Results for “customize” — Page 73

DOE OSTI2015

SU-E-T-760: Tolerance Design for Site-Specific Range in Proton Patient QA Process Using the Six Sigma Model

Purpose: To show how tolerance design and tolerancing approaches can be used to predict and improve the site-specific range in patient QA process in implementing the Six Sigma. Methods: In this study, patient QA plans were selected according to 6 site-treatment groups: head &neck (94 cases), spine (76 cases), lung (89 cases), liver (53 cases), pancreas (55 cases), and prostate (121 cases), treated between 2007 and 2013. We evaluated a model of the Six Sigma that determines allowable deviations in design parameters and process variables in patient-specific QA, where possible, tolerance may be loosened, then customized if it necessary to meet the functional requirements. A Six Sigma problem-solving methodology is known as DMAIC phases, which are used stand for: Define a problem or improvement opportunity, Measure process performance, Analyze the process to determine the root causes of poor performance, Improve the process by fixing root causes, Control the improved process to hold the gains. Results: The process capability for patient-specific range QA is 0.65 with only ±1 mm of tolerance criteria. Our results suggested the tolerance level of ±2–3 mm for prostate and liver cases and ±5 mm for lung cases. We found that customized tolerance between calculated and measured range reduce that patient QA plan failure and almost all sites had failure rates less than 1%. The average QA time also improved from 2 hr to less than 1 hr for all including planning and converting process, depth-dose measurement and evaluation. Conclusion: The objective of tolerance design is to achieve optimization beyond that obtained through QA process improvement and statistical analysis function detailing to implement a Six Sigma capable design.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-792: Validation of a Secondary TPS for IROC-H Recalculation of Anthropomorphic Phantoms

Purpose: To validate a secondary treatment planning system (sTPS) for use by the Imaging & Radiation Oncology Core-Houston (IROC-H). The TPS will recalculate phantom irradiations submitted by institutions to IROC-H and compare plan results of the institution to the sTPS. Methods: In-field dosimetric data was collected by IROC-H for numerous linacs at 6, 10, 15, and 18 MV. The data was aggregated and used to define reference linac classes; each class was then modeled in the sTPS (Mobius3D) by matching the in-field characteristics. Fields used to collect IROC-H data were recreated and recalculated using Mobius3D. The same dosimetric points were measured in the recalculation and compared to the initial collection data. Additionally, a 6MV Monte Carlo beam configuration was used to compare penumbrae in the Mobius3D models. Finally, a handful of IROC-H head and neck phantoms were recalculated using Mobius3D. Results: Recalculation and quantification of differences between reference data and Mobius3D values resulted in a relative matching score of 12.45 (0 is a perfect match) for the default 6MV Mobius3D beam configuration. By adjusting beam configuration options, iterations resulted in scores of 8.45, 6.32, and 3.52, showing that customization could have a dramatic effect on beam configuration. After in-field optimization, penumbra was compared between Monte Carlo and Mobius3D for the reference fields. For open jaw fields, FWHM field widths and penumbra widths were different by <0.6 and <1mm respectively; for MLC open fields the penumbra widths were up to 1.5mm different. Phantom recalculations showed good agreement, having an average of 0.6% error per beam. Conclusion: A secondary TPS has been validated for simple irradiation geometries using reference data collected by IROC-H. The beam was customized to the reference data iteratively and resulted in a good match. This system can provide independent recalculation of phantom plans based on independent reference data.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

TU-AB-303-07: Evaluation of Automatic Segmentation of Critical Structures for Head-And-Neck and Thoracic Radiotherapy Planning

Purpose: To evaluate the performance of commercially available automatic segmentation tools built into treatment planning systems (TPS) in terms of their segmentation accuracy and flexibility in customization. Methods: Twelve head-and-neck cancer patients and twelve thoracic cancer patients were retrospectively selected to benchmark the model-based segmentation (MBS) and atlas-based segmentation (ABS) in RayStation TPS and the Smart Probabilistic Image Contouring Engine (SPICE) in Pinnacle TPS. Multi-atlas contouring service (MACS) that was developed in-house as a plug-in of Pinnacle TPS was evaluated as well. Manual contours used in clinic were reviewed and modified for consistency and served as ground truth for the evaluation. Head-and-neck evaluation included six regions of interest (ROIs): left and right parotid glands, brainstem, spinal cord, mandible, and submandibular glands. Thoracic evaluation includes seven ROIs: left and right lungs, spinal cord, heart, esophagus, and left and right brachial plexus. Auto-segmented contours were compared with the manual contours using the Dice similarity coefficient (DSC) and the mean surface distance (MSD). Results: In head- and-neck evaluation, only mandible has a high accuracy in all segmentations (DSC>85%); SPICE achieved DSC>70% for parotid glands; MACS achieved this for both parotid glands and submandibular glands; and RayStation ABS achieved this for spinal cord. In thoracic evaluation, SPICE achieved the best in lung and heart segmentation, while MACS achieved the best for all other structures. The less distinguishable structures on CT images, such as brainstem, spinal cord, parotid glands, submandibular glands, esophagus, and brachial plexus, showed great variability in different segmentation tools (mostly DSC<70% and MSD>3mm). The template for RayStation ABS can be easily customized by users, while RayStation MBS and SPICE rely on the vendors to provide the templates/models. Conclusion: Great variability was observed in different segmentation tools applied to different structures. These commercially-available segmentation tools should be carefully evaluated before clinical use.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

WE-EF-210-07: Development of a Minimally Invasive Photo Acoustic Imaging System for Early Prostate Cancer Detection

Purpose: The objective of this work is to design, implement and characterize a catheter-based ultrasound/photoacoustic imaging probe for early-diagnosis of prostate cancer and to aid in image-guided radiation therapy. Methods: The need to image across 6–10cm of tissue to image the whole prostate gland limits the resolution achievable with a transrectal ultrasound approach. In contrast, the urethra bisects the prostate gland, providing a minimally invasive pathway for deploying a high resolution ultrasound transducer. Utilizing a high-frequency (20MHz) ultrasound/photoacoustic probe, high-resolution structural and molecular imaging of the prostate tissue is possible. A custom 3D printed probe containing a high-frequency single-element ultrasound transducer is utilized. The diameter of the probe is designed to fit inside a Foley catheter and the probe is rotated around the central axis to achieve a circular B-scan. A custom ultrasound amplifier and receiver was set up to trigger the ultrasound pulse transmission and record the reflected signal. The reconstructed images were compared to images generated by traditional 5 MHz ultrasound transducers. Results: The preliminary results using the high-frequency ultrasound probe show that it is possible to resolve finely detailed information in a prostate tissue phantom that was not achievable with previous low-frequency ultrasound systems. Preliminary ultrasound imaging was performed on tissue mimicking phantom and sensitivity and signal-to-noise ratio of the catheter was measured. Conclusion: In order to achieve non-invasive, high-resolution, structural and molecular imaging for early-diagnosis and image-guided radiation therapy of the prostate tissue, a transurethral catheter was designed. Structural/molecular imaging using ultrasound/photoacoustic of the prostate tissue will allow for localization of hyper vascularized areas for early-stage prostate cancer diagnosis.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

Technical Note: Immunohistochemical evaluation of mouse brain irradiation targeting accuracy with 3D-printed immobilization device

Purpose: Small animal immobilization devices facilitate positioning of animals for reproducible imaging and accurate focal radiation therapy. In this study, the authors demonstrate the use of three-dimensional (3D) printing technology to fabricate a custom-designed mouse head restraint. The authors evaluate the accuracy of this device for the purpose of mouse brain irradiation. Methods: A mouse head holder was designed for a microCT couch using CAD software and printed in an acrylic based material. Ten mice received half-brain radiation while positioned in the 3D-printed head holder. Animal placement was achieved using on-board image guidance and computerized asymmetric collimators. To evaluate the precision of beam localization for half-brain irradiation, mice were sacrificed approximately 30 min after treatment and brain sections were stained for γ-H2AX, a marker for DNA breaks. The distance and angle of the γ-H2AX radiation beam border to longitudinal fissure were measured on histological samples. Animals were monitored for any possible trauma from the device. Results: Visualization of the radiation beam on ex vivo brain sections with γ-H2AX immunohistochemical staining showed a sharp radiation field within the tissue. Measurements showed a mean irradiation targeting error of 0.14 ± 0.09 mm (standard deviation). Rotation between the beam axis and mouse head was 1.2° ± 1.0° (standard deviation). The immobilization device was easily adjusted to accommodate different sizes of mice. No signs of trauma to the mice were observed from the use of tooth block and ear bars. Conclusions: The authors designed and built a novel 3D-printed mouse head holder with many desired features for accurate and reproducible radiation targeting. The 3D printing technology was found to be practical and economical for producing a small animal imaging and radiation restraint device and allows for customization for study specific needs.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

An in vivo dose verification method for SBRT–VMAT delivery using the EPID

Purpose: Radiation treatments have become increasingly more complex with the development of volumetric modulated arc therapy (VMAT) and the use of stereotactic body radiation therapy (SBRT). SBRT involves the delivery of substantially larger doses over fewer fractions than conventional therapy. SBRT–VMAT treatments will strongly benefit from in vivo patient dose verification, as any errors in delivery can be more detrimental to the radiobiology of the patient as compared to conventional therapy. Electronic portal imaging devices (EPIDs) are available on most commercial linear accelerators (Linacs) and their documented use for dosimetry makes them valuable tools for patient dose verification. In this work, the authors customize and validate a physics-based model which utilizes on-treatment EPID images to reconstruct the 3D dose delivered to the patient during SBRT–VMAT delivery. Methods: The SBRT Linac head, including jaws, multileaf collimators, and flattening filter, were modeled using Monte Carlo methods and verified with measured data. The simulation provides energy spectrum data that are used by their “forward” model to then accurately predict fluence generated by a SBRT beam at a plane above the patient. This fluence is then transported through the patient and then the dose to the phosphor layer in the EPID is calculated. Their “inverse” model back-projects the EPID measured focal fluence to a plane upstream of the patient and recombines it with the extra-focal fluence predicted by the forward model. This estimate of total delivered fluence is then forward projected onto the patient’s density matrix and a collapsed cone convolution algorithm calculates the dose delivered to the patient. The model was tested by reconstructing the dose for two prostate, three lung, and two spine SBRT–VMAT treatment fractions delivered to an anthropomorphic phantom. It was further validated against actual patient data for a lung and spine SBRT–VMAT plan. The results were verified with the treatment planning system (TPS) (ECLIPSE AAA) dose calculation. Results: The SBRT–VMAT reconstruction model performed very well when compared to the TPS. A stringent 2%/2 mm χ-comparison calculation gave pass rates better than 91% for the prostate plans, 88% for the lung plans, and 86% for the spine plans for voxels containing 80% or more of the prescribed dose. Patient data were 86% for the lung and 95% for the spine. A 3%/3 mm χ-comparison was also performed and gave pass rates better than 93% for all plan types. Conclusions: The authors have customized and validated a robust, physics-based model that calculates the delivered dose to a patient for SBRT–VMAT delivery using on-treatment EPID images. The accuracy of the results indicates that this approach is suitable for clinical implementation. Future work will incorporate this model into both offline and real-time clinical adaptive radiotherapy.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-P-06: Moving From Computed Radiography to Digital Radiography: A Collaborative Approach to Improve Image Quality

Purpose: To bring together radiologists, technologists, and physicists to utilize post-processing techniques in digital radiography (DR) in order to optimize image acquisition and improve image quality. Methods: Sub-optimal images acquired on a new General Electric (GE) DR system were flagged for follow-up by radiologists and reviewed by technologists and medical physicists. Various exam types from adult musculoskeletal (n=35), adult chest (n=4), and pediatric (n=7) were chosen for review. 673 total images were reviewed. These images were processed using five customized algorithms provided by GE. An image score sheet was created allowing the radiologist to assign a numeric score to each of the processed images, this allowed for objective comparison to the original images. Each image was scored based on seven properties: 1) overall image look, 2) soft tissue contrast, 3) high contrast, 4) latitude, 5) tissue equalization, 6) edge enhancement, 7) visualization of structures. Additional space allowed for additional comments not captured in scoring categories. Radiologists scored the images from 1 – 10 with 1 being non-diagnostic quality and 10 being superior diagnostic quality. Scores for each custom algorithm for each image set were summed. The algorithm with the highest score for each image set was then set as the default processing. Results: Images placed into the PACS “QC folder” for image processing reasons decreased. Feedback from radiologists was, overall, that image quality for these studies had improved. All default processing for these image types was changed to the new algorithm. Conclusion: This work is an example of the collaboration between radiologists, technologists, and physicists at the University of New Mexico to add value to the radiology department. The significant amount of work required to prepare the processing algorithms, reprocessing and scoring of the images was eagerly taken on by all team members in order to produce better quality images and improve patient care.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-J-53: A 3D Printed Phantom for the Use of Daily Quality Assurance Alignment Tests

Purpose: To discuss experiences and results for a 3D printed QA phantom used for daily alignment purposes for a six degrees-of-freedom (6DoF) table Methods: A 3D model was created using a fused deposition modeling (FDM) printer using free online computer-aided design (CAD) software. The model has been under use for daily QA alignment tests for a 6DoF couch. An aligned and angled baseplate were also printed in order to introduce known angles for 6DoF corrections during image-guidance. Unique registration contours were created on the faces of the phantom in order to achieve a better cone-beam computed tomography (CBCT) match using an auto-registration algorithm. A BB was also introduced at the center of the phantom in order to deliver an integrated daily Winston-Lutz (WL) test. Translational, rotational, and WL results were tabulated over one month. Results: The ’honeycomb’ structure of the print was apparent in the EPID images for the WL test, which affected the results of the analysis software. This was fixed by inserting a cube made of polyoxymethylene within the 3D phantom that encompass the BB. Auto-registration results for the three translational and three rotational from a known offset to the BB isocenter consistently fell within 1 mm and 0.2°, respectively. WL tests resulted in an average of 0.71 ± 0.14 mm. Conclusion: 3D printed models allow for accurate builds that can be customized to a variety of clinical needs. Results from translational, rotational, and WL show consistent results over a month’s time. Given its relatively cheap and streamlined workflow, 3D printing could be implemented into any clinic looking to create customized phantoms.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-J-94: Development of a Plug-in Based Image Analysis Tool for Integration Into Treatment Planning

Purpose: To extend the functionality of a commercial treatment planning system (TPS) to support (i) direct use of quantitative image-based metrics within treatment plan optimization and (ii) evaluation of dose-functional volume relationships to assist in functional image adaptive radiotherapy. Methods: A script was written that interfaces with a commercial TPS via an Application Programming Interface (API). The script executes a program that performs dose-functional volume analyses. Written in C#, the script reads the dose grid and correlates it with image data on a voxel-by-voxel basis through API extensions that can access registration transforms. A user interface was designed through WinForms to input parameters and display results. To test the performance of this program, image- and dose-based metrics computed from perfusion SPECT images aligned to the treatment planning CT were generated, validated, and compared. Results: The integration of image analysis information was successfully implemented as a plug-in to a commercial TPS. Perfusion SPECT images were used to validate the calculation and display of image-based metrics as well as dose-intensity metrics and histograms for defined structures on the treatment planning CT. Various biological dose correction models, custom image-based metrics, dose-intensity computations, and dose-intensity histograms were applied to analyze the image-dose profile. Conclusion: It is possible to add image analysis features to commercial TPSs through custom scripting applications. A tool was developed to enable the evaluation of image-intensity-based metrics in the context of functional targeting and avoidance. In addition to providing dose-intensity metrics and histograms that can be easily extracted from a plan database and correlated with outcomes, the system can also be extended to a plug-in optimization system, which can directly use the computed metrics for optimization of post-treatment tumor or normal tissue response models. Supported by NIH - P01 - CA059827.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-J-196: A Prototype System for Portal Imaging for Intensity Modulated Neutron Therapy

Purpose: Fast neutron therapy is offered at the University of Washington Medical Center for treatment of selected cancers. The hardware and control systems of the UW Clinical Neutron Therapy System are undergoing upgrades to enable delivery of IMNT. To clinically implement IMNT, dose verification tools need to be developed. We propose a portal imaging system that relies on the creation of positron emitting isotopes ({sup 11}C and {sup 15}O) through (n, 2n) reactions with a PMMA plate placed below the patient. After field delivery, the plate is retrieved from the vault and imaged using a reader that detects the annihilation photons. The pattern of activity produced in the plate provides information to reconstruct the neutron fluence map that can be compared to fluence maps from Monte Carlo (MCNP) simulations to verify treatment delivery. We have previously performed Monte Carlo simulations of the portal imaging system (GATE simulations) and the beam line (MCNP simulations). In this work, initial measurements using a prototype system are presented. Methods: Custom electronics were developed for BGO detectors read out with photomultiplier tubes (previous generation PET detectors from a CTI ECAT 953 scanner). Two detectors were placed in coincidence, with a detector separation of 2 cm. Custom software was developed to create the crystal look up tables and perform a limited angle planar reconstruction with a stochastic normalization. To test the initial capabilities of the system, PMMA squares were irradiated with neutrons at a depth of 1.5 cm and read out using the prototype system. Doses ranging from 10–200 cGy were delivered. Results: Using the prototype system, dose differences in the therapeutic range could be determined. Conclusion: The prototype portal imaging system is capable of detecting neutron doses as low as 10–50 cGy and shows great promise as a patient QA tool for IMNT.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-82: Dosimetric Evaluation of a Shield Used for Hemi-Body Skin Electron Irradiation

Purpose: We had several mycosis fungoides patients with a limited disease to about half of the skin surface. A custom-made plywood shield was used to protect the non-targeted skin region with our total skin electron irradiation (TSEI) technique. We report a dosimetric evaluation for our “hemi-body” skin electron irradiation technique. Methods: The technique is similar to our clinical total skin electron irradiation (TSEI), performed with a six-pair dual field (Stanford technique) at an extended source-to-skin distance (SSD) of 377 cm, with the addition of a plywood shield placed 50 cm from the patient. The shield is made of three layers of standard 5/8″ thick plywood (total thickness of 4.75 cm) that are clamped securely on an adjustable-height stand. Gafchromic EBT3 films were used in assessing the shield’s transmission factor and the extend of the dose penumbra region. To verify the dose delivered for hemi-body skin radiation in a real patient treatment, in-vivo dosimetry using Gafchromic EBT3 films were performed. Film pieces were taped on the patient skin to measure the dose received during the first two fractions, placed on the forehead and upper body (shielded region); and also at the level of pelvic area, left thigh, and left ankle. Results: The shield transmission factor was found to be 10%, and the width of the penumbra (80-to-20% dose fall-off) was about 12 cm. In-vivo dosimetry of a real case confirmed the expected shielded area dose. Conclusion: Hemi-Body skin electron irradiation at an extended SSD is feasible with the addition of a plywood shield at a distance from patient skin. The penumbra dose region and the shield’s transmission factor should be evaluated prior to clinical use. We have treated several hemi-body skin patients with our custom-made plywood shield, the current patient measurements are representative of these for other patients as well.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-141: Proton Dose Validation in a Phantom Beyond TRUFILL N-BCA Embolization Glue

Purpose: To validate the treatment planning system predicted proton dose beyond a heterogeneity (n-BCA glue) by making a measurement in a custom acrylic phantom. Methods: A custom cubic acrylic phantom was designed for this experiment. A container was designed to fit in the phantom. This container was filled with TRUFILL™ n-Butyl Cyanoacrylate(n-BCA) glue. When the container was placed in the phantom, its center was at a distance of 7.4cm from the entrance. This depth allows us to make measurements around the center of modulation of a 126 MeV proton beam with a 3cm spread-out-Bragg peak. To make measurements at other beam energies, additional acrylic can be added in front of the phantom, to adjust the depth of the heterogeneity. A diamond detector was cross calibrated against a standard cylindrical ion chamber in a 126MeV beam. The diamond detector was then used to make dose measurements beyond the inhomogeneity. The measurement was repeated with the container filled with water. Several measurements were made at each setup, to check reproducibility of measurements. Results: For the same number of Tic3R1 counts, the dose measured with the diamond detector beyond n-BCA glue was 1.053 times the dose measured beyond the water filled container. This result is in agreement with the measured stopping power of glue (1.06). These measurements were in agreement with the dose predicted by the treatment planning system when the electron density of the heterogeneity was replaced with 1.06 before the dose calculation. Conclusion: Our initial measurements validate the dose predicted by our treatment plan in the presence of heterogeneity in a phantom. The material tested (n-BCA glue) is commonly used in the treatment of AVM’s prior to an SRS treatment. An error in dose predicted by the treatment plan in the presence of the glue can be detrimental in a single fraction high dose SRS treatment I received the n-BCA liquid embolic system samples from Codman and Shurtleff, Inc.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-171: Manufacturing Cost Effective Heterogeneous Phantoms for Use in Proton Therapy

Purpose: To study the feasibility of 3D printing cost effective heterogeneous phantoms for use in proton therapy treatment planning quality assurance. Methods: A desktop 3D printer was utilized to create a series of 2 cm × 2 cm × 4 cm PLA plastic blocks of varying fill materials and hexagonal fill pattern. The blocks were than tested when filled with air, polyurethane foam, paraffin, silicone, and caulk of calcium carbonate – acrylic polymer blend. The blocks were evaluated with a “GE Lightspeed” 16 slice CT scanner and average CT# of the materials’ centers evaluated. Blocks were then placed into a custom aperture fitted to a Mevion Proton system to determine the relative stopping power of each. Scans were performed in water tank with Marcus type parallel plate chamber under a beam with a range of 15 cm and modulation of 2 cm. Shifts in range occurring relative to the 80% distal edge of the open SOBP were evaluated. Results: The CT#s of the blocks were plotted against their measured relative stopping power. This curve was compared to that which is in clinical use. While the trend agrees generally, specific differences between the relative stopping powers were as great as 10%. Conclusion: We have demonstrated that it is possible to utilize different cost effective materials in the manufacturing of phantoms for use in proton therapy. While different materials may provide better agreement to established calibration curves, a custom curve specific to the materials used may be utilized to accurately predict proton treatment dose distributions.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-365: Clinical Commissioning of the Monaco Treatment Planning System for the Novalis Tx to Deliver VMAT, SRS and SBRT Treatments

Purpose: To commission the Monaco Treatment Planning System for the Novalis Tx machine. Methods: The commissioning of Monte-Carlo (MC), Collapsed Cone (CC) and electron Monte-Carlo (eMC) beam models was performed through a series of measurements and calculations in medium and in water. In medium measurements relied Octavius 4D QA system with the 1000 SRS detector array for field sizes less than 4 cm × 4 cm and the 1500 detector array for larger field sizes. Heterogeneity corrections were validated using a custom built phantom. Prior to clinical implementation, an end to end testing of a Prostate and H&N VMAT plans was performed. Results: Using a 0.5% uncertainty and 2 mm grid sizes, Tables I and II summarize the MC validation at 6 MV and 18 MV in both medium and water. Tables III and IV show similar comparisons for CC. Using the custom heterogeneity phantom setup of Figure 1 and IGRT guidance summarized in Figure 2, Table V lists the percent pass rate for a 2%, 2 mm gamma criteria at 6 and 18 MV for both MC and CC. The relationship between MC calculations settings of uncertainty and grid size and the gamma passing rate for a prostate and H&N case is shown in Table VI. Table VII lists the results of the eMC calculations compared to measured data for clinically available applicators and Table VIII for small field cutouts. Conclusion: MU calculations using MC are highly sensitive to uncertainty and grid size settings. The difference can be of the order of several per cents. MC is superior to CC for small fields and when using heterogeneity corrections, regardless of field size, making it more suitable for SRS, SBRT and VMAT deliveries. eMC showed good agreement with measurements down to 2 cm − 2 cm field size.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-500: The Effectiveness of a Patient Specific Bolus Made by Using Three-Dimensional Printing Technique in Photon Radiotherapy

Purpose: A commercially available bolus (commercial-bolus) would not completely contact with the irregular shape of a patient’s skin. The purposes of this study were to customize a patient specific three-dimensional (3D) bolus using a 3D printer (3D-bolus) and to evaluate its clinical feasibility for photon radiotherapy. Methods: The 3D-bolus was designed using a treatment planning system (TPS) in DICOM-RT format. To print the 3D bolus, the file was converted into stereolithography format. To evaluate its physical characteristics, plans were created for water equivalent phantoms without the bolus, with the 3D-bolus printed in a flat form, and with the virtual bolus which supposed a commercial-bolus. These plans were compared with the percent depth dose (PDD) measured from the TPS. Furthermore, to evaluate its clinical feasibility, the treatment plans were created for RANDO phantoms without the bolus and with the 3D-bolus which was customized for contacting with the surface of the phantom. Both plans were compared with the dose volume histogram (DVH) of the target volume. Results: In the physical evaluation, dmax of the plan without the bolus, with the 3D-bolus, and with the virtual bolus were 2.2 cm, 1.6 cm, and 1.7 cm, respectively. In the evaluation of clinical feasibility, for the plan without the bolus, Dmax, Dmin, Dmean, D90%, and V90% of the target volume were 102.6 %, 1.6 %, 88.8 %, 57.2 %, and 69.3 %, respectively. By using the 3D-bolus, the prescription dose could be delivered to at least 90 % of the target volume, Dmax, Dmin, Dmean, D90%, and V90% of the target volume were 104.3 %, 91.6 %, 92.1 %, 91.7 %, and 98.0 %, respectively. The 3D-bolus has the potential to be useful for providing effective dose coverage in the buildup region. Conclusion: A 3D-bolus produced using 3D printing technique is comparable to a commercially available bolus.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

WE-G-BRC-00: Experiences with TG100 in Clinical Use

Failure Mode and Effects Analysis (FMEA) originated as an industrial engineering technique used for risk management and safety improvement of complex processes. In the context of radiotherapy, the AAPM Task Group 100 advocates FMEA as the framework of choice for establishing clinical quality management protocols. However, there is concern that widespread adoption of FMEA in radiation oncology will be hampered by the perception that implementation of the tool will have a steep learning curve, be extremely time consuming and labor intensive, and require additional resources. To overcome these preconceptions and facilitate the introduction of the tool into clinical practice, the medical physics community must be educated in the use of this tool and the ease in which it can be implemented. Organizations with experience in FMEA should share their knowledge with others in order to increase the implementation, effectiveness and productivity of the tool. This session will include a brief, general introduction to FMEA followed by a focus on practical aspects of implementing FMEA for specific clinical procedures including HDR brachytherapy, physics plan review and radiosurgery. A description of common equipment and devices used in these procedures and how to characterize new devices for safe use in patient treatments will be presented. This will be followed by a discussion of how to customize FMEA techniques and templates to one’s own clinic. Finally, cases of common failure modes for specific procedures (described previously) will be shown and recommended intervention methodologies and outcomes reviewed. Learning Objectives: Understand the general concept of failure mode and effect analysis Learn how to characterize new equipment for safety Be able to identify potential failure modes for specific procedures and learn mitigation techniques Be able to customize FMEA examples and templates for use in any clinic.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

WE-G-BRC-01: Risk Assessment for Radiosurgery

Failure Mode and Effects Analysis (FMEA) originated as an industrial engineering technique used for risk management and safety improvement of complex processes. In the context of radiotherapy, the AAPM Task Group 100 advocates FMEA as the framework of choice for establishing clinical quality management protocols. However, there is concern that widespread adoption of FMEA in radiation oncology will be hampered by the perception that implementation of the tool will have a steep learning curve, be extremely time consuming and labor intensive, and require additional resources. To overcome these preconceptions and facilitate the introduction of the tool into clinical practice, the medical physics community must be educated in the use of this tool and the ease in which it can be implemented. Organizations with experience in FMEA should share their knowledge with others in order to increase the implementation, effectiveness and productivity of the tool. This session will include a brief, general introduction to FMEA followed by a focus on practical aspects of implementing FMEA for specific clinical procedures including HDR brachytherapy, physics plan review and radiosurgery. A description of common equipment and devices used in these procedures and how to characterize new devices for safe use in patient treatments will be presented. This will be followed by a discussion of how to customize FMEA techniques and templates to one’s own clinic. Finally, cases of common failure modes for specific procedures (described previously) will be shown and recommended intervention methodologies and outcomes reviewed. Learning Objectives: Understand the general concept of failure mode and effect analysis Learn how to characterize new equipment for safety Be able to identify potential failure modes for specific procedures and learn mitigation techniques Be able to customize FMEA examples and templates for use in any clinic.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

WE-G-BRC-02: Risk Assessment for HDR Brachytherapy

Failure Mode and Effects Analysis (FMEA) originated as an industrial engineering technique used for risk management and safety improvement of complex processes. In the context of radiotherapy, the AAPM Task Group 100 advocates FMEA as the framework of choice for establishing clinical quality management protocols. However, there is concern that widespread adoption of FMEA in radiation oncology will be hampered by the perception that implementation of the tool will have a steep learning curve, be extremely time consuming and labor intensive, and require additional resources. To overcome these preconceptions and facilitate the introduction of the tool into clinical practice, the medical physics community must be educated in the use of this tool and the ease in which it can be implemented. Organizations with experience in FMEA should share their knowledge with others in order to increase the implementation, effectiveness and productivity of the tool. This session will include a brief, general introduction to FMEA followed by a focus on practical aspects of implementing FMEA for specific clinical procedures including HDR brachytherapy, physics plan review and radiosurgery. A description of common equipment and devices used in these procedures and how to characterize new devices for safe use in patient treatments will be presented. This will be followed by a discussion of how to customize FMEA techniques and templates to one’s own clinic. Finally, cases of common failure modes for specific procedures (described previously) will be shown and recommended intervention methodologies and outcomes reviewed. Learning Objectives: Understand the general concept of failure mode and effect analysis Learn how to characterize new equipment for safety Be able to identify potential failure modes for specific procedures and learn mitigation techniques Be able to customize FMEA examples and templates for use in any clinic.

60 APPLIED LIFE SCIENCES↗