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SU-F-P-03: Management of Time to Treatment Inititation: Case for An Electronic Whiteboard

Purpose: To determine if data mining of an electronic whiteboard improves the management of the Time to Treatment Initiation (TTI) in radiation oncology. Methods: An electronic whiteboard designed to help in managing the planning workflow and improves communication regarding patient planning progress was used to record the dates at which each phase of the planning process began or completed. These are CT Sim date, Plan Start, Physician Review, Physicist Review, Approval for Treatment Delivery, Setup or Verification of Simulation. Results: During clinical implementation, the electronic whiteboard was able to fulfill its primary objective of providing a transparent account of the planning progress of each patient. Peer pressure also meant that individual tasks, such as contouring, were easily brought to the attention of the responsible party and prioritized accordingly. Data mining to analyze the electronic whiteboard per patient (figure 1), per diagnosis (figure 2), per treatment modality (figure 3), per physician (figure 4), per planner (figure 5), etc., added another sophisticated tool in the management of Time to Treatment Initiation without compromising quality of the plans being generated. A longer than necessary time between CT Sim and Plan Start can be discussed among the members of the treatment team as an indication of inadequate/outdated CT Simulator, Contouring Tools, Image Fusion Tools, Other Imaging Studies (MRI, PET/CT) performed, etc. The same for the Plan Start to Physician Review where an extended time than expected may be due unrealistic planning goals, limited planning system features, etc. Conclusion: An Electronic Whiteboard in radiation oncology is not only helping with organizing planning workflow, it is also a potent tool that can be used to reduce the Time to Treatment Initiation by providing the clinic with hard data about the duration of each phase treatment planning as a function of different variable affecting the planning process. The work is supported by the Global Medical Physics Institute.

60 APPLIED LIFE SCIENCES↗

SU-F-P-08: Medical Physics Perspective On Radiation Therapy Quality and Safety Considerations in Low Income Settings

Purpose: The last few years have seen a significant growth of interest in the global radiation therapy crisis. Various organizations are quantifying the need and providing aid in support of addressing the shortfall existing in many low-to-middle income countries (LMICs). The Lancet Oncology Commission report (Lancet Oncol. Sep;16(10):1153-86, 2015) projects a need of 22,000 new medical physicists in LMICs by 2035 if there is to be equal access globally. With the tremendous demand for new facilities, equipment and personnel, it is very important to recognize quality and safety considerations and to address them directly. Methods: A detailed examination of quality and safety publications was undertaken. A paper by Dunscombe (Front. Oncol. 2: 129, 2012) reviewed the recommendations of 7 authoritative reports on safety in radiation therapy and found the 12 most cited recommendations, summarized in order of most to least cited: training, staffing, documentation/standard operating procedures, incident learning, communication/questioning, check lists, QC/PM, dosimetric audit, accreditation, minimizing interruptions, prospective risk assessment, and safety culture. However, these authoritative reports were generally based on input from high income contexts. In this work, the recommendations were analyzed with a special emphasis on issues that are significant in LMICs. Results: The review indicated that there are significant challenges in LMICs with training and staffing ranking at the top in terms quality and safety. Conclusion: With the recognized need for expanding global access to radiation therapy, especially in LMICs, and the backing by multiple support organizations, quality and safety considerations must be overtly addressed. While multidimensional, training and staffing are top priorities. The use of outdated systems with poor interconnectivity, coupled with a lack of systematic QA in high patient load settings are additional concerns. Any support provided to lower resourced settings must address the multiple facets associated with these quality and safety indicators.

60 APPLIED LIFE SCIENCES↗

SU-F-P-09: A Global Medical Physics Collaboration for Implementation of Modern Radiotherapy in Botswana

Purpose: The global burden of cancer is considerable, particularly in low and middle-income countries. Massachusetts General Hospital (MGH) and Botswana-Harvard AIDS Institute have partnered with the oncology community and government of Botswana to form BOTSOGO (BOTSwana Oncology Global Outreach) to address the rising burden of cancer in Botswana. Currently, radiation therapy (RT) is only available at a single linear accelerator (LINAC) in Gaborone Private Hospital (GPH). BOTSOGO worked to limit the absence of RT during a LINAC upgrade and ensure a safe transition to modern radiotherapy techniques. Methods: The existing Elekta Precise LINAC was decommissioned in November 2015 and replaced with a new Elekta VERSA-HD with IMRT/VMAT/CBCT capability. Upgraded treatment planning and record-and-verify systems were also installed. Physicists from GPH and MGH collaborated during an intensive on-site visit in Botswana during the commissioning process. Measurements were performed using newly purchased Sun Nuclear equipment. Photon beams were matched with an existing model to minimize the time needed for beam modeling and machine down time. Additional remote peer review was also employed. Independent dosimetry was performed by irradiating OSLDs, which were subsequently analyzed at MGH. Results: Photon beam quality agreed with reference data within 0.2%. Electron beam data agreed with example clinical data within 3%. Absolute dose calibration was performed using both IAEA and AAPM protocols. Absolute dose measurements with OSLDs agreed within 5%. Quentry cloud-based software was installed to facilitate remote review of treatment plans. Patient treatments resumed in February 2016. The time without RT was reduced, therefore likely resulting in reduced patient morbidity/mortality. Conclusion: A global physics collaboration was utilized to commission a modern LINAC in a resource-constrained setting. This can be a useful model in other areas with limited resources. Further use of technology and on-site exchanges will facilitate the introduction of more advanced techniques in Botswana. We acknowledge funding support from the AAPM International Educational Activities Committee and the NCI Federal Share Proton Beam Program Income Grant.

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SU-F-P-15: Report On AAPM TG 178 Gamma Knife Dosimetry and Quality Assurance

Purpose: AAPM Task Group 178 Gamma Stereotactic Radiosurgery Dosimetry and Quality Assurance was formed in August, 2008. The Task Group has 12 medical physicists, two physicians and two consultants. Methods: A round robin dosimetry intercomparison of proposed ionization chambers, electrometer and dosimetry phantoms was conducted over a 15 month period in 2011 and 2012 (Med Phys 42, 11, Nov, 2015). The data obtained at 9 institutions (with ten different Elekta Gamma Knife units) was analyzed by the lead author using several protocols. Results: The most consistent results were obtained using the Elekta ABS 16cm diameter phantom, with the TG-51 protocol modified as recommended by Alfonso et al (Med Phys 35, 11, Nov 2008). A key white paper (Med Phys, in press) sponsored by Elekta Corporation, was used to obtain correction factors for the ionization chambers and phantoms used in this intercomparison. Consistent results were obtained for both Elekta Gamma Knife Model 4C and Gamma Knife Perfexion units as measured with each of two miniature ionization chambers Conclusion: The full TG 178 report gives clinical history and background of gamma stereotactic radiosurgery, clinical examples and history, quality assurance recommendations and outline of possible dosimetry protocols. The report will be reviewed by the AAPM Working Group on Recommendations for Radiotherapy External Beam Quality Assurance and then by the AAPM Science Council before publication in Medical Physics. Consultant to Elekta, Inc.

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SU-F-R-06: Traumatic Brachial Plexus Injury Imaging, Developing a Coherent Clinical Protocol From Literature Review Through Practice

Purpose: Medical Physics teams can now play a critical role to help plan and provide studied approaches for traumatic brachial plexus MR imaging (tbpMRI). This is especially important for coordination with uncommon applications, since it is challenging to select the right modality, parameters, and train technologists on the essential components. For this work, we started with a review of the medical literature, performed crossover/volunteer studies to bring tbpMRI to practice with greater image QC and protocol management. Methods: To the best of our knowledge, we reviewed the known searchable domain for tbpMRI. We found 69 total articles since 2000. Articles were evaluated with our published protocol for literature management (LIMES3). Two physicists and two radiologists condensed the information from all articles into a knowledgebase. Results: The initial literature demonstrated great heterogeneity, which was a sign that this area needed greater consistency. Despite inconsistency and imprecision, we extracted the most relevant targets using our long-term experience with protocol development in MSK. We ran volunteers on six different magnets of various field strengths with multiple receiver coils, and rebuilt a coherent protocol for tbpMRI. Our radiologists rated LIMES3 work as superior. We have received referrals from the ER and have conducted four patient evaluations. Conclusion: Traumatic brachial plexus MRI has great possible benefits for patients. This work supports the complexity of tbpMRI scanning. As this is rarely performed, it requires a more diligent protocol workflow, coordination of caregivers, and education within multiple clinical departments. Choosing the correct imaging exam can be critical, as patients can have significant neuropathy and/or paralysis. The LIMES3 protocol is well liked at our institution, and forms the cornerstone of understanding for our work. Our literature management led to a better clinical protocol creation despite the diffuse and inconclusive information presented in the existing medical literature.

60 APPLIED LIFE SCIENCES↗

SU-F-J-34: Automatic Target-Based Patient Positioning Framework for Image-Guided Radiotherapy in Prostate Cancer Treatment

Purpose: Current image-guided radiotherapy (IGRT) procedure is bonebased patient positioning, followed by subjective manual correction using cone beam computed tomography (CBCT). This procedure might cause the misalignment of the patient positioning. Automatic target-based patient positioning systems achieve the better reproducibility of patient setup. Our aim of this study was to develop an automatic target-based patient positioning framework for IGRT with CBCT images in prostate cancer treatment. Methods: Seventy-three CBCT images of 10 patients and 24 planning CT images with digital imaging and communications in medicine for radiotherapy (DICOM-RT) structures were used for this study. Our proposed framework started from the generation of probabilistic atlases of bone and prostate from 24 planning CT images and prostate contours, which were made in the treatment planning. Next, the gray-scale histograms of CBCT values within CTV regions in the planning CT images were obtained as the occurrence probability of the CBCT values. Then, CBCT images were registered to the atlases using a rigid registration with mutual information. Finally, prostate regions were estimated by applying the Bayesian inference to CBCT images with the probabilistic atlases and CBCT value occurrence probability. The proposed framework was evaluated by calculating the Euclidean distance of errors between two centroids of prostate regions determined by our method and ground truths of manual delineations by a radiation oncologist and a medical physicist on CBCT images for 10 patients. Results: The average Euclidean distance between the centroids of extracted prostate regions determined by our proposed method and ground truths was 4.4 mm. The average errors for each direction were 1.8 mm in anteroposterior direction, 0.6 mm in lateral direction and 2.1 mm in craniocaudal direction. Conclusion: Our proposed framework based on probabilistic atlases and Bayesian inference might be feasible to automatically determine prostate regions on CBCT images.

60 APPLIED LIFE SCIENCES↗

SU-F-J-49: IGRT Credentialing in NCTN Trials

Purpose: To make Image Guided Radiation Therapy (IGRT) credentialing a more unified, consistent and efficient process across the entire National Clinical Trial Network (NCTN). Methods: IGRT plays a role in several advanced NCTN trials. Previously an institution had to be IGRT credentialed for each protocol. When institutions were allowed to use previous credentials for new protocols it was limited to the same disease site as the original credentialing. The credentialing was analyzed by the physics PI of the protocol. We consulted with several of these physicists to determine what is important to consider when reviewing submissions and to learn ways to apply credentialing more broadly. Results: For trials open in 2016, IGRT credentialing can be simplified to cover either boney anatomy or soft tissue. This revised credentialing will cover all disease sites based on the type of anatomy, unless otherwise stated within the protocol. Institutions will submit will complete an online questionnaire about their IGRT procedures. Boney anatomy requirements will include submission of data from 2 sequential fraction of both a patient aligned with boney anatomy and pelvic patient. Soft tissue will require similar submissions for a patient aligned using soft tissue and a pelvic patient. Institutions will only be required to submit the pelvic patient once. Data should be in DICOM format and includes planning CT set, RT structure set, RT plan file, RT dose file, localization images and spatial registration file (if available). Reviews will be done by IROC-Houston staff who will continue to provide feedback to the sites. Conclusion: This revised IGRT credentialing process will bring consistency, a savings in time and effort for both the IROC Houston QA office and to those institutions wanting to be credentialed to participate in NCTN Trials. Sponsored by NIH/NCI CA10953.

60 APPLIED LIFE SCIENCES↗

SU-F-J-66: Anatomy Deformation Based Comparison Between One-Step and Two-Step Optimization for Online ART

Purpose: This study investigated that how the quality of adapted plan was affected by inter-fractional anatomy deformation by using one-step and two-step optimization for on line adaptive radiotherapy (ART) procedure. Methods: 10 lung carcinoma patients were chosen randomly to produce IMRT plan by one-step and two-step algorithms respectively, and the prescribed dose was set as 60 Gy on the planning target volume (PTV) for all patients. To simulate inter-fractional target deformation, four specific cases were created by systematic anatomy variation; including target superior shift 0.5 cm, 0.3cm contraction, 0.3 cm expansion and 45-degree rotation. Based on these four anatomy deformation, adapted plan, regenerated plan and non-adapted plan were created to evaluate quality of adaptation. Adapted plans were generated automatically by using one-step and two-step algorithms respectively to optimize original plans, and regenerated plans were manually created by experience physicists. Non-adapted plans were produced by recalculating the dose distribution based on corresponding original plans. The deviations among these three plans were statistically analyzed by paired T-test. Results: In PTV superior shift case, adapted plans had significantly better PTV coverage by using two-step algorithm compared with one-step one, and meanwhile there was a significant difference of V95 by comparison with adapted and non-adapted plans (p=0.0025). In target contraction deformation, with almost same PTV coverage, the total lung received lower dose using one-step algorithm than two-step algorithm (p=0.0143,0.0126 for V20, Dmean respectively). In other two deformation cases, there were no significant differences observed by both two optimized algorithms. Conclusion: In geometry deformation such as target contraction, with comparable PTV coverage, one-step algorithm gave better OAR sparing than two-step algorithm. Reversely, the adaptation by using two-step algorithm had higher efficiency and accuracy as target occurred position displacement. We want to thank Dr. Lei Xing and Dr. Yong Yang in the Stanford University School of Medicine for this work. This work was jointly supported by NSFC (61471226), Natural Science Foundation for Distinguished Young Scholars of Shandong Province (JQ201516), and China Postdoctoral Science Foundation (2015T80739, 2014M551949).

60 APPLIED LIFE SCIENCES↗

SU-F-J-192: A Quick and Effective Method to Validate Patient’s Daily Setup and Geometry Changes Prior to Proton Treatment Delivery Based On Water Equivalent Thickness Projection Imaging (WETPI) for Head Neck Cancer (HNC) Patient

Purpose: With the implementation of Cone-beam Computed-Tomography (CBCT) in proton treatment, we introduces a quick and effective tool to verify the patient’s daily setup and geometry changes based on the Water-Equivalent-Thickness Projection-Image(WETPI) from individual beam angle. Methods: A bilateral head neck cancer(HNC) patient previously treated via VMAT was used in this study. The patient received 35 daily CBCT during the whole treatment and there is no significant weight change. The CT numbers of daily CBCTs were corrected by mapping the CT numbers from simulation CT via Deformable Image Registration(DIR). IMPT plan was generated using 4-field IMPT robust optimization (3.5% range and 3mm setup uncertainties) with beam angle 60, 135, 300, 225 degree. WETPI within CTV through all beam directions were calculated. 3%/3mm gamma index(GI) were used to provide a quantitative comparison between initial sim-CT and mapped daily CBCT. To simulate an extreme case where human error is involved, a couch bar was manually inserted in front of beam angle 225 degree of one CBCT. WETPI was compared in this scenario. Results: The average of GI passing rate of this patient from different beam angles throughout the treatment course is 91.5 ± 8.6. In the cases with low passing rate, it was found that the difference between shoulder and neck angle as well as the head rest often causes major deviation. This indicates that the most challenge in treating HNC is the setup around neck area. In the extreme case where a couch bar is accidently inserted in the beam line, GI passing rate drops to 52 from 95. Conclusion: WETPI and quantitative gamma analysis give clinicians, therapists and physicists a quick feedback of the patient’s setup accuracy or geometry changes. The tool could effectively avoid some human errors. Furthermore, this tool could be used potentially as an initial signal to trigger plan adaptation.

60 APPLIED LIFE SCIENCES↗

SU-F-T-94: Plan2pdf - a Software Tool for Automatic Plan Report for Philips Pinnacle TPS

Purpose: To implement an automatic electronic PDF plan reporting tool for Philips Pinnacle treatment planning system (TPS) Methods: An electronic treatment plan reporting software is developed by us to enable fully automatic PDF report from Pinnacle TPS to external EMR programs such as MOSAIQ. The tool is named “plan2pdf”. plan2pdf is implemented using Pinnacle scripts, Java and UNIX shell scripts, without any external program needed. plan2pdf supports full auto-mode and manual mode reporting. In full auto-mode, with a single mouse click, plan2pdf will generate a detailed Pinnacle plan report in PDF format, which includes customizable cover page, Pinnacle plan summary, orthogonal views through each plan POI and maximum dose point, DRR for each beam, serial transverse views captured throughout the dose grid at a user specified interval, DVH and scorecard windows. The final PDF report is also automatically bookmarked for each section above for convenient plan review. The final PDF report can either be saved on a user specified folder on Pinnacle, or it can be automatically exported to an EMR import folder via a user configured FTP service. In manual capture mode, plan2pdf allows users to capture any Pinnacle plan by full screen, individual window or rectangular ROI drawn on screen. Furthermore, to avoid possible patients’ plan mix-up during auto-mode reporting, a user conflict check feature is included in plan2pdf: it prompts user to wait if another patient is being exported by plan2pdf by another user. Results: plan2pdf is tested extensively and successfully at our institution consists of 5 centers, 15 dosimetrists and 10 physicists, running Pinnacle version 9.10 on Enterprise servers. Conclusion: plan2pdf provides a highly efficient, user friendly and clinical proven platform for all Philips Pinnacle users, to generate a detailed plan report in PDF format for external EMR systems.

60 APPLIED LIFE SCIENCES↗

SU-F-T-99: Data Visualization From a Treatment Planning Tracking System for Radiation Oncology

Purpose: A treatment planning process tracker database with input forms and a TV-viewable display webpage was developed and implemented in our clinic to collect time data points throughout the process. Tracking plan times is important because it directly affects the patient quality of care. Simply, the longer a patient waits after their initial simulation CT for treatment to begin, the more time the cancer has to progress. The tracker helps to drive workflow through the clinic, while the data collected can be used to understand and manage the process to find and eliminate inefficiencies. Methods: The overall process steps tracked are CT-simulation, mark patient, draw normal contours, draw target volumes, create plan, and review/approve plan. Time stamps for task completion were extracted and used to generate a set of clinic metrics, among which include average time for each step in the process split apart by type of treatment, average time to completion for plans started in a given week, and individual overall completion time per plan. Results: Trends have been tracked for fourteen weeks of clinical data (196 plans). On average, drawing normal contours and target volumes is taking 2–5 times as long as creating the plan itself. This is potentially an issue because it could mean the process is taking too long initially, and it could be forcing the planning step to be done in a short amount of time. We also saw from our graphs that there appears to be no clear trend on the average amount of time per plan week-to-week. Conclusion: A tracker of this type has the potential to provide insight into how time is utilized in our clinic. By equipping our dosimetrists, radiation oncologists, and physicists with individualized metric sets, the tracker can help provide visibility and drive workflow. Funded in part by CPRIT (RP140105).

60 APPLIED LIFE SCIENCES↗

SU-F-T-100: Development and Implementation of a Treatment Planning Tracking System Into the Radiation Oncology Clinic

Purpose: With increasing numbers of cancer patients being diagnosed and the complexity of radiotherapy treatments rising it’s paramount that patient plan development continues to stay fluid within the clinic. In order to maintain a high standard of care and clinical efficiency the establishment of a tracking system for patient plan development allows healthcare providers to view real time plan progression and drive clinical workflow. In addition, it provides statistical datasets which can further identify inefficiencies within the clinic. Methods: An application was developed utilizing Microsoft’s ODBC SQL database engine to track patient plan status throughout the treatment planning process while also managing key factors pertaining to the patient’s treatment. Pertinent information is accessible to staff in many locations, including tracking monitors within dosimetry, the clinic network for both computers and handheld devices, and through email notifications. Plans are initiated with a CT and continually tracked through planning stages until final approval by staff. Patient’s status is dynamically updated by the physicians, dosimetrists, and medical physicists based on the stage of the patient’s plan. Results: Our application has been running over a six month period with all patients being processed through the system. Modifications have been made to allow for new features to be implemented along with additional tracking parameters. Based on in-house feedback, the application has been supportive in streamlining patient plans through the treatment planning process and data has been accumulating to further improve procedures within the clinic. Conclusion: Over time the clinic will continue to track data with this application. As data accumulates the clinic will be able to highlight inefficiencies within the workflow and adapt accordingly. We will add in new features to help support the treatment planning process in the future.

60 APPLIED LIFE SCIENCES↗

SU-F-T-163: Improve Proton Therapy Efficiency: Report of a Workshop

Purpose: The technology of proton therapy, especially the pencil beam scanning technique, is evolving very quickly. However, the efficiency of proton therapy seems to lag behind conventional photon therapy. The purpose of the abstract is to report on the findings of a workshop on improvement of QA, planning and treatment efficiency in proton therapy. Methods: A panel of physicists, clinicians, and vendor representatives from over 18 institutions in the United States and internationally were convened in Knoxville, Tennessee in November, 2015. The panel discussed several topics on how to improve proton therapy efficiency, including 1) lean principle and failure mode and effects analysis, 2) commissioning and machine QA, 3) treatment planning, optimization and evaluation, 4) patient positioning and IGRT, 5) vendor liaison and machine availability, and 6) staffing, education and training. Results: The relative time needed for machine QA, treatment planning & check in proton therapy was found to range from 1 to 2.5 times of that in photon therapy. Current status in proton QA, planning and treatment was assessed. Key areas for efficiency improvement, such as elimination of unnecessary QA items or steps and development of efficient software or hardware tools, were identified. A white paper to summarize our findings is being written. Conclusion: It is critical to improve efficiency by developing reliable proton beam lines, efficient software tools on treatment planning, optimization and evaluation, and dedicated proton QA device. Conscious efforts and collaborations from both industry leaders and proton therapy centers are needed to achieve this goal and further advance the technology of proton therapy.

60 APPLIED LIFE SCIENCES↗

SU-F-T-223: Radiotherapy Incident Reporting and Analysis System (RIRAS):Early Experience

Background & Purpose: RIRAS is a web-based information system deployed on the Veterans Health Administration intranet in early 2014 to collect adverse events and good catch data; analyze the causes and contributing factors; and find ways to prevent future occurrences. Material and Methods: Incident learning consists of a feedback loop which starts with reporting an event, followed by analysis of contributing factors, and culminates in the development of a patient safety work product (PSWP) to prevent recurrence. RIRAS permits both anonymous and non-anonymous reporting. Each report is analyzed by a team of medical physicists who are independent of the reporting facility. The analysts usually contact the reporting facilities for additional information. We analyzed all reports and held telephonic interviews (when necessary) with the reporters. We then generated PSWPs with corrective/preventive and learning actions. Anonymous reporting is handled in the same manner, except without the ability to further interview the reporter. Results: In a significant number of reports, the causes and recommended preventive actions were considerably altered by the independent analysis and additional information from the facility. 130 reports have been entered in RIRAS; 9 misadministrations, 83 good catches, 3 anonymous good catches, and 35 earlier reported incidents from FY2005-14. 45% of the reported incidents occurred in the treatment delivery stages, 19% in on-treatment management, and 16% in pre-treatment verification. 80% of the good catches were found in the treatment delivery workflow. Majority of these incidents were due to inconsistent patient setup instructions or documentation, nonadherence to policies and procedures, lax time-out policy, distracted RTTs, and inadequate RTT staffing. Conclusion: RIRAS has identified many areas for improvement and elevated the quality and safety of radiation treatments in the VHA. We found that the ability to learn is significantly diminished when the analysts do not have the ability to request additional information.

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SU-F-T-225: Is It Time to Have Pre-Configured Therapeutic Beams Available in Commercial Treatment Planning Systems?

Purpose: Commissioning radiation beams requires considerable effort to obtain the beam data for beam configuration in a commercial treatment planning system. With the advances in technology, the manufacturer of accelerators now has the ability to adjust radiation beam parameters to meet pre-determined specifications with high precision. This study aims to illustrate the feasibility of making pre-configured radiation beams available in commercial treatment planning systems. Methods: In recent years, Varian has made a set of measured beam data from the TrueBeam accelerator available to users. Although the beam data are provided as “suggestive data” without warranty, the commissioned data measured by users have been shown to be in excellent agreement with the data set provided when the beams from the installed Linacs were adjusted to meet the beam specifications. An unofficial survey among Varian Linac TrueBeam users shows that the suggestive data set has been used with validation by users in some clinics. This indicates that radiation beams from a specified Linac can be standardized and pre-configured in a treatment planning system. Results: Two newly installed Varian TrueBeam accelerators at two different centers were examined in which one set of commissioned beam data was obtained from measurements performed by an independent physics consulting company and the other was measured by local physicists in the department. All beams from both accelerators were tuned to meet the manufacturer’s specifications. Discrepancies of less than 1% were found between the commissioned beam data from both accelerators and the suggestive data set provided by Varian. Conclusion: It may be feasible that radiation beams can be pre-configured in commercial treatment planning systems. The radiation beam users will perform the beam validation and end-to-end tests instead of configuring beams. This framework can increase both the efficiency and the accuracy in commercial radiation treatment planning systems.

43 PARTICLE ACCELERATORS↗

SU-F-T-226: QA Management for a Large Institution with Multiple Campuses for FMEA

Purpose: To redesign our radiation therapy QA program with the goal to improve quality, efficiency, and consistency among a growing number of campuses at a large institution. Methods: A QA committee was established with at least one physicist representing each of our six campuses (22 linacs). Weekly meetings were scheduled to advise on and update current procedures, to review end-to-end and other test results, and to prepare composite reports for internal and external audits. QA procedures for treatment and imaging equipment were derived from TG Reports 142 and 66, practice guidelines, and feedback from ACR evaluations. The committee focused on reaching a consensus on a single QA program among all campuses using the same type of equipment and reference data. Since the recommendations for tolerances referenced to baseline data were subject to interpretation in some instances, the committee reviewed the characteristics of all machines and quantified any variations before choosing between treatment planning system (i.e. treatment planning system commissioning data that is representative for all machines) or machine-specific values (i.e. commissioning data of the individual machines) as baseline data. Results: The configured QA program will be followed strictly by all campuses. Inventory of available equipment has been compiled, and additional equipment acquisitions for the QA program are made as needed. Dosimetric characteristics are evaluated for all machines using the same methods to ensure consistency of beam data where possible. In most cases, baseline data refer to treatment planning system commissioning data but machine-specific values are used as reference where it is deemed appropriate. Conclusion: With a uniform QA scheme, variations in QA procedures are kept to a minimum. With a centralized database, data collection and analysis are simplified. This program will facilitate uniformity in patient treatments and analysis of large amounts of QA data campus-wide, which will ultimately facilitate FMEA.

43 PARTICLE ACCELERATORS↗

SU-F-T-241: Reduction in Planning Errors Via a Process Control Developed Using the Eclipse Scripting API

Purpose: Errors found during initial physics plan checks frequently require replanning and reprinting, resulting decreased departmental efficiency. Additionally, errors may be missed during physics checks, resulting in potential treatment errors or interruption. This work presents a process control created using the Eclipse Scripting API (ESAPI) enabling dosimetrists and physicists to detect potential errors in the Eclipse treatment planning system prior to performing any plan approvals or printing. Methods: Potential failure modes for five categories were generated based on available ESAPI (v11) patient object properties: Images, Contours, Plans, Beams, and Dose. An Eclipse script plugin (PlanCheck) was written in C# to check errors most frequently observed clinically in each of the categories. The PlanCheck algorithms were devised to check technical aspects of plans, such as deliverability (e.g. minimum EDW MUs), in addition to ensuring that policy and procedures relating to planning were being followed. The effect on clinical workflow efficiency was measured by tracking the plan document error rate and plan revision/retirement rates in the Aria database over monthly intervals. Results: The number of potential failure modes the PlanCheck script is currently capable of checking for in the following categories: Images (6), Contours (7), Plans (8), Beams (17), and Dose (4). Prior to implementation of the PlanCheck plugin, the observed error rates in errored plan documents and revised/retired plans in the Aria database was 20% and 22%, respectively. Error rates were seen to decrease gradually over time as adoption of the script improved. Conclusion: A process control created using the Eclipse scripting API enabled plan checks to occur within the planning system, resulting in reduction in error rates and improved efficiency. Future work includes: initiating full FMEA for planning workflow, extending categories to include additional checks outside of ESAPI via Aria database queries, and eventual automated plan checks.

60 APPLIED LIFE SCIENCES↗

SU-F-T-244: Radiotherapy Risk Estimation Based On Expert Group Survey

Purpose: To evaluate the reliability of RPN (Risk Priority Number) decided by expert group and to provide preliminary data for adapting FMEA in Korea. Methods: 1163 Incidents reported in ROSIS for 11 years were used as a real data to be compared with, and were categorized into 146 items. The questionnaire was composed of the 146 items and respondents had to valuate ‘occurrence (O)’, ‘severity (S)’, ‘detectability (D)’ of each item on a scale from 1 to 10 according to the proposed AAPM TG-100 rating scales. 19 medical physicists from 19 different organizations in Korea had participated in the survey. Because the number of ROSIS items was not evenly spread enough to be classified into 10 grades, 1–5 scale was chosen instead of 1–10 and survey result was also fit to 5 grades to compare. Results: The average O,S,D were 1.77, 3.50, 2.13, respectively and the item which had the highest RPN(32) was ‘patient movement during treatment’ in the survey. When comparing items ranked in the top 10 of each survey(O) and ROSIS database, two items were duplicated and ‘Simulation’ and ’Treatment’ were the most frequently ranked RT process in top 10 of survey and ROSIS each. The Chronbach α of each RT process were ranged from 0.74 to 0.99 and p-value was <0.001. When comparing O*D, the average difference was 1.4. Conclusion: This work indicates the deviation between actual risk and expectation. Considering that the respondents were Korean and ROSIS is mainly composed of incidents happened in European countries and some of the top 10 items of ROSIS cannot be applied in radiotherapy procedure in Korea, the deviation could have been came from procedural difference. Moreover, if expert group was consisted of experts from various parts, expectation might have been more accurate. Therefore, further research on radiotherapy risk estimation is needed.

60 APPLIED LIFE SCIENCES↗