benefits of a hybrid VMAT technique in the treatment of non&#x2013;small cell lung cancer},
  journal = {Medical Dosimetry},
  publisher = {Elsevier},
  year = {2013},
  volume = {38},
  number = {4},
  pages = {460--466},
  doi = {https://doi.org/10.1016/j.meddos.2013.08.004}
}
Johnson, D., Weston, S.J., Cosgrove, V.P., Dawoud, S.M. and Thwaites, D.I. COMPARISON OF DOSE CALCULATIONS PERFORMED BY OMP, DIAMOND AND RADCALC FOR 11 CLINICAL VMAT PLANS 2012 Strahlentherapie und Onkologie
Vol. 103, pp. S511 
conference DOI  
Abstract: For more advanced radiotherapy treatments (IMRT and VMAT) it is more time consuming to perform hand dose calculations than with normal 3D conformal treatments, as a consequence, dose checking software has become commercially available. The intention of this investigation was to compare two commercially available checker programs with the dose calculated by the planning system and the dose measured by the 2D array (PTW, Freiburg) for eleven clinical VMAT plans. Materials and Methods: 11 clinical VMAT plans were transposed on to the OCTAVIUS (PTW, Freiburg) phantom and a dose calculation was performed using Oncentra Masterplan. These plans were then delivered, using an Elekta MLCi2, to the OCTAVIUS phantom with the 2Darray inserted. The plans were also processed using the DIAMOND and RadCalc checker software. Five equivalent points, including the isocentre, were compared. The isocentric doses calculated by all three programs and measured on the 2Darray are shown in the included table. Conclusions: It was found that the doses calculated and measured by all the methods were comparable to within 5%.
Comment: =Verification
=Linac
BibTeX:
@conference{Johnson2012,
  author = {Johnson, D. and Weston, S. J. and Cosgrove, V. P. and Dawoud, S. M. and Thwaites, D. I.},
  title = {COMPARISON OF DOSE CALCULATIONS PERFORMED BY OMP, DIAMOND AND RADCALC FOR 11 CLINICAL VMAT PLANS},
  journal = {Strahlentherapie und Onkologie},
  publisher = {Elsevier},
  year = {2012},
  volume = {103},
  pages = {S511},
  doi = {https://doi.org/10.1016/s0167-8140(12)71679-1}
}
Harriss-Phillips, W. and Lawson, J. Evaluating and improving the HDR prostate treatment technique: a retrospective review after the first 100 patientsat the Royal Adelaide Hospital 2012 Australasian Physical & Engineering Sciences in Medicine
Vol. 36(1), pp. 65-141 
conference DOI  
Abstract: We present the procedural improvements and dosimetry data for the first 100 patients treated with HDR boost brachytherapy for prostate adenocarcinoma. Methods HDR prostate brachytherapy commenced at the RAH in May 2006 as a 2-fraction boost treatment in combination with EBRT. The procedure is performed intra-operatively as a temporary interstitial implant with flexible needles inserted via the perineum using transrectal ultrasound guidance. Procedural changes that have improved workflow and accuracy of treatment over the past 6 years are presented. In addition, we present key dosimetry data for the prostate and organs at risk. Major changes in the evolution of the procedure include: (1) changing from virtual to live planning, (2) insertion of initial stabilisation needles, (3) changing from 2 fractions to 1 fraction, (4) addition of RadCalc plan verification, and (5) keeping the ultrasound probe in the rectum during treatment. Results Average procedure times have improved when comparing the first and last 20 patients treated (5.1 ± 1.2 h vs. 3.5 ± 0.5 h), while maintaining high planned V100 percentages (91.8 ± 3.6 % vs. 92.7 ± 2.1 %). The use of 4–6 symmetrically placed needles inserted before the first image capture assisted in prostate stabilisation during insertion of the remaining needles. The 2-fraction procedure resulted in 13 mm (inferior) average overnight needle movement, which was corrected (±3 mm) via cystoscopy and mobile fluoroscopy prior to fraction two. Conclusions Experience in procedure has facilitated improvements in the overall workflow, with significant reductions in overall treatment time. The planned V100 has remained steady and acceptable, while key benefits to the patient include the conversion to a single treatment fraction in which the accuracy in dose delivery is improved due to elimination of errors associated with second fraction needle positioning accuracy and maintaining the planned patient position with the ultrasound probe left within the rectum.
Comment: =Verification
=BT
BibTeX:
@conference{Harriss-Phillips2012c,
  author = {Harriss-Phillips, W and Lawson, J},
  title = {Evaluating and improving the HDR prostate treatment technique: a retrospective review after the first 100 patientsat the Royal Adelaide Hospital},
  journal = {Australasian Physical & Engineering Sciences in Medicine},
  publisher = {Springer Science and Business Media LLC},
  year = {2012},
  volume = {36},
  number = {1},
  pages = {65--141},
  doi = {https://doi.org/10.1007/s13246-012-0168-7}
}
Garcia-Romero, A., Laliena-Bielsa, V.M., Rodicio, J.C., Villa-Gazulla, D., Millan-Cebrian, E., Ortega-Pardina, P., Hernandez-Vitoria, A. and Canellas-Anoz, M. INFLUENCE OF THE CALCULATION ALGORITHM IN THE ANGULAR CORRECTION OF AN IMRT PLANAR VERIFICATION DEVICE 2012 Strahlentherapie und Onkologie
Vol. 103, pp. S511-S512 
conference DOI  
Abstract: When IMRT verification is made by means of an ionisation chamber matrix that measures a dose plane inside a phantom, the treatment planning system (TPS) has to calculate accurately the dose distribution in a CT phantom created by scanning the measurement device in verification conditions. The aim of this work is to investigate if the algorithms of our TPS can reproduce the absorbed dose measured by the device and if further corrections are required by the measurement software, keeping in mind that the measurement device introduces a non-homogenous distortion inside a water equivalent phantom. Materials and Methods: Measurements have been done in a LINAC Mevatron Oncor™ (Siemens Medical Solutions, Concord, California) and two photon energies, 6MV and 15MV. An ionisation chamber matrix array (MatriXX evolution) has been used as a dosimeter using OmniPro-I’mRT software to correct the measured planes and converting them into absorbed dose, by means of a measurement online calibration. A set of static fields with incident angles between 0º and 180º with an angular resolution of 10º have been prepared for both energies. Our TPS, PCRT3D v6.014 (TRF, Spain), has two algorithms that can perform IMRT calculations, one called 'precise'(PR), which is a pencil beam type algorithm, and a collapsed cone superposition algorithm (SCC), which can present the absorbed dose to medium and to water. The TPS can also correct the calculated dose by external elements, as the treatment table. Comparison between them must be done in terms of absorbed dose to water being the detector built in a non-water equivalent material (electronic densities relatives to water up to 1.5). Results: Differences have been found between the two algorithms in terms of calculated absorbed dose at the ionisation chambers plane, due to the different behaviour of the algorithms inside the heterogeneity that introduces the MatriXX device, particularly at posterior beams. We present the absorbed dose results for the total 19 beams. For the 6MV case, the maximum deviation found is a shift in total measured dose of 4.5% between the two algortihms. This discrepancy decreases to 2.1% in the case of 15MV. SCC matches the total absorbed dose measured for the 19 beams with the gantry angle correction tables set by default.Conclusions: SCC calculation predicts properly the measured dose according to the gantry angle correction tables supplied with OmniPro I’mrt, provided that dose to water is calculated and that the treatment table correction is activated. New gantry angle correction tables have to be constructed if an algorithm that cannot manage properly the MatriXX heterogeneity is used
Comment: =Verification
=Linac
BibTeX:
@conference{GarciaRomero2012,
  author = {Garcia-Romero, A. and Laliena-Bielsa, V. M. and Rodicio, J. Cortes and Villa-Gazulla, D. and Millan-Cebrian, E. and Ortega-Pardina, P. and Hernandez-Vitoria, A. and Canellas-Anoz, M.},
  title = {INFLUENCE OF THE CALCULATION ALGORITHM IN THE ANGULAR CORRECTION OF AN IMRT PLANAR VERIFICATION DEVICE},
  journal = {Strahlentherapie und Onkologie},
  publisher = {Elsevier},
  year = {2012},
  volume = {103},
  pages = {S511--S512},
  doi = {https://doi.org/10.1016/s0167-8140(12)71681-x}
}
Al Amri, I., Ravichandran, R., Sivakumar, S.S., Binukumar, J.P., Davis, C.A., Al Rahbi, Z., Al Shukeili, K. and Al Kindi, F. Radiotherapy pre-treatment dose validation: A second verification of monitor units (MU) with a commercial software. 2012 Journal of Medical Physics
Vol. 37, pp. 235-239 
article DOI  
Abstract: Inversely planned intensity-modulated radiotherapy (IMRT) and stereotactic small field radiotherapy should be verified before treatment execution. A second verification is carried out for planned treatments in IMRT and 3D conformal radiotherapy (3D-CRT) using a monitor verification commercial dose calculation management software (DCMS). For the same reference point the ion-chamber measured doses are compared for IMRT plans. DCMS (Diamond) computes dose based on modified Clarkson integration, accounting for multi-leaf collimators (MLC) transmission and measured collimator scatter factors. DCMS was validated with treatment planning system (TPS) (Eclipse 6.5 Version, Varian, USA) separately. Treatment plans computed from TPS are exported to DCMS using DICOM interface. Doses are re-calculated at selected points for fields delivered to IMRT phantom (IBA Scanditronix Wellhofer) in high-energy linac (Clinac 2300 CD, Varian). Doses measured at central axis, for the same points using CC13 (0.13 cc) ion chamber with Dose 1 Electrometer (Scanditronix Wellhofer) are compared with calculated data on DCMS and TPS. The data of 53 IMRT patients with fields ranging from 5 to 9 are reported. The computed dose for selected monitor units (MU) by Diamond showed good agreement with planned doses by TPS. DCMS dose prediction matched well in 3D-CRT forward plans (0.8 ± 1.3%, n = 37) and in IMRT inverse plans (-0.1 ± 2.2%, n = 37). Ion chamber measurements agreed well with Eclipse planned doses (-2.1 ± 2.0%, n = 53) and re-calculated DCMS doses (-1.5 ± 2.6%, n = 37) in phantom. DCMS dose validation is in reasonable agreement with TPS. DCMS calculations corroborate well with ionometric measured doses in most of the treatment plans.
Comment: =Verification
=Linac
BibTeX:
@article{AlAmri2012,
  author = {Al Amri, Iqbal and Ravichandran, Ramamoorthy and Sivakumar, Somangili Satyamoorthi and Binukumar, Johnson Pichi and Davis, Chirayathmanjiyil Antony and Al Rahbi, Zakia and Al Shukeili, Khalsa and Al Kindi, Fatima},
  title = {Radiotherapy pre-treatment dose validation: A second verification of monitor units (MU) with a commercial software.},
  journal = {Journal of Medical Physics},
  year = {2012},
  volume = {37},
  pages = {235--239},
  doi = {https://doi.org/10.4103/0971-6203.103610}
}
Walker, A., Müller, J., Lang, S., Brown, M., Imboden, A., Winter, C. and Studer, G. ADVANCEMENTS IN PALLIATIVE RADIATION THERAPY: DEVELOPMENT OF AN ONLINE SIMULATION AND TREATMENT DELIVERY PROGRAM 2011 Strahlentherapie und Onkologie
Vol. 99, pp. S586 
conference DOI  
Abstract: Advancing clinical practice is resulting in the elimination of our con-ventional simulator; therefore, a new protocol for palliative radiation therapypatients was established. The enhanced features of the Varian TrueBeamallowed us to clinically implement this new program by performing accurateand efficient online simulation and treatment delivery. Our aim was to identifythe benefits and challenges of this new streamlined practice.Materials: Patients received a single radiation therapy appointment in whichboth simulation and treatment was performed. The patient was set up in thetreatment position and bony anatomy utilized to define the reference point.The patient separation was measured and the source to skin distance doc-umented. A kV setup image was acquired and the treatment field edge de-lineated with the option of conformal multi-leaf collimation (MLC). This imagewas utilized as the field reference image. An opposed field image was thenacquired and MLC later opposed if necessary. The RadCalc program wasused to calculate daily monitor units for all treatment fields and remainingdata was entered into a record & verification system including setup notes,daily fractionation doses and imaging protocols. Time data was collected forthe complete simulation and treatment process.Results: 5 patients have successfully been treated with this new protocol.Most cases involved bony metastases treated to a dose of 30 Gy in 10 frac-tions with parallel opposed fields and conformal MLC. Patients received 3-5static kV images in order to acquire suitable reference information to delin-eate the treatment fields. The kV image quality was, in general, found to besuperior to the conventional simulator images. On average, we required 45minutes to perform the entire set-up, simulation, calculation and treatment.Conclusions: Our initial clinical experience demonstrates that online simu-lation and treatment is a feasible and proficient solution, replacing our con-ventional simulation process. We anticipate this new streamlined process willresult in time saving advantages for both patients and departmental workflow;however, further confirmatory studies are required.
Comment: =Verification
=Linac
BibTeX:
@conference{Walker2011,
  author = {Walker, A. and Müller, J. and Lang, S. and Brown, M. and Imboden, A. and Winter, C. and Studer, G.},
  title = {ADVANCEMENTS IN PALLIATIVE RADIATION THERAPY: DEVELOPMENT OF AN ONLINE SIMULATION AND TREATMENT DELIVERY PROGRAM},
  journal = {Strahlentherapie und Onkologie},
  publisher = {Elsevier},
  year = {2011},
  volume = {99},
  pages = {S586},
  doi = {https://doi.org/10.1016/s0167-8140(11)71700-5}
}
Sellakumar, P., Arun, C., Sanjay, S.S. and Ramesh, S.B. Comparison of monitor units calculated by radiotherapy treatment planning system and an independent monitor unit verification software. 2011 Physica medica
Vol. 27, pp. 21-29 
article DOI  
Abstract: In radiation therapy, the monitor units (MU) needed to deliver a treatment plan are calculated by treatment planning systems (TPS). The essential part of quality assurance is to verify the MU with independent monitor unit calculation to correct any potential errors prior to the start of treatment. In this study, we have compared the MU calculated by TPS and by independent MU verification software. The MU verification software was commissioned and tested for the data integrity to ensure that the correct beam data was considered for MU calculations. The accuracy of the calculations was tested by creating a series of test plans and comparing them with ion chamber measurements. The results show that there is good agreement between the two. The MU difference (MUdiff) between the monitor unit calculations of TPS and independent MU verification system was calculated for 623 fields from 245 patients and was analyzed by treatment site for head & neck, thorax, breast, abdomen and pelvis. The mean MUdiff of -0.838% with a standard deviation of 3.04% was observed for all 623 fields. The site specific standard deviation of MUdiff was as follows: abdomen and pelvis (<1.75%), head & neck (2.5%), thorax (2.32%) and breast (6.01%). The disparities were analyzed and different correction methods were used to reduce the disparity.
Comment: =Evaluation
=Linac
BibTeX:
@article{Sellakumar2011,
  author = {Sellakumar, P. and Arun, C. and Sanjay, S. S. and Ramesh, S. B.},
  title = {Comparison of monitor units calculated by radiotherapy treatment planning system and an independent monitor unit verification software.},
  journal = {Physica medica},
  year = {2011},
  volume = {27},
  pages = {21--29},
  doi = {https://doi.org/10.1016/j.ejmp.2010.01.006}
}
Pierno, J., Hamilton, C. and Kanumalla, S. Radcalc IMRT Plan Verification vs. Mapcheck IMRT Plan Verification 2011 Medical Physics
Vol. 38(6Part3), pp. 3392-3392 
conference DOI  
Abstract: To compare the accuracy of the RadCalc (LifeLine Software) IMRT plan verification module to the MapCHECK (Sun Nuclear) IMRT Treatment Plan verification system.Methods: A group of 47 patients were randomly selected to compare the accuracy of the two methods of IMRT verification. IMRT treatment plans were created using the Eclipse treatment planning system (Varian Medical Systems) Version 8.6. For the MapCHECK, a verification plan was created in Eclipse and all beams were calculated with one gantry and collimator angle and exported to the MapCHECK software. The plan was delivered to the MapCHECK device using a Varian 21EX. The data sets were compared in the MapCHECK software with a percent difference of 3% and a distance to agreement of 3mm. For the RadCalc software a calculation point was added to the plan, the plan was approved and exported to RadCalc. The plan was then calculated within the RadCalc software Version 7.0. MUˈs for all fields were examined and the percent difference for the calculation point was reviewed.Results: Both methods were utilized on all selected patients and the results then compared. The MapCHECK data sets averaged a percent difference of 1.27% from the planned dose with an average of 99.29% of the points passing. The RadCalc data sets averaged a percent difference of 1.05%. Conclusions: It was determined that the RadCalc IMRT verification module can be directly substituted for the MapCHECK IMRT Treatment Plan verification system with no loss in verification accuracy. The RadCalc module provides equivalent plan verification for smaller plan size (i.e. under 20.0 cm × 20.0 cm), while providing superior results for large field IMRT due to the field size limits inherent to the MapCHECK device.
Comment: =Evaluation
=Linac
BibTeX:
@conference{Pierno2011,
  author = {Pierno, J and Hamilton, C and Kanumalla, S},
  title = {Radcalc IMRT Plan Verification vs. Mapcheck IMRT Plan Verification},
  journal = {Medical Physics},
  year = {2011},
  volume = {38},
  number = {6Part3},
  pages = {3392-3392},
  doi = {https://doi.org/10.1118/1.3611561}
}
Peng, C., Chen, G., Ahunbay, E., Wang, D., Lawton, C. and Li, X.A. Validation of an online replanning technique for prostate adaptive radiotherapy. 2011 Physics in Medicine and Biology
Vol. 56, pp. 3659-3668 
article DOI  
Abstract: We have previously developed an online adaptive replanning technique to rapidly adapt the original plan according to daily CT. This paper reports the quality assurance (QA) developments in its clinical implementation for prostate cancer patients. A series of pre-clinical validation tests were carried out to verify the overall accuracy and consistency of the online replanning procedure. These tests include (a) phantom measurements of 22 individual patient adaptive plans to verify their accuracy and deliverability and (b) efficiency and applicability of the online replanning process. A four-step QA procedure was established to ensure the safe and accurate delivery of an adaptive plan, including (1) offline phantom measurement of the original plan, (2) online independent monitor unit (MU) calculation for a redundancy check, (3) online verification of plan-data transfer using an in-house software and (4) offline validation of actually delivered beam parameters. The pre-clinical validations demonstrate that the newly implemented online replanning technique is dosimetrically accurate and practically efficient. The four-step QA procedure is capable of identifying possible errors in the process of online adaptive radiotherapy and to ensure the safe and accurate delivery of the adaptive plans. Based on the success of this work, the online replanning technique has been used in the clinic to correct for interfractional changes during the prostate radiation therapy.
Comment: =Verification
=Linac
BibTeX:
@article{Peng2011,
  author = {Peng, Cheng and Chen, Guangpei and Ahunbay, Ergun and Wang, Dian and Lawton, Colleen and Li, X. Allen},
  title = {Validation of an online replanning technique for prostate adaptive radiotherapy.},
  journal = {Physics in Medicine and Biology},
  year = {2011},
  volume = {56},
  pages = {3659--3668},
  doi = {https://doi.org/10.1088/0031-9155/56/12/013}
}
Ford, A., Bydder, S. and Ebert, M.A. The use of On-Board Imaging to plan and deliver palliative radiotherapy in a single cohesive patient appointment 2011 Journal of Medical Imaging and Radiation Oncology
Vol. 55(6), pp. 633-638 
article DOI  
Abstract: To develop and assess a method of palliative radiotherapy utilising a kilovolt-age imaging system incorporated with a linear accelerator. The conventionallyseparate procedures of simulation, planning and treatment were merged intoa single appointment on a linear accelerator. The process was tested using ahumanoid phantom and hypothetical treatment scenarios. A clinical investi-gation was then undertaken for patients requiring palliative radiotherapy. Atotal of 10 treatment sites were simulated, planned and treated using theonline approach. Each step was timed for both the phantom and patienttreatments and was compared with a simulation process involving a separateappointment on a conventional simulator. The contrast and resolution achiev-able with the linear accelerator-based imaging system was found to becomparable with a conventional simulator. Bony anatomy was plainly visibleand suitable for target definition. The mean total treatment time for thehumanoid phantom (n=5) was 21.40.9 (standard error) mins. The meantotal treatment time for actual patients (n=10) was 25.71.6 mins (themean simulation, planning and treatment times were 11.00.5 mins,14.51.0 mins and 3.60.2 mins, respectively). This study demonstratedthat palliative radiotherapy treatments can be simulated, planned and treatedin a single cohesive patient appointment, using an online approach that istechnically comparable with the conventional simulation method. Thisapproach has the potential to expedite palliative radiotherapy service deliveryand reduce resource burdens by minimising the number of patient appoint-ments and wait times between appointments.
Comment: =Verification
=Linac
BibTeX:
@article{Ford2011,
  author = {Andriana Ford and Sean Bydder and Martin Andrew Ebert},
  title = {The use of On-Board Imaging to plan and deliver palliative radiotherapy in a single cohesive patient appointment},
  journal = {Journal of Medical Imaging and Radiation Oncology},
  publisher = {Wiley},
  year = {2011},
  volume = {55},
  number = {6},
  pages = {633--638},
  doi = {https://doi.org/10.1111/j.1754-9485.2011.02321.x}
}
Esmail, A. and James, H. ROUTINE QUALITY ASSURANCE OF RAPIDARC (ROTATIONAL IMRT THERAPY) TREATMENT PLANS 2011 Strahlentherapie und Onkologie
Vol. 99, pp. S537 
conference DOI  
Abstract: This study describes our clinical experience of pre-treatment QAof RapidArc treatment plans performed within our centre over the past 12months. The VarianRapidArcsystem was commissioned in December 2009.Pre-treatment dose plane verification ensures dosimetric accuracy of plansbefore delivery to the patient. A commercially available arc therapy QA tool,theOctaviusPhantom, along with theSeven292D ion chamber array andVerisoftAnalysis software (all supplied by PTW) were commissioned andevaluated.Materials: Initially, the QA of RapidArc treatment plans was carried out byperforming dose point verification in a perspex block using a calibrated pin-point chamber positioned at a fixed point. An independent check of theplanned Monitor Units (MU) was also performed using Radcalc (Sun NuclearSystems) with a tolerance set at±2%. The perspex block method meantonly one dose point could be measured at a time. The 2D-Array allows forthe evaluation of a possible 729 dose points in a single plane. Two orthogo-nal planes were acquired in the Octavius Phantom. A model of the treatmentcouch, provided in the TPS, was included in the verification. Verisoft soft-ware was used to compare the isodose data from the TPS with the measureddata. A Gamma index algorithm, incorporating dose difference and distanceto agreement (DTA), was used for dose evaluationResults: Initial confidence of the RapidArc system was attained with all Per-spex block measurements being within 2% of the expected value obtainedfrom the TPS (average absolute deviation of 0.74%±1.09%) and all RadcalcMU checks being within the tolerance of±2%. For the first 15 RapidArc pa-tients using the Octavius System, the measured dose planes had an averageGamma Index result of 97.5%±2.4%, using a DTA of 3%/2mm with referenceto Local dose. Only 4 out of the 30 dose planes had a result less than 95%but all were greater than 90%. Looking at the Gamma maps, areas of failurewere in low-dose regions outside the PTV and delivered dose was lower thanplanned. These plans were deemed clinically acceptable and proceeded totreatment. Verification plan set-up takes 40 minutes per plane, 10 mins isrequired to set the phantom up on the Linac and perform a dose calibration.Delivery of each arc takes 1-3 mins, and at least 5 mins is required to re-orientate the phantom for the next dose plane. Verisoft evaluation of eachdose plane takes no more than 2 mins. Therefore at least 100 minutes totalQA time is required.Conclusions: The use of the Octavius phantom with the 2D Array andVerisoft software has given us a high level of confidence in the RapidArcplanning and delivery systems. Our tolerance of at least 95% of the evalu-ated dose points passing the Gamma criteria of 3%/2mm DTA, with referenceto Local dose, is met in the majority of cases. Dose plane measurements inOctavius is now routine individual pre-treatment patient QA for all our Rapi-dArc plans.
Comment: =Verification
=Linac
BibTeX:
@conference{Esmail2011,
  author = {Esmail, A. and James, H.},
  title = {ROUTINE QUALITY ASSURANCE OF RAPIDARC (ROTATIONAL IMRT THERAPY) TREATMENT PLANS},
  journal = {Strahlentherapie und Onkologie},
  publisher = {Elsevier},
  year = {2011},
  volume = {99},
  pages = {S537},
  doi = {https://doi.org/10.1016/s0167-8140(11)71566-3}
}
Changkaew, P., Stansook, N., Khachonkham, S., Piriyasang, D., Sakulsingharoj, S. and Tangboonduangjit, P. Commissioning of An Independent Monitor Unit Verification Program (RadCalc Version 6.1) in Photon Point Dose Calculation 2011 Medical Physics
Vol. 38(6Part16), pp. 3567-3567 
conference DOI  
Abstract: To commissioningRadCalc program for secondary point dose check in conventional 2D and 3DCRT calculation techniques. Methods: Test plans for 6 MV and 10 MV photon beams with conventional and 3DCRT planwere created inRadCalc program.Field was varied with a range of field sizes and modifier techniques referred to IAEA-TECDOC-1583 with central axis and off central axis calculation points. The measured dose for each field was then compared to the calculated dose (RadCalc program and Eclipse treatment planning system). Results: In conventional field validation,RadCalc shows good agreement with measured doses.For open and almost all wedge fields, RadCalccalculationagree with dose measurement within +/−1%. Differences of over 1% were found in maximum wedge fields and some half fields. However, the dose difference between calculation and measurementwas within +/−2% in all tests. In 3DCRT plan validation, the central axis point dose between calculation and measurement in all tests are agree within the IAEA-TECDOC-1583 criteria. When measured/ calculated dose points were in non-tissue equivalent such as lung and bone which were off central axis situation, dose difference is more than +/−10%. Unfortunately if measured/ calculated dose points areoutside the field (scatter dose), the result cannot be validated. Part of this large difference between two calculated and measured can be the volume effect of the chamber.In comparison between dose calculated by RadCalc and Eclipse, overall results show dose difference within +/−5%. Conclusions: RadCalc program can be used as a point dose calculation check in conventional 2D and 3DCRT techniques.
Comment: =Evaluation
=Linac
BibTeX:
@conference{Changkaew2011,
  author = {Changkaew, P and Stansook, N and Khachonkham, S and Piriyasang, D and Sakulsingharoj, S and Tangboonduangjit, P},
  title = {Commissioning of An Independent Monitor Unit Verification Program (RadCalc Version 6.1) in Photon Point Dose Calculation},
  journal = {Medical Physics},
  year = {2011},
  volume = {38},
  number = {6Part16},
  pages = {3567-3567},
  doi = {https://doi.org/10.1118/1.3612302}
}
Carreira, P., Madureira, L., Mota, M., Pontes, M., Ribeiro, T., Prudêncio, L., Teixeira, N. and Grillo, I.M. MONITOR UNIT COMPARISON BETWEEN A TREATMENT PLANNING SYSTEM AND AN INDEPENDENT MONITOR UNIT CALCULATION SOFTWARE 2011 Strahlentherapie und Onkologie
Vol. 99, pp. S581 
conference DOI  
Abstract: Monitor unit (MU) calculation is a vital process in external beam ra-diotherapy in order to assure a correct dose distribution and agreement withtreatment prescription. The intent of independent MU calculation software isto verify the MU calculation of the treatment planning system (TPS). Utiliza-tion of MU independent calculation software is recommended by the Ameri-can Association of Physicists in Medicine TG-40 for quality assurance of TPS.The main goal of this study is to compare the MU calculation of TPS with theindependent MU software calculations for several reference fields. Further-more, differences in phantom ionization chamber dose measurements, withMU calculations from both systems, were also object of evaluation.Materials: The machine characterization, for the independent MU calculationsoftware RadCalc®V6.0, were made according to software specification andlinear accelerator ELEKTA Synergy data from commissioning. The TPS XiO®V4.40 with superposition algorithm and the same linear accelerator data wasused.Several reference fields with different photon beam energies, sizes, col-limator and gantry angles as well as wedges were created on XiO. For tissueheterogeneity evaluation CIRS Pelvic phantom was used with different inserts(bone, water and air). The fields were exported to RadCalc for calculation andto ELEKTA Synergy control system for absolute dose measurements in CIRSphantom with a 0.125 cm3PTW ionization chamber. The IAAE TRS-398 pro-tocol was followed for dose correction. Results for MU calculations and dosemeasurements, from XiO plans and RadCalc, were compared and analyzed.Results: The difference in MU from TPS and RadCalc was about 2% for fieldsize less than or equal to 15x15 cm2, increasing to 5% for larger fields. Formore complex fields, with wedge and collimator rotation in heterogeneousmedium, the results show differences up to 7%.Conclusions: The XiO MU calculation difference to RadCalc was studiedand determined for several reference fields including most of beam modifiersand tissue heterogeneities. With these results we should be able to evaluatereal cases differences. Therefore RadCalc should be an important tool forTPS quality assurance in our external beam radiotherapy department.
Comment: =Evaluation
=Linac
BibTeX:
@conference{Carreira2011,
  author = {Carreira, P. and Madureira, L. and Mota, M. and Pontes, M. and Ribeiro, T. and Prudêncio, L. and Teixeira, N. and Grillo, I. Monteiro},
  title = {MONITOR UNIT COMPARISON BETWEEN A TREATMENT PLANNING SYSTEM AND AN INDEPENDENT MONITOR UNIT CALCULATION SOFTWARE},
  journal = {Strahlentherapie und Onkologie},
  publisher = {Elsevier},
  year = {2011},
  volume = {99},
  pages = {S581},
  doi = {https://doi.org/10.1016/s0167-8140(11)71682-6}
}
Al-Mohammed, H.I. Patient Specification Quality Assurance for Glioblastoma Multiforme Brain Tumors Treated with Intensity Modulated Radiation Therapy 2011 International Journal of Medical Sciences
Vol. 8(6), pp. 461-466 
article DOI  
Abstract: The aim of this study was to evaluate the significance of performing patient specification quality assurance for patients diagnosed with glioblastoma multiforme treated with intensity modulated radiation therapy. The study evaluated ten intensity modulated radiation therapy treatment plans using 10 MV beams, a total dose of 60 Gy (2 Gy/fraction, five fractions a week for a total of six weeks treatment). For the quality assurance protocol we used a two-dimensional ionization-chamber array (2D-ARRAY). The results showed a very good agreement between the measured dose and the pretreatment planned dose. All the plans passed >95% gamma criterion with pixels within 5% dose difference and 3 mm distance to agreement. We concluded that using the 2D-ARRAY ion chamber for intensity modulated radiation therapy is an important step for intensity modulated radiation therapy treatment plans, and this study has shown that our treatment planning for intensity modulated radiation therapy is accurately done.
Comment: =Verification
=Linac
BibTeX:
@article{AlMohammed2011,
  author = {H. I. Al-Mohammed},
  title = {Patient Specification Quality Assurance for Glioblastoma Multiforme Brain Tumors Treated with Intensity Modulated Radiation Therapy},
  journal = {International Journal of Medical Sciences},
  publisher = {Ivyspring International Publisher},
  year = {2011},
  volume = {8},
  number = {6},
  pages = {461--466},
  doi = {https://doi.org/10.7150/ijms.8.461}
}
Williams, T., Ramm, D. and Lawson, J Implementation of frame-based stereotactic radiosurgery system 2010 Australasian Physical & Engineering Sciences in Medicine
Vol. 33(1), pp. 65-117 
conference DOI  
Abstract: Recently the existing Fischer-Liebinger frame based Stereotactic Radiosurgery (SRS) system at the Royal Adelaide Hospital was decommissioned and replaced with the BrainLAB SRS frame system. As SRS cone applicators were being used small field measurements were necessary. Output factor measurements were made with both PTW pin point chamber and small chip TLDs, the output factors were then compared and a selective combination of both measurements entered into the planning system. Once the beam data was measured and entered various tests were performed against the old Fischer-Liebinger system. Comparing simple beam arrangements found dose agreement at isocentre between the two systems to be within 2%. Various verification measurements were made with differing complexity, ranging from simple point dose measurements in phantom through to the use of a SRS head phantom. The SRS head phantom was fixed in the headring and progressed from CT to treatment, testing not only the dosimetric accuracy of the system but also positional accuracy and transfer of the treatment parameters from the planning system to the treatment machine. RadCalc was successfully configured so that it can be utilised as a secondary MU checker for the BrainLAB arc treatments. The BrainLAB system is now in clinical use, and although still being used with SRS cones and patient headring, the new planning software has greatly enhanced the quality of service offered to patients. It is envisaged in the near future that the cones will be replaced with dynamic MLC treatments.
Comment: =Verification
=Linac
BibTeX:
@conference{Williams2010a,
  author = {Williams, T and Ramm, D and Lawson J},
  title = {Implementation of frame-based stereotactic radiosurgery system},
  journal = {Australasian Physical & Engineering Sciences in Medicine},
  publisher = {Springer Science and Business Media LLC},
  year = {2010},
  volume = {33},
  number = {1},
  pages = {65--117},
  doi = {https://doi.org/10.1007/s13246-010-0012-x}
}
Mayo, C.S., Ding, L., Addesa, A., Kadish, S., Fitzgerald, T.J. and Moser, R. Initial Experience With Volumetric IMRT (RapidArc) for Intracranial Stereotactic Radiosurgery 2010 International Journal of Radiation Oncology Biology Physics
Vol. 78(5), pp. 1457-1466 
article DOI  
Abstract: Initial experience with delivering frameless stereotactic radiotherapy (SRT) using volumetric intensity-modulated radiation therapy (IMRT) delivered with RapidArc is presented.Methods and Materials: Treatment details for 12 patients (14 targets) with a mean clinical target volume (CTV) of12.8 ± 4.0 cm3 were examined. Dosimetric indices for conformality, homogeneity, and dose gradient were calcu-lated and compared with published results for other frameless, intracranial SRT techniques, including Cyber-Knife, TomoTherapy, and static-beam IMRT. Statistics on setup and treatment times and per patient dosevalidations were examined.Results: Dose indices compared favorably with other techniques. Mean conformality, gradient, and homogeneityindex values were 1.10 ± 0.11, 64.9 ± 14.1, 1.083 ± 0.026, respectively. Median treatment times were 4.8 ± 1.7 min.Conclusion: SRT using volumetric IMRT is a viable alternative to other techniques and enables short treatmenttimes. This is anticipated to have a positive impact on radiobiological effect and for facilitating wider use of SRT.
Comment: =Verification
=Linac
=CK
=TT
BibTeX:
@article{Mayo2010,
  author = {Mayo, Charles S. and Ding, Linda and Addesa, Anthony and Kadish, Sidney and Fitzgerald, T. J. and Moser, Richard},
  title = {Initial Experience With Volumetric IMRT (RapidArc) for Intracranial Stereotactic Radiosurgery},
  journal = {International Journal of Radiation Oncology Biology Physics},
  publisher = {Elsevier},
  year = {2010},
  volume = {78},
  number = {5},
  pages = {1457--1466},
  doi = {https://doi.org/10.1016/j.ijrobp.2009.10.005}
}
Iftimia, I., Cirino, E.T., Xiong, L. and Mower, H.W. Quality assurance methodology for Varian RapidArc treatment plans. 2010 Journal of applied clinical medical physics
Vol. 11, pp. 3164 
article DOI  
Abstract: With the commercial introduction of the Varian RapidArc, a new modality for treatment planning and delivery, the need has arisen for consistent and efficient techniques for performing patient-specific quality assurance (QA) tests. In this paper we present our methodology for a RapidArc treatment plan QA procedure. For our measurements we used a 2D diode array (MapCHECK) embedded at 5 cm water equivalent depth in MapPHAN 5 phantom and an Exradin A16 ion chamber placed in six different positions in a cylindrical homogeneous phantom (QUASAR). We also checked the MUs for the RapidArc plans by using independent software (RadCalc). The agreement between Eclipse calculations and MapCHECK/MapPHAN5 measurements was evaluated using both absolute distance-to-agreement (DTA) and gamma index with 10% dose threshold (TH), 3% dose difference (DD), and 3 mm DTA. The average agreement was 94.4% for the DTA approach and 96.3% for the gamma index approach. In high-dose areas, the discrepancy between calculations and ion chamber measurements using the QUASAR phantom was within 4.5% for prostate cases. For the RadCalc calculations, we used the average SSD along the arc; however, for some patients the agreement for the MUs obtained with RadCalc versus Eclipse was inadequate (discrepancy > 5%). In these cases, the plan was divided into partial arc plans so that RadCalc could perform a better estimation of the MUs. The discrepancy was further reduced to within  4% using this approach. Regardless of the variation in prescribed dose and location of the treated areas, we obtained very good results for all patients studied in this paper.
Comment: =Verification
=Linac
BibTeX:
@article{Iftimia2010,
  author = {Iftimia, Ileana and Cirino, Eileen T. and Xiong, Li and Mower, Herbert W.},
  title = {Quality assurance methodology for Varian RapidArc treatment plans.},
  journal = {Journal of applied clinical medical physics},
  year = {2010},
  volume = {11},
  pages = {3164},
  doi = {https://doi.org/10.1120/jacmp.v11i4.3164}
}
Feygelman, V., Zhang, G. and Stevens, C. Initial dosimetric evaluation of SmartArc - a novel VMAT treatment planning module implemented in a multi-vendor delivery chain 2010 Journal of Applied Clinical Medical Physics
Vol. 11(1), pp. 99-116 
article DOI  
Abstract: We performed an initial dosimetric evaluation of SmartArc - a novel VMAT planning module for the Philips Pinnacle treatment planning system. It was implemented in a multi-vendor environment, with the other two major components of the delivery chain being MOSAIQ record and verify system (IMPAC Medical Systems, Sunnyvale, CA) and a Trilogy linac (Varian Medical Systems, Palo Alto, CA). A test suite of structure sets and dose objectives provided by the AAPM for multi-institutional comparison of IMRT dosimetry was used. A total of fifty plans were successfully delivered. The effect of control point spacing on dosimetric accuracy was investigated. When calculated with the 4° spacing, the overall mean point dose errors measured with an ion chamber were and for the PTV and OAR, respectively. The gamma (3%, 3 mm) passing rate, measured for absolute dose with a biplanar diode array, was (range 94.5?99.9%). Ninety percent of the passing rate values were above 97.7%. With the 6° control point spacing, the highly modulated plans exhibited large dosimetric errors (e.g. ?(3%, 3 mm) passing rates below 90% and ion chamber point dose errors of 6?12%), while the results were still acceptable for the simpler cases. The data show that the practical accuracy of the small-arc approximation, which is at the heart of VMAT dose calculations, depends not only on the control point spacing, but also on the size and relative position of the MLC openings corresponding to the consecutive control points. The effect of the minimum allowed separation between the opposing leaves was found to be minimal. It appears that 4° control point spacing may be a good compromise between calculation speed and accuracy. However each institution is encouraged to establish its own treatment planning guidelines based on the case complexity and acceptable error level. PACS number: 87.55Qr
Comment: =Verification
=Linac
=TT
BibTeX:
@article{Feygelman2010,
  author = {Feygelman, Vladimir and Zhang, Geoffrey and Stevens, Craig},
  title = {Initial dosimetric evaluation of SmartArc - a novel VMAT treatment planning module implemented in a multi-vendor delivery chain},
  journal = {Journal of Applied Clinical Medical Physics},
  publisher = {John Wiley & Sons, Ltd},
  year = {2010},
  volume = {11},
  number = {1},
  pages = {99--116},
  doi = {https://doi.org/10.1120/jacmp.v11i1.3169}
}
Esquivel, C., Wang, X., Calvo, O., Stathakis, S., Corona, I., Mihailidis, D. and Papanikolaou, N. Implications of 120-MLC Plans Treated on an 80-MLC Linear Accelerator 2010 Medical Physics
Vol. 37(6Part18), pp. 3222-3222 
conference DOI  
Abstract: This study reviews nine head-and-neck IMRT plans created on Pinnacle3 Treatment Planning System for a Varian 120-Millenium MLC linac. Using the Varian MLC Shaper application, each field was reconfigured for an 80-Millenium MLC machine. The reconfigured fields were exported to RadCalc and were replaced with the new MLC configurations before being exported to Pinnacle. Each plan was recalculated to deliver the same dose to the same target volume using the same number of monitor units for the same number of fractions. Isodose distributions and dose volume histograms were compared. In addition, a 2D-array system was used for absolute dose verification of each plan delivered on the 120-MLC machine and on the 80-MLC machine. Isodose distributions, histogram and the gamma fluence were evaluated for each delivery. Results: The MLC Shaper averages two adjacent leaves to form a single leaf which may significantly affect the dose delivery. The isodose distributions and comparative DVHs of the same plan delivered show adequate sparing of normal tissues and other surrounding structures for low isodose regions. However, structures close to or adjacent to the target region may receive higher doses. Both the planning and dose validation confirm that there are larger high-isodose regions with higher hotspots for the 80-MLC plan. Conclusion: The results indicated that delivery of a 120-MLC IMRT head-and-neck plan after undergoing MLC shaping can be delivered on an 80-MLC linac. In cases were a patient is transferred from a 120-MLC machine to an 80-MLC linac for a small number of fractions of the total dose regime, there may be insignificant changes in dose distribution. However, investigation of each individual plan must be evaluated, either through the treatment planning system or dose validation for extended treatments.
Comment: =Verification
=Linac
BibTeX:
@conference{Esquivel2010,
  author = {Esquivel, C and Wang, X and Calvo, O and Stathakis, S and Corona, I and Mihailidis, D and Papanikolaou, N},
  title = {Implications of 120-MLC Plans Treated on an 80-MLC Linear Accelerator},
  journal = {Medical Physics},
  year = {2010},
  volume = {37},
  number = {6Part18},
  pages = {3222-3222},
  doi = {https://doi.org/10.1118/1.3468553}
}
Dempsey, C. Methodology for commissioning a brachytherapy treatment planning system in the era of 3D planning. 2010 Australasian physical & engineering sciences in medicine
Vol. 33, pp. 341-349 
article DOI  
Abstract: To describe the steps undertaken to commission a 3D high dose rate (HDR) brachytherapy treatment planning system (TPS). Emphasis was placed on validating previously published recommendations, in addition to checking 3D parameters such as treatment optimization and dose volume histogram (DVH) analysis. Commissioning was performed of the brachytherapy module of the Nucletron Oncentra MasterPlan treatment planning system (version 3.2). Commissioning test results were compared to an independent external beam TPS (Varian Eclipse v 8.6) and the previously commissioned Nucletron Plato (v 14.3.7) brachytherapy treatment planning system, with point doses also independently verified using the brachytherapy module in RadCalc (v 6.0) independent point dose calculation software. Tests were divided into eight categories: (i) Image import accuracy, (ii) Reconstruction accuracy, (iii) Source configuration data check, (iv) Dose calculation accuracy, (v) Treatment optimization validation, (vi) DVH reproducibility, (vii) Treatment export check and (viii) Printout consistency. Point dose agreement between Oncentra, Plato and RadCalc was better than 5% with source data and dose calculation protocols following the American Association of Physicists in Medicine (AAPM) guidelines. Testing of image accuracy (import and reconstruction), along with validation of automated treatment optimization and DVH analysis generated a more comprehensive set of testing procedures than previously listed in published recommendations.
Comment: =Verification
=BT
BibTeX:
@article{Dempsey2010,
  author = {Dempsey, Claire},
  title = {Methodology for commissioning a brachytherapy treatment planning system in the era of 3D planning.},
  journal = {Australasian physical & engineering sciences in medicine},
  year = {2010},
  volume = {33},
  pages = {341--349},
  doi = {https://doi.org/10.1007/s13246-010-0036-2}
}
Chen, G., Ahunbay, E. and Li, A. Automatic Verification of Plan Data Transfer for Online Adaptive Radiotherapy 2010 International Journal of Radiation Oncology Biology Physics
Vol. 78(3), pp. S738-S739 
conference DOI  
Abstract: Verification of the plan data transferred from planning system to delivery machine prior to treatment delivery is a necessary step for quality assurance (QA) and safety and is often performed via visual inspection. However, such visual inspection can be time consuming for intensity modulated radiotherapy (IMRT), a particular concern for online adaptive re-planning, and human errors are inevitable. The purpose of this work is to develop a software tool to automatically verify the plan data transfer for online adaptive radiotherapy. Materials/Methods: A software tool was developed using Microsoft Visual C++. The tool can read/extract treatment plan data including gantry/collimator/couch parameters, MLC positions, and monitor unit (MU) numbers from three sources: (1) a treatment planning system (TPS) (RealART, Prowess, or Xio, CMS) via RTP link, DICOM transfer or a direct interface to TPS, (2) an independent MU calculation system (RadCalc, LifeLine Software Inc.) for secondary MU check, and (3) a record and verify (R&V) system (Lantis, Siemens, or Mosaiq, Elekta) by retrieving the imported and stored plan data with an open database connectivity (ODBC) connection. The ODBC connection to the R&V system database was created to be read only and password protected. The data from aforementioned three sources were compared to verify the consistency between the data in the TPS and those stored in the R&V system and to search for any discrepancy between the MU numbers calculated by the TPS and by the secondary MU check program. The comparison results were output by the software
tool. Results: The verification software tool was tested with real IMRT plans from regular treatments and from the online adaptive radiotherapy. The tool was capable of automatically detecting any inconsistency between the beam data from the TPS and the data transferred and stored in the R&V system and identifying any discrepancy between the MU numbers calculated from the TPS and from the secondary MU check program. The execution of the tool lasted only a few seconds. The tool is being integrated into our clinical online adaptive re-planning process as a necessary QA step to be performed prior to the delivery of the adaptive plan. The use of this tool speeded the online adaptive process by eliminating the manual and tedious visual inspection. The tool was also found to be useful for regular plan check and verification. Conclusions: A QA software tool has been developed to automatically verify the plan data transfer from the planning system to the R&V system and to identify discrepancy in MU calculations between the planning system and the secondary MU check. This tool speeds up the online adaptive re-planning process and improves QA and safety.
Comment: =Verification
=Linac
BibTeX:
@conference{Chen2010,
  author = {Chen, G. and Ahunbay, E. and Li, A.},
  title = {Automatic Verification of Plan Data Transfer for Online Adaptive Radiotherapy},
  journal = {International Journal of Radiation Oncology Biology Physics},
  publisher = {Elsevier},
  year = {2010},
  volume = {78},
  number = {3},
  pages = {S738--S739},
  doi = {https://doi.org/10.1016/j.ijrobp.2010.07.1710}
}
Williams, A. A SIMPLE TONGUE AND GROOVE EFFECT ESTIMATOR FOR IMRT QA 2009 Strahlentherapie und Onkologie
Vol. 92, pp. S210 
conference DOI  
Abstract: In dynamic IMRT, the tongue and groove (T&G) effect has longbeen known to reduce, by as much as 20%, the dose delivered between ad-jacent leaves whose movement is not synchronised [1, 2]. The effect canbe reduced by improved optimisation/synchronisation of the leaf movements[3], or its effect limited by using collimator twists so that the likelihood of T&Geffects from multiple fields adding up are minimised [4]. For our head andneck IMRT treatments at the Norfolk and Norwich University Hospital, neitherof these options is available; we use the Varian Eclipse[5] planning systemwhose leaf motion calculator minimises MU delivered at the expense of goodleaf synchronisation; and we have chosen a technique that maintains easytransferability between IMRT and conventional treatment which prevents theuse of collimator twists. The only methods we have available to us to checkthe level of the T&G effect is to make measurements on the treatment ma-chine, either using film or portal dosimetry (PD). In order to reduce the amountof machine time required, a simple programme in Mathcad[6] has been writ-ten to estimate the T&G present in dynamic IMRT fields. None of the commer-cially available IMRT QA check programs, such as IMSure[7], MUCheck[8],Radcalc[9] or Diamond[10] currently offer this functionality.Materials: The steps taken by the Mathcad programme to calculate the T&Gare as follows: The Varian MLC file is imported The leaf positions and doseweight for each segment are extracted For each segment, the fluence throughthe leaf centre (intra-leaf transmission), the leaf join (either inter-leaf transmis-sion or half the open field fluence modified by a user definable T&G factor,depending on adjacent leaf positions) and the open portion of the field arecalculated The fluence for all segments is summed. The above two stepsare then repeated but without taking into account the T&G effect. The localgamma value is then calculated by comparing 1) the percentage differencebetween the ’with T&G’ and the ’without T&G’ fluences, and 2) the value ofthe neighbouring point equivalent to using a distance to agreement (DTA)value of 2.5 mm. The area of the field for which the gamma value is aboveone is calculated.Results: A test field designed to produce the largest possible T&G effectalong the centre of a 10x10 field was used to calibrate the system againsta portal dosimetry image. The PD image gave a minimum dose value inthe T&G that was 80.5% of the adjacent dose, in good agreement with pub-lished data [1, 2]. This value was then used directly in the T&G programmeas the user-defined T&G factor. Figure 1 shows a typical result of using theT&G programme for an IMRT field compared with the result from using por-tal dosimetry (using 3%/2.5mm and normalised to remove imager calibrationartefacts). The correlation between PD and the T&G programme images isexcellent, demonstrating that the areas that will exhibit T&G artefacts will beaccurately identified by the T&G programme. The percentage area gammavalues are also in very good agreement in this example both scoring 2.3%.Initial analysis of 22 fields gives an average difference in the percentage areagamma value of 0.2%. We have found that tongue and groove effects are sig-nificant and required further investigation when the percentage area gammais higher than about 1.5%.Caption for Figure 1: Portal dosimetry measure-ment (top) and T&G programme calculation (bottom) for an IMRT field. Bothwere analysed using 3% dose, 2.5 mm DTA, and are displaying areas ofgamma above the value.
Comment: =Promotion
=Linac
BibTeX:
@conference{Williams2009,
  author = {Williams, A.},
  title = {A SIMPLE TONGUE AND GROOVE EFFECT ESTIMATOR FOR IMRT QA},
  journal = {Strahlentherapie und Onkologie},
  publisher = {Elsevier},
  year = {2009},
  volume = {92},
  pages = {S210},
  doi = {https://doi.org/10.1016/s0167-8140(12)73149-3}
}
Peng, C., Ahunbay, E., Chen, G., Lawton, C. and Li, X. Dosimetric QA Tests of An Online Replanning Technique for Prostate Adaptive Radiotherapy 2009 Medical Physics
Vol. 36(6Part9), pp. 2537-2537 
conference DOI  
Abstract: We have previously developed an online replanning technique to be completed within 8 minutes. In preparation for its clinical implementation, a comprehensive QA test was performed to ensure its dosimetric accuracy and operational efficiency. Method and Materials: The newly developed online replanning technique based on fast aperture morphing and weight optimization has been integrated into a planning system (Prowess). Daily CTs acquired using a CT-on-Rails (Siemens) of 3 randomly selected fractions for each of 5 representative prostate cancer cases were used to generate 15 daily plans in total. An independent MU calculation tool (RadCalc) was used to verify the MU numbers. All daily plans were delivered and measured with a 2D diode array (MapCheck). Results: The time required for the entire replanning process starting from loading daily CT to getting the daily plan ready for delivery were less than 8 minutes, comparable to the time of the current IGRT repositioning procedure. The average time required for generating contours of prostate, rectum and bladder, aperture morphing and weight optimization, plan review, and transferring into the delivery system were 3, 2, 1, and 0.5 minutes, respectively. The agreement between MU numbers from RadCalc and from the online replanning tool remained the same as for the original plans and was acceptable (within 5%). The QA passing rates (the agreements between the measured and calculated dose distributions) for daily plans were equivalent to those for the original plans and were acceptable (within 95%). Conclusion: This new online replanning technique is dosiemtrically accurate and practically efficient. Since the daily adaptive plans are not drastically different from the original plan, a QA measurement may not be necessary. A clinical trial to test the feasibility and efficacy of this replanning technique for prostate cancer is being initiated.
Comment: =Verification
=Linac
BibTeX:
@conference{Peng2009,
  author = {Peng, C and Ahunbay, E and Chen, G and Lawton, C and Li, X},
  title = {Dosimetric QA Tests of An Online Replanning Technique for Prostate Adaptive Radiotherapy},
  journal = {Medical Physics},
  year = {2009},
  volume = {36},
  number = {6Part9},
  pages = {2537-2537},
  doi = {https://doi.org/10.1118/1.3181552}
}
Morales, J. and Cho, G. Evaluation of RadCalc V5.2 as An Independent Monitor Unit Checking Program for Dynamic IMRT Plans 2009 Medical Physics
Vol. 36(6Part12), pp. 2569-2569 
conference DOI  
Abstract: To evaluate the accuracy of an independent monitor unit check program for checking Head and Neck IMRT plans generated by Eclipse v8.6 Treatment Planning System (Varian, Palo Alto, USA). Method and Materials: The independent monitor unit check program, RadCalc v5.2 (Lifeline Software, Texas, USA), was first commissioned to check conventional 3D conformal radiotherapy treatment plans. The IMRT module in RadClac was then optimized to test the controlled dynamic fluences used for IMRT delivery by Varian linear accelerators. The optimization involved adjustment of four RadCalc parameters: phantom scatter factor represented by Sp to the value of 1.5% from published values of C. McKerracher and D. I. Thwaites (1), Collimator scatter factor correction Sc to 0.650, Radiation Light offset to 0.95 and MLC transmission to 0.022. Preliminary data obtained from RadCalc has been compared to predicted doses by Eclipse TPS and to the ionization chamber measurements for a “chair” optimal fluence proposed by Van Esch et al (2). Preliminary analysis of three IMRT plans for Tonsil and Parotid treatments was also carried out using clinical verification data. Results: Initial investigation has shown that RadCalc is capable of predicting doses to within 2% for “chair” optimal fluence. For clinical IMRT cases RadCalc predicted dose agreed within 5% of ionization chamber measurements in a homogenous medium. Conclusion: RadCalc has the potential to be a useful independent monitor check QA tool for checking IMRT treatment plans. Further analysis is required to evaluate the accuracy and adequacy in a clinical IMRT program.
Comment: =Evaluation
=Linac
BibTeX:
@conference{Morales2009,
  author = {Morales, J and Cho, G},
  title = {Evaluation of RadCalc V5.2 as An Independent Monitor Unit Checking Program for Dynamic IMRT Plans},
  journal = {Medical Physics},
  year = {2009},
  volume = {36},
  number = {6Part12},
  pages = {2569-2569},
  doi = {https://doi.org/10.1118/1.3181688}
}
Cui, J., Stern, R., Yang, C. and Purdy, J. Testing the Sc, Sp, Scp Formulism for Elekta Beam Modulator 2009 Medical Physics
Vol. 36(6Part19), pp. 2672-2672 
conference DOI  
Abstract: The Elekta Beam Modulator™ (EBM) has a unique design in the sense that no movable jaws exist. The MLC has 40 leaf pairs with 4 mm wide leaves. A fixed diaphragm is beneath the MLC to form an aperture of 21 cm by 16 cm. The radiation fields are shaped primarily by the MLC. The goal of this work is to test whether the conventional Sc, Sp, Scp formalism holds true for this accelerator head configuration. Method and Materials: We have postulated two methods for determining Sc for the EBM: Method A: set Sc = 1 for all fields because there are no movable jaws; and Method B: regard the MLC as the “jaws”, since the apertures are formed by the MLC. We measured Sc for Method B using Wellhofer CC13 and PTW 30010 ion chamber with build-up caps. Both setups were configured in RadCalc and calculations compared to measurements. Results: 6 MV results are reported. For 100 MU, dose was measured for standard square, rectangle, and off-axis irregular shaped fields. For the standard fields, both methods agree with measurements to within 0.5%, except for the smallest field 2.4×2.4 cm2. For the off-axis and irregular fields, both calculations differ from the measured dose by 3∼7%. The two methods agree within 0.5% for most standard fields, and the difference between them tends to increase for the off-axis and irregular fields. Conclusions: Two methods to calculate Elekta Beam Modulator (EBM) point doses using the Sc, Sp, Scp formalism were tested. Both agree well with the measurement for the standard fields. However, they start to deviate from the measurements for off-axis and irregular fields. More testing, including 10MV and 15MV, is planned and will be presented for this unique machine.
Comment: =Verification
=Linac
BibTeX:
@conference{Cui2009,
  author = {Cui, J and Stern, R and Yang, C and Purdy, J},
  title = {Testing the Sc, Sp, Scp Formulism for Elekta Beam Modulator},
  journal = {Medical Physics},
  year = {2009},
  volume = {36},
  number = {6Part19},
  pages = {2672-2672},
  doi = {https://doi.org/10.1118/1.3182139}
}
Corona, I., Esquivel, C., Gutiérrez, A., Stathakis, S., Shi, C. and Papanikolaou, N. Dosimetric Evaluation of a 120-MLC Plan Delivered On a 80-MLC Linear Accelerator 2009 Medical Physics
Vol. 36(6Part16), pp. 2629-2629 
conference DOI  
Abstract: To evaluate a 120-multileaf collimator IMRT plan delivered on a 80-multileaf collimator linear accelerator. Materials and Method: In practice, it is possible to deliver a conventional treatment plan generated for the planned linear accelerator on another machine with matching characteristics. This study reviewed four intensity modulated radiotherapy treatment plans (IMRT) using the Pinnacle3 Treatment Planning System generated for a Varian 2100C/D 120-Millenium MLC linac. Using the Varian MLC Shaper application, each field was reconfigured for a 80-MLC Millennium machine. The new fields were uploaded to the Pinnacle treatment planning system via RadCalc software. Each plan was recalculated to deliver the same dose to the same treatment volume using the same number of monitor units for the entire treatment regime. The isodose distribution and dose volume histogram (DVH) of both plans were compared. Results: Evaluation of 120- and 80-MLC plans was based on DVHs of the planned target volume and critical structures and isodose line distribution. Generally, the lower isodose lines were similar for both plans. The higher isodose values differed. Hotspots were significantly larger for the 80-MLC plans for the planned target volumes. Conclusion: The results indicated that delivery of a 120-MLC IMRT plan delivered on an 80-MLC linac can vary. Investigation of each individual plan must be evaluated before the transfer delivery of treatment on the 80-MLC linac. In cases were a patient is transferred to another machine for a small number of fractions of the total dose regime, changes in dose distribution may be insignificant. Further investigation of evaluating delivery of dose with both and 120 and 80-MLC units is forthcoming.
Comment: =Verification
=Linac
BibTeX:
@conference{Corona2009,
  author = {Corona, I and Esquivel, C and Gutiérrez, A and Stathakis, S and Shi, C and Papanikolaou, N},
  title = {Dosimetric Evaluation of a 120-MLC Plan Delivered On a 80-MLC Linear Accelerator},
  journal = {Medical Physics},
  year = {2009},
  volume = {36},
  number = {6Part16},
  pages = {2629-2629},
  doi = {https://doi.org/10.1118/1.3181943}
}
Wilcox, E.E., Daskalov, G.M., Pavlonnis, G., Shumway, R., Kaplan, B. and VanRooy, E. Dosimetric verification of intensity modulated radiation therapy of 172 patients treated for various disease sites: comparison of EBT film dosimetry, ion chamber measurements, and independent MU calculations. 2008 Medical Dosimetry
Vol. 33, pp. 303-309 
article DOI  
Abstract: Three independent dose verification methods for intensity modulated radiation therapy (IMRT) were evaluated. Planar IMRT dose distributions were delivered to EBT film and scanned with the Epson Expression 1680 flatbed scanner. The measured dose distributions were then compared to those calculated with a Pinnacle treatment planning system. The IMRT treatments consisted of 7 to 9 6-MV beams for different treatment sites. The films were analyzed using FilmQA (3cognition LLC, Great Neck, NY) software. Comparisons between measured and calculated dose distributions are reported as dose difference (DD) (pixels within +/- 5%), distance to agreement (DTA) (3 mm), as well as gamma values (gamma) (dose = +/- 3%, distance = 2 mm). Point dose measurements with an ion chamber at isocenter were compared to dose calculated at that point. An independent monitor units (MUs) calculation program was also used for verification. For the film dose distributions, DD values varied from 92% to 97%, with head-and-neck and lung treatments showing lower values. Gamma varied from 93% to 98%, and DTA was well above 99%. The isocenter dose measurements deviated from 0.008 to 0.028 from the calculated dose. The larger deviations were attributed to high-dose gradients at the isocenter. RadCalc MU calculations gave differences from 0.027 to 0.079. The larger differences observed were for beams crossing large areas of heterogeneous tissue and were attributed to the limitations of the simple path-length correction method employed in RadCalc. In conclusion, the 3 independent verification methods for each IMRT patient at our institution demonstrated very good agreement between measurements and calculations and gave us the confidence that our IMRT treatments are delivered accurately.
Comment: =Verification
=Linac
BibTeX:
@article{Wilcox2008a,
  author = {Wilcox, Ellen E. and Daskalov, George M. and Pavlonnis, George and Shumway, Richard and Kaplan, Bruce and VanRooy, Eric},
  title = {Dosimetric verification of intensity modulated radiation therapy of 172 patients treated for various disease sites: comparison of EBT film dosimetry, ion chamber measurements, and independent MU calculations.},
  journal = {Medical Dosimetry},
  year = {2008},
  volume = {33},
  pages = {303--309},
  doi = {https://doi.org/10.1016/j.meddos.2008.03.004}
}
Kay, I. and Meyer, T. Verifying monitor unit calculations for tangential whole-breast fields in three-dimensional planning 2008 Journal of Applied Clinical Medical Physics
Vol. 9(1), pp. 47-53 
article DOI  
Abstract: Verification of the accuracy of monitor unit calculations is an essential component of quality assurance in radiation therapy. For tangential breast fields, monitor unit differences between primary calculations and second checks are usually larger than would be considered acceptable at other anatomic sites. Here, we present a simple model to reconcile the differences between sophisticated and simple algorithms, based on estimating the volume irradiated by the field, replacing the breast contour with a rectangular block having an equal volume, but using a new field width that provides almost equivalent scatter to the prescription point. This analysis can also assist the treatment planning physicist in selecting a tolerance window for verifying monitor unit calculations for tangential breast fields.
Comment: =Verification
=Linac
BibTeX:
@article{Kay2008,
  author = {Kay, Ian and Meyer, Tyler},
  title = {Verifying monitor unit calculations for tangential whole-breast fields in three-dimensional planning},
  journal = {Journal of Applied Clinical Medical Physics},
  publisher = {John Wiley & Sons, Ltd},
  year = {2008},
  volume = {9},
  number = {1},
  pages = {47--53},
  doi = {https://doi.org/10.1120/jacmp.v9i1.2713}
}
Bedford, J.L., Hansen, V.N., McNair, H.A., Aitken, A.H., Brock, J.E.C., Warrington, A.P. and Brada, M. Treatment of lung cancer using volumetric modulated arc therapy and image guidance: A case study 2008 Acta Oncologica
Vol. 47(7), pp. 1438-1443 
article DOI  
Abstract: Volumetric modulated arc therapy (VMAT) is a radiotherapy technique in which the gantry rotates while the beam is on. Gantry speed, multileaf collimator (MLC) leaf position and dose rate vary continuously during the irradiation. For optimum results, this type of treatment should be subject to image guidance. The application of VMAT and image guidance to the treatment of a lung cancer patient is described. MATERIAL AND METHODS: In-house software AutoBeam was developed to facilitate treatment planning for VMAT beams. The algorithm consisted of a fluence optimisation using the iterative least-squares technique, a segmentation and then a direct-aperture optimisation. A dose of 50 Gy in 25 fractions was planned, using a single arc with 35 control points at 10 degrees intervals. The resulting plan was transferred to a commercial treatment planning system for final calculation. The plan was verified using a 0.6 cm(3) ionisation chamber and film in a rectangular phantom. The patient was treated supine on a customised lung board and imaged daily with cone-beam CT for the first three days then weekly thereafter. RESULTS: The VMAT plan provided slightly improved coverage of the planning target volume (PTV) and slightly lower volume of lung irradiated to 20 Gy (V(20)) than a three-field conformal plan (PTV minimum dose 85.0 Gy vs. 81.8 Gy and lung V(20) 31.5% vs. 34.8%). The difference between the measured and planned dose was -1.1% (measured dose lower) and 97.6% of the film passed a gamma test of 3% and 3mm. The VMAT treatment required 90 s for delivery of a single fraction of 2 Gy instead of 180 s total treatment time for the conformal plan. CONCLUSION: VMAT provides a quality dose distribution with a short treatment time as shown in an example of a lung tumour. The technique should allow for more efficient delivery of high dose treatments, such as used for hypofractionated radiotherapy of small volume lung tumours, and the technique may also be used in conjunction with Active Breathing Control, where fewer breath holds will be required.
Comment: =Verification
=Linac
BibTeX:
@article{Bedford2008,
  author = {James L. Bedford and Vibeke Nordmark Hansen and Helen A. McNair and Alexandra H. Aitken and Juliet E. C. Brock and Alan P. Warrington and Michael Brada},
  title = {Treatment of lung cancer using volumetric modulated arc therapy and image guidance: A case study},
  journal = {Acta Oncologica},
  publisher = {Informa UK Limited},
  year = {2008},
  volume = {47},
  number = {7},
  pages = {1438--1443},
  doi = {https://doi.org/10.1080/02841860802282778}
}
Sharma, S.C., Ott, J.T., Williams, J.B. and Dickow, D. Commissioning and acceptance testing of a CyberKnife linear accelerator 2007 Journal of Applied Clinical Medical Physics
Vol. 8(3), pp. 119-125 
article DOI  
Abstract: Acceptance testing and commissioning of a CyberKnife robotic stereotactic radiosurgery system was performed in April 2006. The CyberKnife linear accelerator produces a photon beam of 6 MV nominal energy, without the use of a flattening filter. Clinically measured tissue?phantom ratios, off-center ratios, and output factors are presented and compared with similar data from other CyberKnife sites throughout the United States. In general, these values agreed to within 2%.
Comment: =Verification
=CK
BibTeX:
@article{Sharma2007,
  author = {Sharma, Subhash C. and Ott, Joseph T. and Williams, Jamone B. and Dickow, Danny},
  title = {Commissioning and acceptance testing of a CyberKnife linear accelerator},
  journal = {Journal of Applied Clinical Medical Physics},
  publisher = {John Wiley & Sons, Ltd},
  year = {2007},
  volume = {8},
  number = {3},
  pages = {119--125},
  doi = {https://doi.org/10.1120/jacmp.v8i3.2473}
}
Morton, J.P., Bhat, M., Williams, T. and Kovendy, A. Clinical results of entrance dose in vivo dosimetry for high energy photons in external beam radiotherapy using MOSFETs. 2007 Australasian physical & engineering sciences in medicine
Vol. 30, pp. 252-259 
article DOI  
Abstract: Thomson and Nielsen TN-502 RD MOSFETs were used for entrance dose in vivo dosimetry for 6 and 10 MV photons. A total of 24 patients were tested, 10 breast, 8 prostate, 5 lung and 1 head and neck. For prostates three fields were checked. For all other plans all fields were checked. An action threshold of 8% was set for any one field and 5% for all fields combined. The total number of fields tested was 56, with a mean discrepancy of 1.4% and S.D. of 2.6%. Breasts had a mean discrepancy of 1.8% and S.D. of 2.8%. Prostates had a mean discrepancy of 1.3% and S.D. of 2.9%. For 3 fields combined, prostates had a mean of 1.3% and S.D. of 1.8%. These results are similar to results obtained with diodes and TLDs for the same techniques.
Comment: =Verification
=Linac
BibTeX:
@article{Morton2007,
  author = {Morton, J. P. and Bhat, M. and Williams, T. and Kovendy, A.},
  title = {Clinical results of entrance dose in vivo dosimetry for high energy photons in external beam radiotherapy using MOSFETs.},
  journal = {Australasian physical & engineering sciences in medicine},
  year = {2007},
  volume = {30},
  pages = {252--259},
  doi = {https://doi.org/10.1007/bf03178434}
}
Krayenbuehl, J., Oertel, S., Davis, J.B. and Ciernik, I.F. Combined Photon and Electron Three-Dimensional Conformal Versus Intensity-Modulated Radiotherapy With Integrated Boost for Adjuvant Treatment of Malignant Pleural Mesothelioma After Pleuropneumonectomy 2007 International Journal of Radiation Oncology Biology Physics
Vol. 69(5), pp. 1593-1599 
article DOI  
Abstract: The optimal technique for postoperative radiotherapy (RT) after extrapleural pleuropneumonectomy(EPP) of malignant pleural mesothelioma (MPM) remains debated.Methods and Materials: The data from 8 right-sided and 9 left-sided consecutive cases of MPM treated with RTafter radical EPP were reviewed. Of the 17 patients, 8 had been treated with three-dimensional (3D) conformal RT(3D-CRT) and 9 with intensity-modulated RT (IMRT) with 6-MV photons. The clinical outcome and adverseevents were assessed. For comparative planning, each case was replanned with 3D-CRT using photons andelectrons or with IMRT. Homogeneity, doses to the organs at risk, and target volume coverage were analyzed.Results: Both techniques yielded acceptable plans. The dose coverage and homogeneity of IMRT increased by7.7% for the first planning target volume and 9.7% for the second planning target volume, ensuring$95% ofthe prescribed dose compared with 3D-CRT (p< 0.01). Compared with 3D-CRT, IMRT increased the dose tothe contralateral lung, with an increase in the mean lung dose of 7.8 Gy and an increase in the volume receiving13 Gy and 20 Gy by 20.5% and 7.2%, respectively (p< 0.01). A negligible dose increase to the contralateral kidneyand liver was observed. No differences were seen for the spinal cord and ipsilateral kidney. Two adverse events ofclinical relevant lung toxicity were observed with IMRT. Conclusion: Intensity-modulated RTand 3D-CRTare both suitable for adjuvant RT. IMRT improves the planningtarget volume coverage but delivered greater doses to the organs at risk. Rigid dose constraints for the lung shouldbe respected.
Comment: =Verification
=Linac
BibTeX:
@article{Krayenbuehl2007,
  author = {Krayenbuehl, Jerôme and Oertel, Susanne and Davis, J. Bernard and Ciernik, I. Frank},
  title = {Combined Photon and Electron Three-Dimensional Conformal Versus Intensity-Modulated Radiotherapy With Integrated Boost for Adjuvant Treatment of Malignant Pleural Mesothelioma After Pleuropneumonectomy},
  journal = {International Journal of Radiation Oncology Biology Physics},
  publisher = {Elsevier},
  year = {2007},
  volume = {69},
  number = {5},
  pages = {1593--1599},
  doi = {https://doi.org/10.1016/j.ijrobp.2007.07.2370}
}
Harrison, A., Misic, V., Podder, T., Bednarz, G., Cryan, G., Fallon, K., Houser, C., Yu, Y. and Xiao, Y. Special Dosimetric/Measurement Considerations in Commissioning a Novel Integrated MiniMLC Linear Accelerator 2007 Medical Physics
Vol. 34(6Part13), pp. 2489-2490 
conference DOI  
Abstract: To present an overview of commissioning a novel integrated miniMLC linear accelerator system, including the complete steps in final clinical implementation. Special precautions due to the collimator design are identified. Reference datasets for electrons are included. Method and Materials: Elekta Beam Modulator has 40 pairs of 4mm leaves. There are no movable backup diaphragms and the field is defined only by the open leaves. Smaller field sizes and more precise leaf positioning (<1mm) are specified. The film scanning system was verified to within 0.2mm accuracy. Microchambers were used for in-water scanning. Brass and graphite miniphantoms were constructed for head-scatter factor measurements of fields from 0.8cm×0.8cm to 16cm×16cm. A complete set of scan and point measurement data was collected for photons and electrons. Beams were modeled in XIO and PrecisePlan and an independent calculation program (RADCALC). Before actual clinical implementation, periodic QA baselines were established, and site specific IMRT plans and QA measurements were performed on phantoms. Results and Conclusion: An extensive and comprehensive program was employed in commissioning. Beam data collection and calibration were internally verified by at least two independent measurements and checked against standard datasets. Treatment planning system modeling followed the guidelines of TG53. When compromises had to be made, the best fits were chosen for situations mimicking IMRT segments (4cm×4cm and 4.8cm×4.8cm). QA measurements of 3D conformal plans and IMRT plans achieved the following agreement statistics: 3mm DTA, 3% difference, produced pass rate of 97.8% average (2.6%STD). Dose point measurements with chambers agreed to plan values within 3.6%. After comparisons between 3D dose, independent monitor unit(MU) and manual calculations; Radcalc and XIO independent MU calculation programs were deemed unusable (the discrepancy reaching 5.4%), due to incorrect modeling of head-scatter factors for this collimator. Additionally, measured electron cone factors varied up to 13% from standard Elekta linacs.
Comment: =Verification
=Linac
BibTeX:
@conference{Harrison2007,
  author = {Harrison, A and Misic, V and Podder, T and Bednarz, G and Cryan, G and Fallon, K and Houser, C and Yu, Y and Xiao, Y},
  title = {Special Dosimetric/Measurement Considerations in Commissioning a Novel Integrated MiniMLC Linear Accelerator},
  journal = {Medical Physics},
  year = {2007},
  volume = {34},
  number = {6Part13},
  pages = {2489-2490},
  doi = {https://doi.org/10.1118/1.2761107}
}
Dzintars, E., Watts, R. and Bice, W. Characterization of Dose in Heterogeneous Situations: A Comparison of Treatment Planning System and Computer Aided Second Check Dosimetry QA Software Dose Evaluations 2007 Medical Physics
Vol. 34(6Part15), pp. 2521-2521 
conference DOI  
Abstract: To quantify and compare the dosimetric predictions calculated by a treatment planning system, second check dosimetric computer QA software, and ion chamber measurements in heterogeneous situations for 6 and 18 MV photon beams. Method and Materials: An assortment of plastic tissue equivalent materials was used to compare the calculated dose predictions between the Pinnacle3 treatment planning system, the RadCalc® QA computer software, and ion chamber measurements. The dosimetric accuracy of the plastic water, lung, and bone equivalent slab materials was assessed and validated through the use of simple geometries. After planning, doses for each slab arrangement were measured on a Varian 21EX accelerator with a second check performed by the RadCalc® computer software. Percentage differences between the computed and measured doses were then compared and quantified, providing information on the accuracy of the dose predictions. Results: Evaluation and comparison between the calculated dose values from the Pinnacle3, RadCalc®, and measured data indicate that discrepancies exist, even for simple geometric setups. Looking at percentage differences, the Pinnacle3 system (−3.82% – 4.33%) more accurately calculates the dose in the heterogeneous locations than does the RadCalc® software (−8.30% – 4.15%). Examination of all measured point locations show only about 4% of the Pinnacle3 system dose calculations, and almost 18% of the RadCalc® software dose calculations, have a percentage difference greater than ±3%. Conclusion: This work explores the clinical application and accuracy of using RadCalc® for dosimetric second checks. Even with the use of heterogeneity corrections, it is still not guaranteed that an accurate dose calculation will result when heterogeneous material is present. The CIRS Inc. IMRT Thorax and Pelvic 3D phantoms will be utilized for the continuing investigation of the accuracy of dose calculations performed by Pinnacle3 and RadCalc® involving additional complex geometries in a more anatomical construct.
Comment: =Evaluation
=Linac
BibTeX:
@conference{Dzintars2007,
  author = {Dzintars, E and Watts, R and Bice, W},
  title = {Characterization of Dose in Heterogeneous Situations: A Comparison of Treatment Planning System and Computer Aided Second Check Dosimetry QA Software Dose Evaluations},
  journal = {Medical Physics},
  year = {2007},
  volume = {34},
  number = {6Part15},
  pages = {2521-2521},
  doi = {https://doi.org/10.1118/1.2761237}
}
Workie, D., Sehgal, V., He, B. and Al-Ghazi, M. Independent Monitor Unit Verification with the RadCalc® Program of Serial Tomotherapy IMRT Treatment Delivery 2006 Medical Physics
Vol. 33(6Part11), pp. 2112-2112 
conference DOI  
Abstract: To present our initial experience with the implementation of commercially available independent monitor unit (MU) verification calculation software (RadCalc®) for dose verification for patients undergoing IMRT (serial tomotherapy) treatments planned using a commercially available IMRT planning system (CORVUS® 6.0) and delivered using the multileaf intensity modulating collimator (MIMiC) delivery device. Method and Materials: As a first step we defined a separate machine within the RadCalc® software to facilitate the dose verification process. At our facility, serial tomotherapy is used to deliver IMRT treatments. This is accomplished using the MIMiC delivery device attached to a Varian 600C linear accelerator producing a 6 MV photon beam. Dosimetric data for this treatment machine which included collimator and phantom scatter factors (Sc and Sp) and leaf transmission for the MIMiC were also incorporated in the RadCalc® Software. After the treatment plans are approved for treatment by the radiation oncologist a hybrid QA (quality assurance) plan is generated and delivered to an ion chamber and film placed in a rectangular solid water phantom of dimensions 30 cm × 30 cm × 22 cm. The phantom geometry was also defined in the RadCalc® software to facilitate dose calculation and comparison with the dose determined from ion-chamber measurements. In this preliminary study a total of 13 patients undergoing IMRT treatment with the MIMiC were analyzed. Results: Initial results indicate a good agreement (within ±5%) between dose calculated from the hybrid plan, ion chamber measurements, and the dose calculated by the RadCalc® program. Conclusion: Based on initial results presented here we have set an action level of ±5% which will be reviewed and revised as necessary as we continue to acquire and analyze additional patient data.
Comment: =Evaluation
=TT
BibTeX:
@conference{Workie2006,
  author = {Workie, D and Sehgal, V and He, B and Al-Ghazi, M},
  title = {Independent Monitor Unit Verification with the RadCalc® Program of Serial Tomotherapy IMRT Treatment Delivery},
  journal = {Medical Physics},
  year = {2006},
  volume = {33},
  number = {6Part11},
  pages = {2112-2112},
  doi = {https://doi.org/10.1118/1.2241202}
}
Rothley, D., Paras, S., Clifton, C. and Ray, J. A Simple Method for Selecting a Pinnacle IMRT Point for Verification in RadCalc 2006 Medical Physics
Vol. 33(6Part7), pp. 2061-2062 
conference DOI  
Abstract: To select a reference point in a low dose gradient region of an IMRT treatment plan to enhance the MU and point dose agreement between Pinnacle and RadCalc. Method and Materials: After generating an IMRT plan within Pinnacle, we export it to RadCalc for a second check of the MU's. Frequently, the MU difference is significant for a plan with split beams or isocenter out of the field. In contrast to Pinnacle, RadCalc displays a coordinate grid over its BEV fluence. By utilizing this feature for the problematic beams, we selected reference points in low gradient regions of each beam's fluence map. In RadCalc's BEV, we identified the coordinate shifts relative to isocenter of the preferred points. We generated an Excel spreadsheet to calculate the updated coordinates in Pinnacle's 3-D CT-based coordinate system to reflect the desired point shift in RadCalc. These new coordinates were then entered in Pinnacle for the patient plan and re-exported to RadCalc. The modified MU and dose comparisons within RadCalc generally fell within 5% per beam. Results: While this method adds a few extra steps to the planning process, it provides a way to choose reference points whereby the MU's and point doses between Pinnacle and RadCalc are likely to agree within a few percent, and it makes determining the coordinates of such points a reasonably efficient process. Conclusion: RadCalc is a useful program for verifying IMRT MU's and point doses generated by Pinnacle. However because Pinnacle exports the user selected reference point (typically isocenter), there are common conditions in which RadCalc understandably determines large percent differences in calculations. Our method uses RadCalc's fluence map along with a spreadsheet to determine the Pinnacle coordinates of a preferred calculation point, rather than “guessing” where to place a POI to bring about better calculation agreement.
Comment: =Verification
=Linac
BibTeX:
@conference{Rothley2006,
  author = {Rothley, D and Paras, S and Clifton, C and Ray, J},
  title = {A Simple Method for Selecting a Pinnacle IMRT Point for Verification in RadCalc},
  journal = {Medical Physics},
  year = {2006},
  volume = {33},
  number = {6Part7},
  pages = {2061-2062},
  doi = {https://doi.org/10.1118/1.2240984}
}
Reich, P., Bezak, E., Mohammadi, M. and Fog, L. The prediction of transmitted dose distributions using a 3D treatment planning system. 2006 Australasian physical & engineering sciences in medicine
Vol. 29, pp. 18-29 
article DOI  
Abstract: Patient dose verification is becoming increasingly important with the advent of new complex radiotherapy techniques such as conformal radiotherapy (CRT) and intensity-modulated radiotherapy (IMRT). An electronic portal imaging device (EPID) has potential application for in vivo dosimetry. In the current work, an EPID has been modelled using a treatment planning system (TPS) to predict transmitted dose maps. A thin slab of RW3 material used to initially represent the EPID. A homogeneous RW3 phantom and the thin RW3 slab placed at a clinical distance away from the phantom were scanned using a CT simulator. The resulting CT images were transferred via DICOM to the TPS and the density of the CT data corresponding to the thin RW3 slab was changed to 1 g/cm3. Transmitted dose maps (TDMs) in the modelled EPID were calculated by the TPS using the collapsed-cone (C-C) convolution superposition (C/S) algorithm. A 6 MV beam was used in the simulation to deliver 300 MU to the homogenous phantom using an isocentric and SSD (source-to-surface) technique. The phantom thickness was varied and the calculated TDMs in the modelled EPID were compared with corresponding measurements obtained from a calibrated scanning liquid-filled ionisation chamber (SLIC) EPID. The two TDMs were compared using the gamma evaluation technique of Low et al. The predicted and measured TDMs agree to within 2 % (averaged over all phantom thicknesses) on the central beam axis. More than 90 % of points in the dose maps (excluding field edges) produce a gamma index less than or equal to 1, for dose difference (averaged over all phantom thicknesses), and distance-to-agreement criteria of 4 %, 3.8 mm, respectively. In addition, the noise level on the central axis in the predicted dose maps is less than 0.1 %. We found that phantom thickness changes of approximately 1 mm, which correspond to dose changes on the central beam axis of less than 0.6 %, can be detected in the predicted transmitted dose distributions.
Comment: =Verification
=Linac
BibTeX:
@article{Reich2006,
  author = {Reich, P. and Bezak, E. and Mohammadi, M. and Fog, L.},
  title = {The prediction of transmitted dose distributions using a 3D treatment planning system.},
  journal = {Australasian physical & engineering sciences in medicine},
  year = {2006},
  volume = {29},
  pages = {18--29},
  doi = {https://doi.org/10.1007/bf03178824}
}
Lasher, D., Wojcicka, J. and Bialkowski, M. The Effect of Total MU, Number of Segments, and Field Size On IMRT Point Dose QA Results 2006 Medical Physics
Vol. 33(6Part13), pp. 2142-2142 
conference DOI  
Abstract: To investigate the relationship between Corvus IMRT treatment plan parameters (total MU, number of segments, and average field size) and point dose QA results (ion chamber measurements and RadCalc independent MU calculation software). Method and Materials: The Corvus treatment planing system (TPS) employs a “calibration factor” in its dose calculations. We determined this factor using a set of test plans with an average of 555 MU, 220 segments, and 7.3×7.3cm2 equivalent square field size. The TPS was then used to calculate 95 patient plans. Hybrid plans were created by transferring patient plans to a 30×30×18 cm3 solid phantom. A 0.3cc ion chamber and Kodak EDR2 film were placed inside the phantom. The treatment fields were delivered on a Varian 21EX via the QA Mode of Impac Multi-Access R&V system. For each plan, dose to the isocenter was calculated with RadCalc and compared to the plan's prediction. Ion chamber and RadCalc percent error values versus total MU, number of segments, and field size are plotted and analyzed with the Pearson's product moment correlation coefficient. Results: The data indicate that for this equipment configuration, both ion chamber measurement and independent calculation percent error results are directly proportional to total MU, number of segments, and average field size. In general, RadCalc predicts a smaller percent error than ion chamber measurements for all three variables. For ion chamber measurement, field size produces the strongest positive correlation with percent error and MU the weakest. For RadCalc percent error, number of segments produces the strongest correlation and field size the weakest. Conclusion: For the Corvus TPS, the measured dose percent error increases as the total MU, number of segments, and field size increases beyond the average value used to determine the calibration factor. RadCalc independent MU calculation software predicts the same trend.
Comment: =Verification
=Linac
BibTeX:
@conference{Lasher2006,
  author = {Lasher, D and Wojcicka, J and Bialkowski, M},
  title = {The Effect of Total MU, Number of Segments, and Field Size On IMRT Point Dose QA Results},
  journal = {Medical Physics},
  year = {2006},
  volume = {33},
  number = {6Part13},
  pages = {2142-2142},
  doi = {https://doi.org/10.1118/1.2241337}
}
Kay, I. and Dunscombe, P. Verifying monitor unit calculations for tangential breast fields 2006 Journal of Applied Clinical Medical Physics
Vol. 7(2), pp. 50-57 
article DOI  
Abstract: An essential component of quality assurance in radiation therapy is verifying the accuracy of monitor unit calculations. Differences between sophisticated algorithms using 2.5D or 3D calculations and simpler monitor unit check algorithms or hand calculations assuming a flat water phantom must be expected. For many anatomical sites, such differences are small and of little or no consequence in the context of expected clinical impact. However, for tangential breast fields the discrepancies are considerably larger than those that would generally be considered acceptable. A simple model to reconcile the differences between sophisticated and simple algorithms is presented, based on replacing the breast contour with a triangular or elliptical contour and using this to estimate an equivalent rectangular prism providing equivalent scatter to the prescription point. The elliptical approximation reconciles the observed differences in calculated monitor units. The analysis we present can assist the treatment planning physicist in selecting a method and tolerance window for verifying monitor unit calculations for tangential breast fields. PACS: 87.53.Kn, 87.53.Tf, 87.53.Xd
Comment: =Evaluation
=Linac
BibTeX:
@article{Kay2006,
  author = {Kay, Ian and Dunscombe, Peter},
  title = {Verifying monitor unit calculations for tangential breast fields},
  journal = {Journal of Applied Clinical Medical Physics},
  publisher = {John Wiley & Sons, Ltd},
  year = {2006},
  volume = {7},
  number = {2},
  pages = {50--57},
  doi = {https://doi.org/10.1120/jacmp.v7i2.2177}
}
Al-Hallaq, H.A., Reft, C.S. and Roeske, J.C. The dosimetric effects of tissue heterogeneities in intensity-modulated radiation therapy (IMRT) of the head and neck. 2006 Physics in Medicine and Biology
Vol. 51, pp. 1145-1156 
article DOI  
Abstract: The dosimetric effects of bone and air heterogeneities in head and neck IMRT treatments were quantified. An anthropomorphic RANDO phantom was CT-scanned with 16 thermoluminescent dosimeter (TLD) chips placed in and around the target volume. A standard IMRT plan generated with CORVUS was used to irradiate the phantom five times. On average, measured dose was 5.1% higher than calculated dose. Measurements were higher by 7.1% near the heterogeneities and by 2.6% in tissue. The dose difference between measurement and calculation was outside the 95% measurement confidence interval for six TLDs. Using CORVUS' heterogeneity correction algorithm, the average difference between measured and calculated doses decreased by 1.8% near the heterogeneities and by 0.7% in tissue. Furthermore, dose differences lying outside the 95% confidence interval were eliminated for five of the six TLDs. TLD doses recalculated by Pinnacle3's convolution/superposition algorithm were consistently higher than CORVUS doses, a trend that matched our measured results. These results indicate that the dosimetric effects of air cavities are larger than those of bone heterogeneities, thereby leading to a higher delivered dose compared to CORVUS calculations. More sophisticated algorithms such as convolution/superposition or Monte Carlo should be used for accurate tailoring of IMRT dose in head and neck tumours.
Comment: =Verification
=Linac
BibTeX:
@article{AlHallaq2006,
  author = {Al-Hallaq, H. A. and Reft, C. S. and Roeske, J. C.},
  title = {The dosimetric effects of tissue heterogeneities in intensity-modulated radiation therapy (IMRT) of the head and neck.},
  journal = {Physics in Medicine and Biology},
  year = {2006},
  volume = {51},
  pages = {1145--1156},
  doi = {https://doi.org/10.1088/0031-9155/51/5/007}
}
Zhang, T., Norrlinger, B., Heaton, R. and Islam, M. Complex IMRT Plan Verification Using a Commercial MU Calculation Package 2005 Medical Physics
Vol. 32(6Part8), pp. 1980-1981 
conference DOI  
Abstract: The general availability of IMRT treatments is constrained by the need to perform dosimetry measurements as part of the patient plan verification. While secondary IMRT MU calculators have been successfully used to validate some plans for a restricted number of sites, these calculators have suffered from unacceptably large uncertainties when applied to sites confined to the head and neck region. A strategy to reduce these calculational uncertainties has been developed which permits a greater use of IMRT MU calculators and reduces the need for dosimetric measurements, enabling a larger patient population to receive the benefits offered by IMRT treatments. Method and Materials: Segmental IMRT head and neck treatments were developed using the Pinnacle 6.2b inverse planning module. The IMRT treatment plans where then calculated on a CT image set of PMH IMRT phantom, and validation points corresponding to key target and avoidance regions where identified. The dosimetric data corresponding to these points was exported to RadCalc, a commercial IMRT MU calculator, and the calculations were compared to Pinnacle calculations and in-phantom measurements. Results: A total of 10 clinical patient cases, each containing 7 to 9 gantry angles, were assessed. Agreement was assessed on basis of total dose delivered to the point of calculation. The measured and RadCalc calculated doses were found to agree within 3% at the high dose point and 5% at the low dose point in all cases, while the Pinnacle calculated dose was found to agree with the measured dose within 2.5% at the high dose point, with deviations as large as 13.5% observed at the low dose point. Conclusion: In-phantom IMRT verification calculations of the total dose yields similar results as in-phantom measurements. Consequently, a secondary MU calculator can be used to verify IMRT treatment plans and reduce the frequency of validation measurements.
Comment: =Verification
=Linac
BibTeX:
@conference{Zhang2005,
  author = {Zhang, T and Norrlinger, B and Heaton, R and Islam, M},
  title = {Complex IMRT Plan Verification Using a Commercial MU Calculation Package},
  journal = {Medical Physics},
  year = {2005},
  volume = {32},
  number = {6Part8},
  pages = {1980-1981},
  doi = {https://doi.org/10.1118/1.1997806}
}
Sehgal, V., He, B. and Al-Ghazi, M. Clinical Implementation of An In-Vivo Dosimetry System in Conjunction with the RadCalc™ Program 2005 Medical Physics
Vol. 32(6Part10), pp. 2003-2003 
conference DOI  
Abstract: To present the clinical implementation of an in-vivo dosimetry system in conjunction with the RadCalc™ monitor unit calculation program. Method and Materials: A wireless PC-based in-vivo dosimetry system (rf-IVD, Sun Nuclear Corporation, Melbourne, FL) was acquired with n-type QED diodes for in-vivo dosimetry for photon and electron treatment verification. A series of acceptance tests to assess reliability of this system for in-vivo dosimetry applications were performed. These included post-irradiation signal stability, dose linearity and angular dependence. As a first step, the system was implemented on a Varian 600C 6 MV beam. Calibration measurements were performed in conjunction with an ADCL calibrated PTW N2333 Farmer-type ion chamber in a solid water phantom. The chamber was placed at dmax (1.5 cm) and the diode was placed at the surface of the phantom. Correction factors were determined for tray, wedges, field size and source to surface distance (SSD). The SSD correction factors were obtained for a range of distances (80–120 cm). Field size correction factors were obtained for a range of field sizes (4 × 4 – 30 × 30 cm2). The RadCalc™ software allows a simple interface to enter the collected data and computes the expected diode reading for each treatment field. Results: Preliminary results indicate that the agreement between expected and measured readings is within ±5%. Conclusion: In-vivo dosimetry system based on surface measurements using diodes can be effectively implemented in conjunction with the RadCalc™ program, facilitating implementation of this quality assurance tool. Specific action levels have been set for agreement between planned dose and dose determined using diodes for different treatment sites. Future work will include commissioning of the of the in-vivo dosimetry system in conjunction with RadCalc™ for IMRT and electron beam treatment verification.
Comment: =Verification
=Linac
BibTeX:
@conference{Sehgal2005,
  author = {Sehgal, V and He, B and Al-Ghazi, M},
  title = {Clinical Implementation of An In-Vivo Dosimetry System in Conjunction with the RadCalc™ Program},
  journal = {Medical Physics},
  year = {2005},
  volume = {32},
  number = {6Part10},
  pages = {2003-2003},
  doi = {https://doi.org/10.1118/1.1997961}
}
Purdie, T.G., Mosseri, A., Jezioranski, J., Heaton, R., Norrlinger, B., Islam, M.K. and Sharpe, M.B. Plan evaluation and quality assurance in breast IMRT 2004 International Journal of Radiation Oncology Biology Physics
Vol. 60(1), pp. S395-S396 
conference DOI  
Abstract: Intensity-modulated radiation therapy (IMRT) is an established way to improve dose uniformity in whole-breast radiation therapy. Here, we present our experience with the clinical implementation of two-field breast IMRT using a step-and-shoot multi-leaf collimator (sMLC) approach. The primary focus was to establish quality assurance (QA) benchmarks and processes that could be related to previous experience and applied on a very large scale. Materials/Methods: We have adopted an aperture-based IMRT technique, which uses weight optimization of MLC field segments to achieve dose uniformity in the irradiated breast1. In a retrospective planning study of twelve patient cases, IMRT plans were compared to our prior experience with conventional wedged-tangent plans. The target volume definition followed the work of Vicini et al 2. Treatment planning was completed using a commercially available treatment planning system (Pinnacle, Philips Radiation Oncology Systems). The IMRT and physical wedge plans were optimized using the same dose-volume objectives for optimization1 and both plans included tissue density corrections. The same field size and shielding, as well as gantry and collimator angles were used for plan comparison. In ten of the twelve patients studied, the dose-volume objectives were easily achieved with 6 MV photons. In two cases, the patient separation exceeded 24 cm and mixed 6 and 18 MV photon beams were required. The mixed energy approach was adopted for both IMRT and wedged tangents. Plan comparisons were performed by examining the minimum dose received by 99% of the target volume, the maximum dose received by a 2 cc “hotspot” and the proportion of the target volume receiving 95% of the prescribed dose. These comparisons were used to establish plan evaluation benchmarks for clinical implementation. Finally, independent MU verification for the sMLC fields was implemented using a commercially available software package (RadCalc, LifeLine Software). Ion chamber measurements were acquired in a water-equivalent phantom at multiple points within each patient field to verify the performance of the MU verification software and planning system. Based on this study, an average correction factor was determined for MU verification calculations, to account for simplified tissue heterogeneity corrections, patient “skin-flash” from the tangential open fields and surface contour corrections. Results: The mean target volume for the 12 patients studied was 825 cc (229–3081 cc range). Based on the DVH evaluation criteria above, the target dose uniformity of the IMRT plans compared favorably with the weight optimized wedge plans and the target volume receiving 95% of the prescription dose was significantly higher as shown in the table. A systematic difference was observed between the planning system and MU verification software and increased as a function of distance from the lung-chest wall interface. An average correction of 1% is necessary to account for “skin-flash” and an average correction of 3% for variations in patient surface contour. When these corrections are applied, the MU calculated by Pinnacle agree within 1.1 ± 0.7 percent of the RadCalc measurements and the dose agrees within −0.6 ± 0.9 percent of the ion chamber measurements at multiple points within each patient field. Conclusions: We have established a plan evaluation criteria and objective quality assurance benchmarks for IMRT breast plans. The plan evaluation criteria highlight the improved dose uniformity achievable with sMLC fields over wedged fields and systematic corrections required to implement an independent dose verification.
Comment: =Verification
=Linac
BibTeX:
@conference{Purdie2004,
  author = {Purdie, T. G. and Mosseri, A. and Jezioranski, J. and Heaton, R. and Norrlinger, B. and Islam, M. K. and Sharpe, M. B.},
  title = {Plan evaluation and quality assurance in breast IMRT},
  journal = {International Journal of Radiation Oncology Biology Physics},
  publisher = {Elsevier},
  year = {2004},
  volume = {60},
  number = {1},
  pages = {S395--S396},
  doi = {https://doi.org/10.1016/j.ijrobp.2004.07.266}
}
Lutters, G., Schoenmaker, E., Krayenbühl, J. and Davis, J. IMPLEMENTATION OF THE RADCALC PROGRAMME FOR CHECKING MONITORUNIT CALCULATIONS 2004 Strahlentherapie und Onkologie
Vol. 180(S1), pp. 89-108 
conference DOI  
Abstract: Hand MU calculation is standard in every radiotherapy department but is often limited to simple field set-ups or for checking TPS plans. RadCalc is a new PC-based dose calculation programme which extends the calculations to include corrections for head and phantom scatter. The implementation of the programme for clinical use is described. Material and Methods: Head and phantom scatter factors were measured for photon beams of 1 x 1 cm to 40 x 40 cm, nominal energy 6 MV and 18 MV and for an 80 and 120 leaf MLC using an ionisation chamber. Electronic equilibrium was achieved by using a mini-phantom or a brass build-up cap. MU calculated with Radcalc were compared with 3-D TPS calculations to evaluate scatter and inhomogeneity correction. Results: For 85% of all open, wedged and symmetric beams, agreement was within 2.5%. For tangential beams the deviation was within 3.5%. This was expected as the algorithm only partially corrects for missing scatter. No dependence on beam energy or beam geometry was observed. Asymmetric beam deviation was within 4%. Conclusion: RadCalc as a reliable tool for quickly checking TPS plans and hand calculations prior to patient treatment. It has been implemented in the clinic for routine MU checks and simple field calculations and will be extended to check IMRT dose calculations.
Comment: =Evaluation
=Linac
BibTeX:
@conference{Allal2004,
  author = {Lutters, G and Schoenmaker, E and Krayenbühl, J and Davis, J},
  title = {IMPLEMENTATION OF THE RADCALC PROGRAMME FOR CHECKING MONITORUNIT CALCULATIONS},
  journal = {Strahlentherapie und Onkologie},
  publisher = {Springer Science and Business Media LLC},
  year = {2004},
  volume = {180},
  number = {S1},
  pages = {89--108},
  doi = {https://doi.org/10.1007/bf03356735}
}
Krayenbuehl, J., Lutters, G., Schoenmake, E. and Davis, J. IMRT dose verification: use of the RadCalc software for independent MU calculation 2004 Strahlentherapie und Onkologie
Vol. 73, pp. S342 
conference DOI  
Abstract: The verification of dose distribution for an intensity modulated radiotherapy treatment (IMRT) quality assurance (QA) is a process which is time consuming. RadCalc (version 4.3.9) is a new independent and fast PCbased program which calculates dose points (DP) and monitor units (MU) for standard treatment planning system (TPS) and for IMRT. Material and Methods: IMRT is delivered on a Varian Clinac 6EX, nominal beam energy 6 MV, 120 multileaf collimator (MLC). CadPlan (version 6.2.7) was the TPS used for inverse planning. MU calculated by the TPS were validated using RadCalc and measurements in a solid water phantom (RW3) with a Farmer ionization chamber. RadCalc uses an independent database. Results: The percent disparity between the TPS, measurements and RadCalc was assessed in over 50 IMRT plans (head and neck). The mean dose calculated by RadCalc (respectively measured) was, on average, 1.7 % (resp. 1.1%) lower then the dose calculated by CadPlan with one standard deviation of 0.8% (resp. 2.6%). This discrepancy is under investigation. All doses checked by RadCalc were within 3% of the CadPlan doses, which is less than the 5% recommended by the AAPM Task Group 40. Conclusion: RadCalc is a reliable fast and independent check for DP and MU for IMRT. We estimate at 30 minutes the time spared for the QA per patient. RadCalc has been integrated as a routine QA procedure for the patient's IMRT dose verification at Zuich University Hospital since April 2004.
Comment: =Evaluation
=Linac
BibTeX:
@conference{Krayenbuehl2004a,
  author = {Krayenbuehl, J and Lutters, G and Schoenmake, E and Davis, J},
  title = {IMRT dose verification: use of the RadCalc software for independent MU calculation},
  journal = {Strahlentherapie und Onkologie},
  publisher = {Elsevier BV},
  year = {2004},
  volume = {73},
  pages = {S342},
  doi = {https://doi.org/10.1016/s0167-8140(04)82663-x}
}
James, H.V., Scrase, C.D. and Poynter, A.J. Practical experience with intensity-modulated radiotherapy 2004 The British Journal of Radiology
Vol. 77(913), pp. 3-14 
article DOI  
Abstract: At the Ipswich Hospital implementation of intensity-modulated radiotherapy (IMRT) commenced inFebruary 2001 based on an established 3D conformal radiotherapy (3D CRT) service. This paper describes ourexperiences as we commissioned a fully-integrated IMRT planning and delivery system, and established IMRTwithin the department. Commissioning measurements incorporated a series of tests to ensure the integrity of thesystem and form the basis of routine quality assurance (QA) procedures. Potential IMRT patients proceededthrough pre-treatment in the same way as standard 3D CRT patients. All were dual-planned for IMRT and 3DCRT with no change in established fractionation regimen, and the resulting plans evaluated. IMRT was selectedfor treatment where it offered a significant advantage by improving dose homogeneity and conformity withinthe target volume and/or reducing dose to organs at risk. Extensive pre-treatment verification was undertakenon all plans to check dynamic multileaf collimator (MLC) delivery and monitor unit calculation. Patients weremonitored throughout treatment with amorphous silicon electronic portal imaging to ensure reproducibility ofset-up. Between June 2001 and June 2003 21 patients were treated with inverse-planned IMRT to sites withinthe head and neck and lung. IMRT has enabled precise delivery to irregular shaped target volumes, avoidingorgans at risk and enabling doses to be increased to radical levels in some cases. Additionally over 200 CTscanned breast patients were treated with forward-planned electronic compensation delivered by dynamic MLC,improving dose homogeneity within the breast volume compared with standard wedged plans. The IMRTprogramme will continue at the Ipswich Hospital with the introduction of further clinical sites and adoption ofmore aggressive fractionation regimens within the confines of multicentre clinical trials.
Comment: =Verification
=Linac
BibTeX:
@article{James2004,
  author = {H V James and C D Scrase and A J Poynter},
  title = {Practical experience with intensity-modulated radiotherapy},
  journal = {The British Journal of Radiology},
  publisher = {British Institute of Radiology},
  year = {2004},
  volume = {77},
  number = {913},
  pages = {3--14},
  doi = {https://doi.org/10.1259/bjr/14996943}
}
Haslam, J.J., Bonta, D.V., Lujan, A.E., Rash, C., Jackson, W. and Roeske, J.C. Comparison of dose calculated by an intensity modulated radiotherapy treatment planning system and an independent monitor unit verification program 2003 Journal of Applied Clinical Medical Physics
Vol. 4(3), pp. 224-230 
article DOI  
Abstract: A comparison of isocenter dose calculated by a commercial intensity modulated radiation therapy treatment planning system and independent monitor unit verification calculation (MUVC) software was made. The percent disparity between the treatment plan and MUVC doses were calculated for 507 treatments (head and neck, prostate, abdomen, female pelvis, rectum and anus, and miscellaneous) from 303 patients. The MUVC calculated dose was, on average, 1.4% higher than the treatment planning dose, with a 1.2% standard deviation. The distribution of the disparities appeared to be Gaussian in shape with some variation by treatment site. Based on our analysis, disparities outside the range of about the mean value should be checked and resolved prior to treatment delivery.
Comment: =Verification
=Linac
BibTeX:
@article{Haslam2003a,
  author = {Haslam, J. J. and Bonta, D. V. and Lujan, A. E. and Rash, C. and Jackson, W. and Roeske, J. C.},
  title = {Comparison of dose calculated by an intensity modulated radiotherapy treatment planning system and an independent monitor unit verification program},
  journal = {Journal of Applied Clinical Medical Physics},
  publisher = {John Wiley & Sons, Ltd},
  year = {2003},
  volume = {4},
  number = {3},
  pages = {224--230},
  doi = {https://doi.org/10.1120/jacmp.v4i3.2519}
}
Mundt, A.J., Roeske, J.C. and Lujan, A.E. Intensity-modulated radiation therapy in gynecologic malignancies 2002 Medical Dosimetry
Vol. 27(2), pp. 131-136 
article DOI  
Abstract: Radiation therapy (RT) is commonly used in the treatment of gynecologic malignancies. Unfortunately, RT exposes patients to a wide variety of sequelae. Concerns over toxicity also limit the use of higher doses in select patients. To improve the efficacy of conventional RT and to explore the possibility of dose escalation, we have turned to the use of intensity-modulated RT (IMRT). This report reviews our preclinical studies, implementation, and clinical experience to date with IMRT for gynecologic malignancies.
Comment: =Verification
=Linac
BibTeX:
@article{Mundt2002,
  author = {Mundt, Arno J. and Roeske, John C. and Lujan, Anthony E.},
  title = {Intensity-modulated radiation therapy in gynecologic malignancies},
  journal = {Medical Dosimetry},
  publisher = {Elsevier},
  year = {2002},
  volume = {27},
  number = {2},
  pages = {131--136},
  doi = {https://doi.org/10.1016/s0958-3947(02)00095-x}
}