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Article ; Online: Survey results of 3D-CRT and IMRT quality assurance practice.

Mehrens, Hunter / Taylor, Paige / Followill, David S / Kry, Stephen F

Journal of applied clinical medical physics

2020 Volume 21, Issue 7, Page(s) 70–76

Abstract: ... verification were a 2D diode array (52.8%), point(s) measurement (39.0%), EPID (27.4%), and 2D ion chamber ... in reference to TG-218's recommendations. ...

Abstract	Purpose: 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. Methods: 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. Results: 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 of 2.1. Conclusion: 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.
MeSH term(s)	Humans ; Quality Assurance, Health Care ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Conformal ; Radiotherapy, Intensity-Modulated
Language	English
Publishing date	2020-04-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2010347-5
ISSN	1526-9914 ; 1526-9914
ISSN (online)	1526-9914
ISSN	1526-9914
DOI	10.1002/acm2.12885
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Article ; Online: Failure Modes in IROC Photon Liver Phantom Irradiations.

Taylor, Paige A / Alvarez, Paola E / Mehrens, Hunter / Followill, David S

Practical radiation oncology

2020 Volume 11, Issue 3, Page(s) e322–e328

Abstract: ... Radiation Oncology Core's anthropomorphic liver phantom simulates multitarget liver disease with respiratory motion ...

Abstract	Purpose: Our purpose was to analyze and classify the patterns of failure for irradiations of the Imaging and Radiation Oncology Core photon liver phantom. Methods and materials: Imaging and Radiation Oncology Core's anthropomorphic liver phantom simulates multitarget liver disease with respiratory motion. Two hundred forty-nine liver phantom results from 2013 to 2019 were analyzed. Phantom irradiations that failed were categorized by the error attributed to the failure. Phantom results were also compared by demographic data, such as machine type, treatment planning system, motion management technique, number of isocenters, and whether the phantom was a first time or repeat irradiation. Results: The failure rate for the liver phantom was 27%. From the 68 irradiations that did not pass, 5 failure modes were identified. The most common failure mode was localization errors in the direction of motion, with over 50% of failures attributed to this mode. The second-most common failure mode was systematic dose errors. The internal target volume technique performed worse than other motion management techniques. Failure modes were different by the number of isocenters used, with multi-isocenter irradiations having more failure modes in a single phantom irradiation. Conclusions: Motion management techniques and proper alignment of moving targets play a large role in the successful irradiation of the liver phantom. These errors should be examined to ensure accurate patient treatment for liver disease or other sites where multiple moving targets are present.
MeSH term(s)	Humans ; Liver/diagnostic imaging ; Phantoms, Imaging ; Radiation Oncology ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Intensity-Modulated
Language	English
Publishing date	2020-11-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2655748-4
ISSN	1879-8519 ; 1879-8500
ISSN (online)	1879-8519
ISSN	1879-8500
DOI	10.1016/j.prro.2020.11.008
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Article ; Online: Evaluation of image quality of a novel computed tomography metal artifact management technique on an anthropomorphic head and neck phantom.

Branco, Daniela / Kry, Stephen / Taylor, Paige / Rong, John / Zhang, Xiaodong / Frank, Steven / Followill, David

Physics and imaging in radiation oncology

2021 Volume 17, Page(s) 111–116

Abstract: ... well throughout the phantom's posterior region.: Conclusions: A novel MAR algorithm was evaluated ...

Abstract	Background and purpose: Artefacts caused by dental amalgam implants present a common challenge in computed tomography (CT) and therefore treatment planning dose calculations. The goal was to perform a quantitative image quality analysis of our Artifact Management for Proton Planning (AMPP) algorithm which used gantry tilts for managing metal artefacts on Head and Neck (HN) CT scans and major vendors' commercial approaches. Materials and methods: Metal artefact reduction (MAR) algorithms were evaluated using an anthropomorphic phantom with a removable jaw for the acquisition of images with and without (baseline) metal artifacts. AMPP made use of two angled CT scans to generate one artifact-reduced image set. The MAR algorithms from four vendors were applied to the images with artefacts and the analysis was performed with respective baselines. Planar HU difference maps and volumetric HU differences were analyzed. Results: AMPP algorithm outperformed all vendors' commercial approaches in the elimination of artefacts in the oropharyngeal region, showing the lowest percent of pixels outside +- 20 HU criteria, 4%; whereas those in the MAR-corrected images ranged from 26% to 67%. In the region of interest within the affected slices, the commercial MAR algorithms showed inconsistent performance, whereas the AMPP algorithm performed consistently well throughout the phantom's posterior region. Conclusions: A novel MAR algorithm was evaluated and compared to four commercial algorithms using an anthropomorphic phantom. Unanimously, the analysis showed the AMPP algorithm outperformed vendors' commercial approaches, showing the potential to be broadly implemented, improve visualizations in patient anatomy and provide accurate HU information.
Language	English
Publishing date	2021-02-21
Publishing country	Netherlands
Document type	Journal Article
ISSN	2405-6316
ISSN (online)	2405-6316
DOI	10.1016/j.phro.2021.01.007
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Article ; Online: The Value of On-Site Proton Audits.

Taylor, Paige A / Lowenstein, Jessica / Followill, David / Kry, Stephen F

International journal of radiation oncology, biology, physics

2021 Volume 112, Issue 4, Page(s) 1004–1011

Abstract: Purpose: This study aimed to highlight the value and key findings of on-site proton audits.: Methods and materials: The authors performed 38 on-site measurement-based peer reviews of proton centers participating in National Cancer Institute-funded ... ...

Abstract	Purpose: This study aimed to highlight the value and key findings of on-site proton audits. Methods and materials: The authors performed 38 on-site measurement-based peer reviews of proton centers participating in National Cancer Institute-funded clinical trials. The reviews covered beam calibration, lateral and depth measurements, mechanical checks, treatment planning and clinical practice, and quality assurance (QA) practices. Program deficiencies were noted, and recommendations were made about ways institutions could improve their practices. Results: Institutions received an average of 3 (range, 1-8) recommendations for practice improvements. The number of deficiencies did not decrease over time, highlighting the continued need for this type of peer review. The most common deficiencies were for Task Group-recommended QA compliance (97% of centers), computed tomography number (CTN) to relative linear stopping power conversion (59%), and QA procedures (53%). In addition, 32% of institutions assessed failed at least 1 lateral beam profile measurement (<90% of pixels passing 3% [global]/3 mm; 10% threshold), despite passing internal QA measurements. These failures occurred for several different plan configurations (large, small, shallow, and deep targets) and at different depths in the beam path (proximal to target, central, and distal). CTN to relative linear stopping power conversion curves showed deviations at low, mid, and high CTNs and highlighted areas of inconsistency between proton centers, with many centers falling outside of 2 sigma of the mean curve of their peers. All deficiencies from the peer review were discussed with the institutions, and many implemented dosimetric treatment planning and practice changes to improve the accuracy of their system and consistency with other institutions. Conclusions: This peer review program has been integral in confirming and promoting consistency and best practice across proton centers for clinical trials, minimizing deviations for outcomes data.
MeSH term(s)	Calibration ; Clinical Audit ; Humans ; National Cancer Institute (U.S.) ; Proton Therapy/methods ; Proton Therapy/standards ; Quality Assurance, Health Care ; Radiometry ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted/methods ; United States
Language	English
Publishing date	2021-11-13
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	197614-x
ISSN	1879-355X ; 0360-3016
ISSN (online)	1879-355X
ISSN	0360-3016
DOI	10.1016/j.ijrobp.2021.10.145
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Article ; Online: Response to Thomsen et al.: Comments on "The Radiological Physics Center's standard dataset for small field size output factors".

Followill, David S / Kry, Stephen

Journal of applied clinical medical physics

2014 Volume 15, Issue 2, Page(s) 4841

MeSH term(s)	Humans ; Particle Accelerators/standards ; Radiotherapy Dosage/standards ; Radiotherapy Planning, Computer-Assisted/standards ; Radiotherapy, Intensity-Modulated/standards
Language	English
Publishing date	2014-03-06
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2010347-5
ISSN	1526-9914 ; 1526-9914
ISSN (online)	1526-9914
ISSN	1526-9914
DOI	10.1120/jacmp.v15i2.4841
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Article ; Online: AAPM Task Group Report 306: Quality control and assurance for tomotherapy: An update to Task Group Report 148.

Chen, Quan / Rong, Yi / Burmeister, Jay W / Chao, Edward H / Corradini, Nathan A / Followill, David S / Li, X Allen / Liu, An / Qi, X Sharon / Shi, Hairong / Smilowitz, Jennifer B

Medical physics

2023 Volume 50, Issue 3, Page(s) e25–e52

Abstract: Since the publication of AAPM Task Group (TG) 148 on quality assurance (QA) for helical tomotherapy, there have been many new developments on the tomotherapy platform involving treatment delivery, on-board imaging options, motion management, and ... ...

Abstract	Since the publication of AAPM Task Group (TG) 148 on quality assurance (QA) for helical tomotherapy, there have been many new developments on the tomotherapy platform involving treatment delivery, on-board imaging options, motion management, and treatment planning systems (TPSs). In response to a need for guidance on quality control (QC) and QA for these technologies, the AAPM Therapy Physics Committee commissioned TG 306 to review these changes and make recommendations related to these technology updates. The specific objectives of this TG were (1) to update, as needed, recommendations on tolerance limits, frequencies and QC/QA testing methodology in TG 148, (2) address the commissioning and necessary QA checks, as a supplement to Medical Physics Practice Guidelines (MPPG) with respect to tomotherapy TPS and (3) to provide risk-based recommendations on the new technology implemented clinically and treatment delivery workflow. Detailed recommendations on QA tests and their tolerance levels are provided for dynamic jaws, binary multileaf collimators, and Synchrony motion management. A subset of TPS commissioning and QA checks in MPPG 5.a. applicable to tomotherapy are recommended. In addition, failure mode and effects analysis has been conducted among TG members to obtain multi-institutional analysis on tomotherapy-related failure modes and their effect ranking.
MeSH term(s)	Radiotherapy, Intensity-Modulated/methods ; Radiotherapy Planning, Computer-Assisted/methods ; Radiotherapy Dosage ; Quality Control ; Phantoms, Imaging
Language	English
Publishing date	2023-01-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	188780-4
ISSN	2473-4209 ; 0094-2405
ISSN (online)	2473-4209
ISSN	0094-2405
DOI	10.1002/mp.16150
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Article ; Online: Dosimetric impact of commercial CT metal artifact reduction algorithms and a novel in-house algorithm for proton therapy of head and neck cancer.

Branco, Daniela / Kry, Stephen / Taylor, Paige / Zhang, Xiaodong / Rong, John / Frank, Steven / Followill, David

Medical physics

2020 Volume 48, Issue 1, Page(s) 445–455

Abstract: ... in the analysis. The phantom was scanned with the metal teeth in place using each respective vendor's MAR ...

Abstract	Purpose: To compare the dosimetric impact of all major commercial vendors' metal artifact reduction (MAR) algorithms to one another, as well as to a novel in-house technique (AMPP) using an anthropomorphic head phantom. Materials and methods: The phantom was an Alderson phantom, modified to allow for artifact-filled and baseline (no artifacts) computed tomography (CT) scans using teeth capsules made with metal amalgams or bone-equivalent materials. It also included a cylindrical insert that was accessible from the bottom of the neck and designed to introduce soft tissue features into the phantom that were used in the analysis. The phantom was scanned with the metal teeth in place using each respective vendor's MAR algorithm: OMAR (Philips), iMAR (Siemens), SEMAR (Canon), and SmartMAR (GE); the AMPP algorithm was designed in-house. Uncorrected and baseline (bone-equivalent teeth) image sets were also acquired using a Siemens scanner. Proton spot scanning treatment plans were designed on the baseline image set for five targets in the phantom. Once optimized, the proton beams were copied onto the different artifact-corrected image sets, with no reoptimization of the beams' parameters, to evaluate dose distribution differences in the different MAR-corrected and -uncorrected image sets. Dose distribution differences were evaluated by comparing dose-volume histogram (DVH) metrics, including planning target volume D95 and clinical target volume D99 coverages, V100, D0.03cc, and heterogeneity indexes, along with a qualitative and water equivalent thickness (WET) analysis. Results: Uncorrected CT metal artifacts and commercial MAR algorithms negatively impacted the proton dose distributions of all five target shapes and locations in an inconsistent manner, sometimes overdosing by as much as 11.1% (D0.03) or underdosing by as much as 11.7% (V100) the planning target volumes. The AMPP-corrected images, however, provided dose distributions that consistently agreed with the baseline dose distribution. The dosimetry results also suggest that the commercial MAR algorithms' performances varied more with target location and less with target shape. Once relocated further from the metal, the target showed dose distributions that agreed more with the baseline for all commercial solutions, improving the overdosing by as much as 6%, implying inadequate HU correction from commercial MAR algorithms. In comparison to the baseline, HU profile shapes were considerably altered by commercial algorithms and reference values showed differences that represent stopping power percentage differences of 2.7-10%. The AMPP algorithm plans showed the smallest WET differences with the baseline (0.06 cm on average), while the commercial image sets created differences that ranged from 0.11 to 0.54 cm. Conclusions: Computed tomography metal artifacts negatively impacted proton dose distributions on all five targets analyzed. The commercial MAR solutions performed inconsistently throughout all targets compared to the metal-free baseline. A lack of CTV coverage and an increased number of hotspots were observed throughout all commercial solutions. Dose distribution errors were related to the proximity to the artifacts, demonstrating the inability of commercial techniques to adequately correct severe artifacts. In contrast, AMPP consistently showed dose distributions that best matched the baseline, likely because it makes use of accurate HU information, as opposed to interpolated data like commercial algorithms.
MeSH term(s)	Algorithms ; Artifacts ; Head and Neck Neoplasms/diagnostic imaging ; Head and Neck Neoplasms/radiotherapy ; Humans ; Phantoms, Imaging ; Proton Therapy ; Tomography, X-Ray Computed
Language	English
Publishing date	2020-11-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	188780-4
ISSN	2473-4209 ; 0094-2405
ISSN (online)	2473-4209
ISSN	0094-2405
DOI	10.1002/mp.14591
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Article ; Online: Pencil Beam Algorithms Are Unsuitable for Proton Dose Calculations in Lung.

Taylor, Paige A / Kry, Stephen F / Followill, David S

International journal of radiation oncology, biology, physics

2017 Volume 99, Issue 3, Page(s) 750–756

Abstract: Purpose: To compare analytic and Monte Carlo-based algorithms for proton dose calculations in the lung, benchmarked against anthropomorphic lung phantom measurements.: Methods and materials: A heterogeneous anthropomorphic moving lung phantom has ... ...

Abstract	Purpose: To compare analytic and Monte Carlo-based algorithms for proton dose calculations in the lung, benchmarked against anthropomorphic lung phantom measurements. Methods and materials: A heterogeneous anthropomorphic moving lung phantom has been irradiated at numerous proton therapy centers. At 5 centers the treatment plan could be calculated with both an analytic and Monte Carlo algorithm. The doses calculated in the treatment plans were compared with the doses delivered to the phantoms, which were measured using thermoluminescent dosimeters and film. Point doses were compared, as were planar doses using a gamma analysis. Results: The analytic algorithms overestimated the dose to the center of the target by an average of 7.2%, whereas the Monte Carlo algorithms were within 1.6% of the physical measurements on average. In some regions of the target volume, the analytic algorithm calculations differed from the measurement by up to 31% in the internal gross target volume (iGTV) (46% in the planning target volume), over-predicting the dose. All comparisons showed a region of at least 15% dose discrepancy within the iGTV between the analytic calculation and the measured dose. The Monte Carlo algorithm recalculations showed dramatically improved agreement with the measured doses, showing mean agreement within 4% for all cases and a maximum difference of 12% within the iGTV. Conclusions: Analytic algorithms often do a poor job predicting proton dose in lung tumors, over-predicting the dose to the target by up to 46%, and should not be used unless extensive validation counters the consistent results of the present study. Monte Carlo algorithms showed dramatically improved agreement with physical measurements and should be implemented to better reflect actual delivered dose distributions.
MeSH term(s)	Algorithms ; Equipment Design ; Humans ; Lung/radiation effects ; Lung Neoplasms/radiotherapy ; Monte Carlo Method ; Phantoms, Imaging ; Proton Therapy ; Radiotherapy Dosage ; Tumor Burden
Language	English
Publishing date	2017-06-13
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Multicenter Study ; Research Support, N.I.H., Extramural
ZDB-ID	197614-x
ISSN	1879-355X ; 0360-3016
ISSN (online)	1879-355X
ISSN	0360-3016
DOI	10.1016/j.ijrobp.2017.06.003
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Article ; Online: Photon beam modeling variations predict errors in IMRT dosimetry audits.

Glenn, Mallory C / Brooks, Fre'Etta / Peterson, Christine B / Howell, Rebecca M / Followill, David S / Pollard-Larkin, Julianne M / Kry, Stephen F

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

2021 Volume 166, Page(s) 8–14

Abstract: Background & purpose: To evaluate treatment planning system (TPS) beam modeling parameters as contributing factors to IMRT audit performance.: Materials & methods: We retrospectively analyzed IROC Houston phantom audit performance and concurrent beam ...

Abstract	Background & purpose: To evaluate treatment planning system (TPS) beam modeling parameters as contributing factors to IMRT audit performance. Materials & methods: We retrospectively analyzed IROC Houston phantom audit performance and concurrent beam modeling survey responses from 337 irradiations performed between August 2017 and November 2019. Irradiation results were grouped based on the reporting of typical or atypical beam modeling parameter survey responses (<10th or >90th percentile values), and compared for passing versus failing (>7% error) or "poor" (>5% error) irradiation status. Additionally, we assessed the impact on the planned dose distribution from variations in modeling parameter value. Finally, we estimated the overall impact of beam modeling parameter variance on dose calculations, based on reported community variations. Results: Use of atypical modeling parameters were more frequently seen with failing phantom audit results (p = 0.01). Most pronounced was for Eclipse AAA users, where phantom irradiations with atypical values of dosimetric leaf gap (DLG) showed a greater incidence of both poor-performing (p = 0.048) and failing phantom audits (p = 0.014); and in general, DLG value was correlated with dose calculation accuracy (r = 0.397, p < 0.001). Manipulating TPS parameters induced systematic changes in planned dose distributions which were consistent with prior observations of how failures manifest. Dose change estimations based on these dose calculations agreed well with true dosimetric errors identified. Conclusion: Atypical TPS beam modeling parameters are associated with failing phantom audits. This is identified as an important factor contributing to the observed failing phantom results, and highlights the need for accurate beam modeling.
MeSH term(s)	Humans ; Phantoms, Imaging ; Radiometry ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted/methods ; Radiotherapy, Intensity-Modulated ; Retrospective Studies
Language	English
Publishing date	2021-11-05
Publishing country	Ireland
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	605646-5
ISSN	1879-0887 ; 0167-8140
ISSN (online)	1879-0887
ISSN	0167-8140
DOI	10.1016/j.radonc.2021.10.021
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Article ; Online: Differences in the Patterns of Failure Between IROC Lung and Spine Phantom Irradiations.

Edward, Sharbacha S / Alvarez, Paola E / Taylor, Paige A / Molineu, H Andrea / Peterson, Christine B / Followill, David S / Kry, Stephen F

Practical radiation oncology

2020 Volume 10, Issue 5, Page(s) 372–381

Abstract: Purpose: Our purpose was to investigate and classify the reasons why institutions fail the Imaging and Radiation Oncology Core (IROC) stereotactic body radiation therapy (SBRT) spine and moving lung phantoms, which are used to credential institutions ... ...

Abstract	Purpose: Our purpose was to investigate and classify the reasons why institutions fail the Imaging and Radiation Oncology Core (IROC) stereotactic body radiation therapy (SBRT) spine and moving lung phantoms, which are used to credential institutions for clinical trial participation. Methods and materials: All IROC moving lung and SBRT spine phantom irradiation failures recorded from January 2012 to December 2018 were evaluated in this study. A failure was a case where the institution did not meet the established IROC criteria for agreement between planned and delivered dose. We analyzed the reports for all failing irradiations, including point dose disagreement, dose profiles, and gamma analyses. Classes of failure patterns were created and used to categorize each instance. Results: There were 158 failing cases analyzed: 116 of 1052 total lung irradiations and 42 of 263 total spine irradiations. Seven categories were required to describe the lung phantom failures, whereas 4 were required for the spine. Types of errors present in both phantom groups included systematic dose and localization errors. Fifty percent of lung failures were due to a superior-inferior localization error, that is, error in the direction of major motion. Systematic dose errors, however, contributed to only 22% of lung failures. In contrast, the majority (60%) of spine phantom failures were due to systematic dose errors, with localization errors (in any direction) accounting for only 14% of failures. Conclusions: There were 2 distinct patterns of failure between the IROC moving lung and SBRT spine phantoms. The majority of the lung phantom failures were due to localization errors, whereas the spine phantom failures were largely attributed to systematic dose errors. Both of these errors are clinically relevant and could manifest as errors in patient cases. These findings highlight the value of independent end-to-end dosimetry audits and can help guide the community in improving the quality of radiation therapy by focusing attention on where errors manifest in the community.
MeSH term(s)	Humans ; Lung/diagnostic imaging ; Phantoms, Imaging ; Radiation Oncology ; Radiosurgery ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Intensity-Modulated
Language	English
Publishing date	2020-05-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	2655748-4
ISSN	1879-8519 ; 1879-8500
ISSN (online)	1879-8519
ISSN	1879-8500
DOI	10.1016/j.prro.2020.04.004
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