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Article ; Online: Adding customized electron energy beams to TrueBeam linear accelerators.

Gao, Song / Muruganandham, Manickam / Du, Weiliang / Ohrt, Jared / Kudchadker, Rajat J / Balter, Peter A

Journal of applied clinical medical physics

2022 Volume 23, Issue 7, Page(s) e13633

Abstract: Purpose: To better meet clinical needs and facilitate optimal treatment planning, we added two new electron energy beams (7 and 11 MeV) to two Varian TrueBeam linacs.: Methods: We worked with the vendor to create two additional customized electron ... ...

Abstract	Purpose: To better meet clinical needs and facilitate optimal treatment planning, we added two new electron energy beams (7 and 11 MeV) to two Varian TrueBeam linacs. Methods: We worked with the vendor to create two additional customized electron energies without hardware modifications. For each beam, we set the bending magnet current and then optimized other beam-specific parameters to achieve depths of 50% ionization (I Results: The I Conclusion: We were able to add two new beam energies with no hardware modifications. Tuning of the new beams was facilitated by the ICP/DW system allowing us to have the procedures done in a few hours and achieve highly consistent results across two linacs. PACS numbers: 87.55.Qr, 87.56.Fc.
MeSH term(s)	Electrons ; Humans ; Particle Accelerators ; Phantoms, Imaging ; Radiometry ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted/methods
Language	English
Publishing date	2022-05-09
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/acm2.13633
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Article ; Online: Using Failure Mode and Effects Analysis to Evaluate Risk in the Clinical Adoption of Automated Contouring and Treatment Planning Tools.

Nealon, Kelly A / Balter, Peter A / Douglas, Raphael J / Fullen, Danna K / Nitsch, Paige L / Olanrewaju, Adenike M / Soliman, Moaaz / Court, Laurence E

Practical radiation oncology

2022 Volume 12, Issue 4, Page(s) e344–e353

Abstract: Purpose: In this study, we applied the failure mode and effects analysis (FMEA) approach to an automated radiation therapy contouring and treatment planning tool to assess, and subsequently limit, the risk of deploying automated tools.: Methods and ... ...

Abstract	Purpose: In this study, we applied the failure mode and effects analysis (FMEA) approach to an automated radiation therapy contouring and treatment planning tool to assess, and subsequently limit, the risk of deploying automated tools. Methods and materials: Using an FMEA, we quantified the risks associated with the Radiation Planning Assistant (RPA), an automated contouring and treatment planning tool currently under development. A multidisciplinary team identified and scored each failure mode, using a combination of RPA plan data and experience for guidance. A 1-to-10 scale for severity, occurrence, and detectability of potential errors was used, following American Association of Physicists in Medicine Task Group 100 recommendations. High-risk failure modes were further explored to determine how the workflow could be improved to reduce the associated risk. Results: Of 290 possible failure modes, we identified 126 errors that were unique to the RPA workflow, with a mean risk priority number (RPN) of 56.3 and a maximum RPN of 486. The top 10 failure modes were caused by automation bias, operator error, and software error. Twenty-one failure modes were above the action threshold of RPN = 125, leading to corrective actions. The workflow was modified to simplify the user interface and better training resources were developed, which highlight the importance of thorough review of the output of automated systems. After the changes, we rescored the high-risk errors, resulting in a final mean and maximum RPN of 33.7 and 288, respectively. Conclusions: We identified 126 errors specific to the automated workflow, most of which were caused by automation bias or operator error, which emphasized the need to simplify the user interface and ensure adequate user training. As a result of changes made to the software and the enhancement of training resources, the RPNs subsequently decreased, showing that FMEA is an effective way to assess and reduce risk associated with the deployment of automated planning tools.
MeSH term(s)	Automation ; Healthcare Failure Mode and Effect Analysis ; Humans ; Software
Language	English
Publishing date	2022-03-16
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.2022.01.003
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Article ; Online: Monitoring linear accelerators electron beam energy constancy with a 2D ionization chamber array and double-wedge phantom.

Gao, Song / Chetvertkov, Mikhail A / Simon, William E / Sadeghi, Amir / Balter, Peter A

Journal of applied clinical medical physics

2019 Volume 21, Issue 1, Page(s) 18–25

Abstract: Validate that a two-dimensional (2D) ionization chamber array (ICA) combined with a double-wedge plate (DWP) can track changes in electron beam energy well within 2.0 mms as recommended by TG-142 for monthly quality assurance (QA). Electron beam profiles ...

Abstract	Validate that a two-dimensional (2D) ionization chamber array (ICA) combined with a double-wedge plate (DWP) can track changes in electron beam energy well within 2.0 mms as recommended by TG-142 for monthly quality assurance (QA). Electron beam profiles of 4-22 MeV were measured for a 25 × 25 cm
MeSH term(s)	Calibration ; Electrons ; Humans ; Monte Carlo Method ; Particle Accelerators/instrumentation ; Phantoms, Imaging ; Quality Assurance, Health Care/standards ; Quality Control ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted/methods ; Radiotherapy, Intensity-Modulated/methods ; Reproducibility of Results
Language	English
Publishing date	2019-10-21
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/acm2.12751
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Article: The potential of biology-guided radiation therapy in thoracic cancer: A preliminary treatment planning study.

Seyedin, Steven N / Bassalow, Rostem / Mawlawi, Osama R / Turner, Lehendrick M / Patel, Roshal R / Mazin, Samuel R / Oderinde, Oluwaseyi M / Voronenko, Yevgen / Wages, Cody A / Olcott, Peter D / Chang, Joe Y / Balter, Peter A / Welsh, James W

Frontiers in oncology

2022 Volume 12, Page(s) 921473

Abstract: Purpose: We investigated the feasibility of biology-guided radiotherapy (BgRT), a technique that utilizes real-time positron emission imaging to minimize tumor motion uncertainties, to spare nearby organs at risk.: Methods: Volumetric modulated arc ... ...

Abstract	Purpose: We investigated the feasibility of biology-guided radiotherapy (BgRT), a technique that utilizes real-time positron emission imaging to minimize tumor motion uncertainties, to spare nearby organs at risk. Methods: Volumetric modulated arc therapy (VMAT), intensity-modulated proton (IMPT) therapy, and BgRT plans were created for a paratracheal node recurrence (case 1; 60 Gy in 10 fractions) and a primary peripheral left upper lobe adenocarcinoma (case 2; 50 Gy in four fractions). Results: For case 1, BgRT produced lower bronchus V40 values compared to VMAT and IMPT. For case 2, total lung V20 was lower in the BgRT case compared to VMAT and IMPT. Conclusions: BgRT has the potential to reduce the radiation dose to proximal critical structures but requires further detailed investigation.
Language	English
Publishing date	2022-10-14
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2649216-7
ISSN	2234-943X
ISSN	2234-943X
DOI	10.3389/fonc.2022.921473
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Article ; Online: A Novel Method for Quantifying Total Thoracic Tumor Burden in Mice.

Viswanath, Pavitra / Peng, Shaohua / Singh, Ratnakar / Kingsley, Charles / Balter, Peter A / Johnson, Faye M

Neoplasia (New York, N.Y.)

2018 Volume 20, Issue 10, Page(s) 975–984

Abstract: Mouse models are powerful tools to study lung cancer initiation and progression in vivo and have contributed significantly to recent advances in therapy. Using micro-computed tomography to monitor and study parenchymal and extra-parenchymal metastases in ...

Abstract	Mouse models are powerful tools to study lung cancer initiation and progression in vivo and have contributed significantly to recent advances in therapy. Using micro-computed tomography to monitor and study parenchymal and extra-parenchymal metastases in existing murine models of lung cancer is challenging owing to a lack of radiographic contrast and difficulty in achieving respiratory gating. To facilitate the analysis of these in vivo imaging studies and study of tumor progression in murine models we developed a novel, rapid, semi-automated method of calculating thoracic tumor burden from computed tomography images. This method, in which commercially available software is used to calculate the mass of the thoracic cavity (MTC), takes into account the aggregate tumor burden in the thoracic cavity. The present study showed that in tumor-free mice, the MTC does not change over time and is not affected by breathing, whereas in tumor-bearing mice, the increase in the MTC is a measure of tumor mass that correlates well with tumor burden measured by lung weight. Tumor burden calculated with our MTC method correlated with that measured by lung weight as well as or better than that calculated using four established methods. To test this method, we assessed metastatic tumor development and response to a pharmacologic PLK1 inhibitor in an orthotopic xenograft mouse model. PLK1 inhibition significantly inhibited tumor growth. Our results demonstrate that the MTC method can be used to study dynamic changes in tumor growth and response to therapeutics in genetically engineered mouse models and orthotopic xenograft mouse models of lung cancer.
MeSH term(s)	Animals ; Antineoplastic Agents/pharmacology ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/drug therapy ; Lung Neoplasms/pathology ; Male ; Mice, Inbred Strains ; Mice, Transgenic ; Neoplasms, Experimental/diagnostic imaging ; Neoplasms, Experimental/pathology ; Pteridines/pharmacology ; Thoracic Cavity/diagnostic imaging ; Thoracic Cavity/pathology ; Thoracic Neoplasms/diagnostic imaging ; Tumor Burden/drug effects ; X-Ray Microtomography/methods
Chemical Substances	Antineoplastic Agents ; BI 6727 ; Pteridines
Language	English
Publishing date	2018-08-26
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1483840-0
ISSN	1476-5586 ; 1522-8002
ISSN (online)	1476-5586
ISSN	1522-8002
DOI	10.1016/j.neo.2018.08.003
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Article ; Online: Quantification of beam steering with an ionization chamber array.

Gao, Song / Balter, Peter A / Tran, Benjamin / Rose, Mark / Simon, William E

Journal of applied clinical medical physics

2018 Volume 19, Issue 3, Page(s) 168–176

Abstract: Routine quality assurance for linear accelerators (linacs) usually involves verification of beam steering with a water scanning system. We established a beam steering procedure that uses a 2D ionization chamber array (ICA) and verified the equivalence of ...

Abstract	Routine quality assurance for linear accelerators (linacs) usually involves verification of beam steering with a water scanning system. We established a beam steering procedure that uses a 2D ionization chamber array (ICA) and verified the equivalence of beam symmetry between the ICA and a water scanning system. The ICA calibration accuracy, reproducibility and stability were evaluated and the uncertainty in the measurement of beam symmetry due to the array calibration was examined. Forty-five photon beams and 80 electron beams across 7 Varian C-series and 4 TrueBeam linacs were steered in the radial and transverse directions using an ICA. After beam steering, profiles were re-measured using the ICA and in-water using a 3D Scanner (3DS). Beam symmetries measured with the ICA and 3DS were compared by (a) calculating the difference in point-by-point symmetry, (b) plotting the histogram distribution of the symmetry differences, and (c) comparing ICA and 3DS differences with their respective Varian symmetry protocol analysis. Array calibrations from five different occurrences (2012 to 2016) over six different beams reproduced within 0.5%. The uncertainty in beam symmetry was less than 0.5% due to the uncertainties in the array calibration. After all beams were steered using the ICA, the point-by-point symmetry differences between ICA and 3DS at the off-axis positions of 20% and 80% of field size for all beam profiles indicated that 95% of point-by-point symmetry comparisons agreed within 0.7%, and 100% agreed within 1.0%; after steering with the ICA 97.8% of photon beam profiles (88 of 90) and 97.5% of electron beam profiles (156 of 160) had symmetry within 1% when measured with the 3DS. All photon and electron beam profiles had symmetry within 1.1% and 1.2%, respectively, for profiles measured with the 3DS. Our data demonstrate that a calibrated ICA can be used to steer photon and electron beams achieving beam symmetry within 1% when re-measured with a 3D water scanning system.
MeSH term(s)	Calibration ; Humans ; Particle Accelerators/instrumentation ; Photons ; Radiotherapy Planning, Computer-Assisted/instrumentation ; Radiotherapy Planning, Computer-Assisted/methods ; Radiotherapy, Intensity-Modulated/instrumentation
Language	English
Publishing date	2018-03-25
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/acm2.12315
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Article ; Online: A comparison of methods for monitoring photon beam energy constancy.

Gao, Song / Balter, Peter A / Rose, Mark / Simon, William E

Journal of applied clinical medical physics

2016 Volume 17, Issue 6, Page(s) 242–253

Abstract: In extension of a previous study, we compared several photon beam energy metrics to determine which was the most sensitive to energy change; in addition to those, we accounted for both the sensitivity of each metric and the uncertainty in determining ... ...

Abstract	In extension of a previous study, we compared several photon beam energy metrics to determine which was the most sensitive to energy change; in addition to those, we accounted for both the sensitivity of each metric and the uncertainty in determining that metric for both traditional flattening filter (FF) beams (4, 6, 8, and 10 MV) and for flattening filter-free (FFF) beams (6 and 10 MV) on a Varian TrueBeam. We examined changes in these energy metrics when photon energies were changed to ± 5% and ± 10% from their nominal energies: 1) an attenuation-based metric (the percent depth dose at 10 cm depth, PDD(10)) and, 2) profile-based metrics, including flatness (Flat) and off-axis ratios (OARs) measured on the orthogonal axes or on the diagonals (diagonal normalized flatness, FDN). Profile-based metrics were measured near dmax and also near 10 cm depth in water (using a 3D scanner) and with ioniza-tion chamber array (ICA). PDD(10) was measured only in water. Changes in PDD, OAR, and FDN were nearly linear to the changes in the bend magnet current (BMI) over the range from -10% to +10% for both FF and FFF beams: a ± 10% change in energy resulted in a ± 1.5% change in PDD(10) for both FF and FFF beams, and changes in OAR and FDN were > 3.0% for FF beams and > 2.2% for FFF beams. The uncertainty in determining PDD(10) was estimated to be 0.15% and that for OAR and FDN about 0.07%. This resulted in minimally detectable changes in energy of 2.5% for PDD(10) and 0.5% for OAR and FDN. We found that the OAR- or FDN- based metrics were the best for detecting energy changes for both FF and FFF beams. The ability of the OAR-based metrics determined with a water scanner to detect energy changes was equivalent to that using an ionization chamber array. We recommend that OAR be measured either on the orthogonal axes or the diagonals, using an ionization chamber array near the depth of maximum dose, as a sensitive and efficient way to confirm stability of photon beam energy.
MeSH term(s)	Energy Transfer ; Filtration/instrumentation ; Humans ; Particle Accelerators/instrumentation ; Photons ; Radiation Dosage ; Radiometry/instrumentation ; Radiometry/methods ; Uncertainty
Language	English
Publishing date	2016--08
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	10.1120/jacmp.v17i6.6454
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Article ; Online: Point/Counterpoint. Because of the advantages of rotational techniques, conventional IMRT will soon become obsolete.

Popple, Richard A / Balter, Peter A / Orton, Colin G

Medical physics

2014 Volume 41, Issue 10, Page(s) 100601

MeSH term(s)	Algorithms ; Cost-Benefit Analysis ; Humans ; Quality of Health Care ; Radiotherapy, Intensity-Modulated/instrumentation ; Radiotherapy, Intensity-Modulated/methods ; Rotation ; Time
Language	English
Publishing date	2014-10
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	10.1118/1.4885996
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Article ; Online: Beam energy metrics for the acceptance and quality assurance of Halcyon linear accelerator.

Gao, Song / Chetvertkov, Mikhail A / Cai, Bin / Dwivedi, Abhishek / Mihailidis, Dimitris / Ray, Xenia / Netherton, Tucker / Court, Laurence E / Simon, William E / Balter, Peter A

Journal of applied clinical medical physics

2021 Volume 22, Issue 7, Page(s) 121–127

Abstract: Purpose: Establish and compare two metrics for monitoring beam energy changes in the Halcyon platform and evaluate the accuracy of these metrics across multiple Halcyon linacs.: Method: The first energy metric is derived from the diagonal normalized ... ...

Abstract	Purpose: Establish and compare two metrics for monitoring beam energy changes in the Halcyon platform and evaluate the accuracy of these metrics across multiple Halcyon linacs. Method: The first energy metric is derived from the diagonal normalized flatness (F Results: Five Halcyon linacs from five institutions were used to evaluate the accuracy of the D Conclusion: The F
MeSH term(s)	Benchmarking ; Humans ; Linear Models ; Particle Accelerators ; Photons ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted
Language	English
Publishing date	2021-05-27
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/acm2.13281
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Article ; Online: Deep learning-based automatic segmentation of cardiac substructures for lung cancers.

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

2023 Volume 191, Page(s) 110061

Abstract: Purpose: Accurate and comprehensive segmentation of cardiac substructures is crucial for minimizing the risk of radiation-induced heart disease in lung cancer radiotherapy. We sought to develop and validate deep learning-based auto-segmentation models ... ...

Abstract	Purpose: Accurate and comprehensive segmentation of cardiac substructures is crucial for minimizing the risk of radiation-induced heart disease in lung cancer radiotherapy. We sought to develop and validate deep learning-based auto-segmentation models for cardiac substructures. Materials and methods: Nineteen cardiac substructures (whole heart, 4 heart chambers, 6 great vessels, 4 valves, and 4 coronary arteries) in 100 patients treated for non-small cell lung cancer were manually delineated by two radiation oncologists. The valves and coronary arteries were delineated as planning risk volumes. An nnU-Net auto-segmentation model was trained, validated, and tested on this dataset with a split ratio of 75:5:20. The auto-segmented contours were evaluated by comparing them with manually drawn contours in terms of Dice similarity coefficient (DSC) and dose metrics extracted from clinical plans. An independent dataset of 42 patients was used for subjective evaluation of the auto-segmentation model by 4 physicians. Results: The average DSCs were 0.95 (+/- 0.01) for the whole heart, 0.91 (+/- 0.02) for 4 chambers, 0.86 (+/- 0.09) for 6 great vessels, 0.81 (+/- 0.09) for 4 valves, and 0.60 (+/- 0.14) for 4 coronary arteries. The average absolute errors in mean/max doses to all substructures were 1.04 (+/- 1.99) Gy and 2.20 (+/- 4.37) Gy. The subjective evaluation revealed that 94% of the auto-segmented contours were clinically acceptable. Conclusion: We demonstrated the effectiveness of our nnU-Net model for delineating cardiac substructures, including coronary arteries. Our results indicate that this model has promise for studies regarding radiation dose to cardiac substructures.
MeSH term(s)	Humans ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/radiotherapy ; Carcinoma, Non-Small-Cell Lung/diagnostic imaging ; Carcinoma, Non-Small-Cell Lung/radiotherapy ; Deep Learning ; Radiotherapy Planning, Computer-Assisted/methods ; Heart/diagnostic imaging ; Organs at Risk
Language	English
Publishing date	2023-12-19
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	605646-5
ISSN	1879-0887 ; 0167-8140
ISSN (online)	1879-0887
ISSN	0167-8140
DOI	10.1016/j.radonc.2023.110061
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