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At least 163 records · Page 9

Emotional and Behavioral Functioning After Conformal Radiation Therapy for Pediatric Ependymoma

Purpose: The standard of care for pediatric patients with ependymoma involves postoperative radiation therapy. Prior research suggests that conformal radiation therapy (CRT) is associated with relative sparing of cognitive and academic functioning, but little is known about the effect of CRT on emotional and behavioral functioning. Methods and Materials: A total of 113 patients with pediatric ependymoma underwent CRT using photons as part of their enrollment on an institutional trial. Patients completed annual evaluations of neurocognitive functioning during the first 5 years after CRT. Emotional and behavioral functioning was assessed via the Child Behavior Checklist. Results: Before CRT, emotional and behavioral functioning were commensurate with those of the normative population and within normal limits. After 5 years, means remained within normal limits but were significantly below the normative mean. Linear mixed models revealed a significant increase in attention problems over time. These problems were associated with age at diagnosis/CRT, tumor location, and extent of resection. A higher-than-expected incidence of school problems was present at all assessment points after baseline. Conclusions: The use of photon CRT for ependymoma is associated with relatively stable emotional and behavioral functioning during the first 5 years after treatment. The exception is an increase in attention problems. Results suggest that intervening earlier in the survivorship period—during the first year posttreatment—may be beneficial.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

A critical review and meta-analysis of energy demand, carbon footprint, and other environmental impacts from carbon fiber manufacturing

The demand for carbon fibers and carbon fiber-reinforced polymers (CFRPs) is rapidly growing due to their outstanding mechanical properties and potential to enhance sustainability, particularly for lightweighting applications. However, carbon fibers are typically produced from fossil-based feedstocks, involve energy-intensive processes, and have limited options for sustainable end-of-life management or circularity. Despite these challenges, the energy demand and lifecycle environmental implications of their production remain poorly understood. Here, we conduct a critical literature review and meta-analysis of carbon fiber manufacturing, revealing significant variations in reported energy demand, carbon footprint, and lifecycle inventory data. Our analysis makes two novel contributions. First, we identify key underlying factors driving these variations. Second, we highlight that carbon fiber, far from being a homogeneous product, has grades varying substantially in mechanical properties, end-use markets, energy intensity of manufacturing processes, and therefore environmental impacts—an aspect often underrepresented in life cycle assessments. We assert that current data are insufficient for reliably evaluating environmental impacts, posing a risk of misleading decision-making. Addressing this gap requires new lifecycle inventory datasets clearly incorporating carbon fiber heterogeneity and key influencing factors identified in this study. Additionally, we propose actionable recommendations, including a checklist, to advance sustainability in the carbon fiber sector.

CED↗

Enhancing the Quality and Reliability of Machine Learning Interatomic Potentials through Better Reporting Practices

Recent developments in machine learning interatomic potentials (MLIPs) have empowered even nonexperts in machine learning to train MLIPs for accelerating materials simulations. However, reproducibility and independent evaluation of presented MLIP results is hindered by a lack of clear standards in current literature. In this Perspective, we aim to provide guidance on best practices for documenting MLIP use while walking the reader through the development and deployment of MLIPs including hardware and software requirements, generating training data, training models, validating predictions, and MLIP inference. We also suggest useful plotting practices and analyses to validate and boost confidence in the deployed models. Finally, we provide a step-by-step checklist for practitioners to use directly before publication to standardize the information to be reported. Altogether, we hope that our work will encourage the reliable and reproducible use of these MLIPs, which will accelerate their ability to make a positive impact in various disciplines including materials science, chemistry, and biology, among others.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH↗

Minimum information about a single amplified genome (MISAG) and a metagenome-assembled genome (MIMAG) of bacteria and archaea

Here, we present two standards developed by the Genomic Standards Consortium (GSC) for reporting bacterial and archaeal genome sequences. Both are extensions of the Minimum Information about Any (x) Sequence (MIxS). The standards are the Minimum Information about a Single Amplified Genome (MISAG) and the Minimum Information about a MetagenomeAssembled Genome (MIMAG), including, but not limited to, assembly quality, and estimates of genome completeness and contamination. These standards can be used in combination with other GSC checklists, including the Minimum Information about a Genome Sequence (MIGS), Minimum Information about a Metagenomic Sequence (MIMS), and Minimum Information about a Marker Gene Sequence (MIMARKS). Community-wide adoption of MISAG and MIMAG will facilitate more robust comparative genomic analyses of bacterial and archaeal diversity.

59 BASIC BIOLOGICAL SCIENCES↗

Corrigendum: Minimum information about a single amplified genome (MISAG) and a metagenome-assembled genome (MIMAG) of bacteria and archaea

Here, we present two standards developed by the Genomic Standards Consortium (GSC) for reporting bacterial and archaeal genome sequences. Both are extensions of the Minimum Information about Any (x) Sequence (MIxS). The standards are the Minimum Information about a Single Amplified Genome (MISAG) and the Minimum Information about a Metagenome- Assembled Genome (MIMAG), including, but not limited to, assembly quality, and estimates of genome completeness and contamination. These standards can be used in combination with other GSC checklists, including the Minimum Information about a Genome Sequence (MIGS), Minimum Information about a Metagenomic Sequence (MIMS), and Minimum Information about a Marker Gene Sequence (MIMARKS). Community-wide adoption of MISAG and MIMAG will facilitate more robust comparative genomic analyses of bacterial and archaeal diversity.

59 BASIC BIOLOGICAL SCIENCES↗

STREAMS guidelines: standards for technical reporting in environmental and host-associated microbiome studies

The interdisciplinary nature of microbiome research, coupled with the generation of complex multi-omics data, makes knowledge sharing challenging. The Strengthening the Organization and Reporting of Microbiome Studies (STORMS) guidelines provide a checklist for the reporting of study information, experimental design and analytical methods within a scientific manuscript on human microbiome research. Here, in this Consensus Statement, we present the standards for technical reporting in environmental and host-associated microbiome studies (STREAMS) guidelines. The guidelines expand on STORMS and include 67 items to support the reporting and review of environmental (for example, terrestrial, aquatic, atmospheric and engineered), synthetic and non-human host-associated microbiome studies in a standardized and machine-actionable manner. Based on input from 248 researchers spanning 28 countries, we provide detailed guidance, including comparisons with STORMS, and case studies that demonstrate the usage of the STREAMS guidelines. In conclusion, STREAMS, like STORMS, will be a living community resource updated by the Consortium with consensus-building input of the broader community.

59 BASIC BIOLOGICAL SCIENCES↗

Community-Driven Metadata Standards for Agricultural Microbiome Research

Accelerating the pace of microbiome science to enhance crop productivity and agroecosystem health will require transdisciplinary studies, comparisons among datasets, and synthetic analyses of research from diverse crop management contexts. However, despite the widespread availability of crop-associated microbiome data, variation in field sampling and laboratory processing methodologies, as well as metadata collection and reporting, significantly constrains the potential for integrative and comparative analyses. Here we discuss the need for agriculture-specific metadata standards for microbiome research, and propose a list of “required” and “desirable” metadata categories and ontologies essential to be included in a future minimum information metadata standards checklist for describing agricultural microbiome studies. We begin by briefly reviewing existing metadata standards relevant to agricultural microbiome research, and describe ongoing efforts to enhance the potential for integration of data across research studies. Our goal is not to delineate a fixed list of metadata requirements. Instead, we hope to advance the field by providing a starting point for discussion, and inspire researchers to adopt standardized procedures for collecting and reporting consistent and well-annotated metadata for agricultural microbiome research.

59 BASIC BIOLOGICAL SCIENCES↗

Design and Evaluation of joint resistance in SSC Rutherford type cable splices for Torus magnet for the Jefferson Lab 12 GeV Upgrade

The Hall B 3.6-T superconducting torus magnet is being designed and built as part of the Jefferson Lab 12-GeV upgrade. The magnet consists of six trapezoidal coils connected in series, with an operating current of 3770 A. The magnet and the joints (or splices) connecting the coils are all conduction cooled by supercritical 4.6-K helium. This paper studies the design and manufacturing process of the splices made between two SSC Rutherford-type cables and discusses the tests performed to evaluate the performance of the splices under varying incident magnetic fields.

Ghoshal, Probir K.↗

Implementation of early psychosis services in Latin America: A scoping review

Abstract Aim The evidence of the effectiveness and cost‐effectiveness of early intervention for psychosis (EIP) services has motivated their implementation worldwide. However, complex interventions of such EIP services require local adaptations to successfully match population needs and cultural differences. Latin America is a heterogenous region where EIP services are progressively being adopted. Our aim is to map such initiatives in the region with a focus on implementation outcomes. Methods A scoping review following the Preferred Reporting Items for Systematic review and Meta‐Analysis extension for Scoping Reviews guidelines was conducted. International and regional databases were searched for publications describing EIP programmes in the region. Besides mapping the services, we described implementation outcomes based on the Standards for Reporting Implementation Studies Checklist. Results Ten articles describing seven EIP initiatives from the region were found. Four countries were represented: Argentina, Brazil, Chile and Mexico. The implementation outcomes reporting was heterogenous, although it was possible to ascertain EIP services are feasible and adequate for the region's context. Also, there is some evidence of effectiveness in terms of reducing hospitalizations and improving symptoms. Information about fidelity measures was scarce and there was no information about costs or cost‐effectiveness. Conclusions Only a small proportion of Latin American countries have adopted EIP services. Although these programmes seem to be feasible and effective, data on other implementation outcomes, such as fidelity, cultural appropriateness, cost‐effectiveness and affordability are not available. This might in part explain why this effective approach has not been yet scaled‐up at nationwide levels.

Aceituno, David↗

SU-D-18C-06: Initial Experience with Implementing MRI Safety Guidelines for Patients with Pacemakers - Medical Physicist Perspective

Purpose: Several institutions have developed MRI guidelines for patients with MR-unsafe or MR-conditional pacemakers. Here we highlight the role of a medical physicist in implementing these guidelines for non-pacemaker dependent patients. Guidelines: Implementing these guidelines requires involvement from several medical specialties and a strong collaboration with the site MRI supervisor to develop a structured workflow. A medical physicist is required to be present during the scan to supervise the MR scanning and to maintain a safety checklist that ensures: 1) uninterrupted patient communication with the technologist, 2) continuous patient physiologic monitoring (e.g. blood pressure and electrocardiography) by a trained nurse, 3) redundant patient vitals monitoring (e.g. pulse oximetry) due to the possibility of in vivo electrocardiography reading fluctuations during image acquisition. A radiologist is strongly recommended to be available to review the images before patients are discharged from the scanner. Pacemaker MRI should be restricted to 1.5T field strength. The MRI sequences should be optimized by the physicist with regards to: a) SAR: limited to <1.5 W/Kg for MR-unsafe pacemakers in normal operating mode, b) RF exposure time: <30 min, c) Coils: use T/R coils but not restricted to such, d) Artifacts: further optimization of sequences whenever image quality is compromised due to the pacemaker. In particular, cardiac, breast and left-shoulder MRIs are most susceptible to these artifacts. Possible strategies to lower the SAR include: a) BW reduction, 2) echo-train-length reduction, 3) increase TR, 4) decrease number of averages, 5) decrease flip angle, 6) reduce slices and/or a combination of all the options. Conclusion: A medical physicist in collaboration with the MR supervisor plays an important role in the supervision/implementation of safe MR scanning of pacemaker patients. Developing and establishing a workflow has enabled our institution to scan over 30 patients with pacemakers without complications, including 3 cardiac MR exams.

60 APPLIED LIFE SCIENCES↗

SU-E-T-310: Targeting Safety Improvements Through Analysis of Near-Miss Error Detection Points in An Incident Learning Database

Purpose: Radiation treatment planning involves a complex workflow that can make safety improvement efforts challenging. This study utilizes an incident reporting system to identify detection points of near-miss errors, in order to guide our departmental safety improvement efforts. Previous studies have examined where errors arise, but not where they are detected or their patterns. Methods: 1377 incidents were analyzed from a departmental nearmiss error reporting system from 3/2012–10/2013. All incidents were prospectively reviewed weekly by a multi-disciplinary team, and assigned a near-miss severity score ranging from 0–4 reflecting potential harm (no harm to critical). A 98-step consensus workflow was used to determine origination and detection points of near-miss errors, categorized into 7 major steps (patient assessment/orders, simulation, contouring/treatment planning, pre-treatment plan checks, therapist/on-treatment review, post-treatment checks, and equipment issues). Categories were compared using ANOVA. Results: In the 7-step workflow, 23% of near-miss errors were detected within the same step in the workflow, while an additional 37% were detected by the next step in the workflow, and 23% were detected two steps downstream. Errors detected further from origination were more severe (p<.001; Figure 1). The most common source of near-miss errors was treatment planning/contouring, with 476 near misses (35%). Of those 476, only 72(15%) were found before leaving treatment planning, 213(45%) were found at physics plan checks, and 191(40%) were caught at the therapist pre-treatment chart review or on portal imaging. Errors that passed through physics plan checks and were detected by therapists were more severe than other errors originating in contouring/treatment planning (1.81 vs 1.33, p<0.001). Conclusion: Errors caught by radiation treatment therapists tend to be more severe than errors caught earlier in the workflow, highlighting the importance of safety checks in dosimetry and physics. We are utilizing our findings to improve manual and automated checklists for dosimetry and physics.

60 APPLIED LIFE SCIENCES↗

SU-E-T-627: Failure Modes and Effect Analysis for Monthly Quality Assurance of Linear Accelerator

Purpose: To develop and implement a failure mode and effect analysis (FMEA) on routine monthly Quality Assurance (QA) tests (physical tests part) of linear accelerator. Methods: A systematic failure mode and effect analysis method was performed for monthly QA procedures. A detailed process tree of monthly QA was created and potential failure modes were defined. Each failure mode may have many influencing factors. For each factor, a risk probability number (RPN) was calculated from the product of probability of occurrence (O), the severity of effect (S), and detectability of the failure (D). The RPN scores are in a range of 1 to 1000, with higher scores indicating stronger correlation to a given influencing factor of a failure mode. Five medical physicists in our institution were responsible to discuss and to define the O, S, D values. Results: 15 possible failure modes were identified and all RPN scores of all influencing factors of these 15 failue modes were from 8 to 150, and the checklist of FMEA in monthly QA was drawn. The system showed consistent and accurate response to erroneous conditions. Conclusion: The influencing factors of RPN greater than 50 were considered as highly-correlated factors of a certain out-oftolerance monthly QA test. FMEA is a fast and flexible tool to develop an implement a quality management (QM) frame work of monthly QA, which improved the QA efficiency of our QA team. The FMEA work may incorporate more quantification and monitoring fuctions in future.

07 ISOTOPE AND RADIATION SOURCES↗

SU-E-T-408: Evaluation of the Type and Frequency of Variations Discovered During Routine Secondary Patient Chart Review

Purpose: Desire to improve efficiency and throughput inspired a review of our physics chart check procedures. Departmental policy mandates plan checks pre-treatment, after first treatment and weekly every 3–5 days. This study examined the effectiveness of the “after first” check with respect to improving patient safety and clinical efficiency. Type and frequency of variations discovered during this redundant secondary review was examined over seven months. Methods: A community spreadsheet was created to record variations in care discovered during chart review following the first fraction of treatment and before the second fraction (each plan reviewed prior to treatment). Entries were recorded from August 2014 through February 2015, amounting to 43 recorded variations out of 906 reviewed charts. The variations were divided into categories and frequencies were assessed month-to-month. Results: Analysis of recorded variations indicates an overall variation rate of 4.7%. The initial rate was 13.5%; months 2–7 average 3.7%. The majority of variations related to discrepancies in documentation at 46.5%, followed by prescription, plan deficiency, and dose tracking related variations at 25.5%, 12.8%, and 12.8%, respectively. Minor variations (negligible consequence on patient treatment) outweighed major variations 3 to 1. Conclusion: This work indicates that this redundant secondary check is effective. The first month spike in rates could be due to the Hawthorne/observer effect, but the consistent 4% variation rate suggests the need for periodical re-training on variations noted as frequent to improve awareness and quality of the initial chart review process, which may lead to improved treatment quality, patient safety and increased clinical efficiency. Utilizing these results, a continuous quality improvement process following Deming’s Plan-Do-Study-Act (PDSA) methodology was generated. The first iteration of this PDSA was adding a specific dose tracking checklist item in the pre-treatment plan check assessment; the ramification of which will be assessed in future data.

60 APPLIED LIFE SCIENCES↗

SU-E-T-421: Failure Mode and Effects Analysis (FMEA) of Xoft Electronic Brachytherapy for the Treatment of Superficial Skin Cancers

Purpose: To perform a failure mode and effects analysis (FMEA) of the process for treating superficial skin cancers with the Xoft Axxent electronic brachytherapy (eBx) system, given the recent introduction of expanded quality control (QC) initiatives at our institution. Methods: A process map was developed listing all steps in superficial treatments with Xoft eBx, from the initial patient consult to the completion of the treatment course. The process map guided the FMEA to identify the failure modes for each step in the treatment workflow and assign Risk Priority Numbers (RPN), calculated as the product of the failure mode’s probability of occurrence (O), severity (S) and lack of detectability (D). FMEA was done with and without the inclusion of recent QC initiatives such as increased staffing, physics oversight, standardized source calibration, treatment planning and documentation. The failure modes with the highest RPNs were identified and contrasted before and after introduction of the QC initiatives. Results: Based on the FMEA, the failure modes with the highest RPN were related to source calibration, treatment planning, and patient setup/treatment delivery (Fig. 1). The introduction of additional physics oversight, standardized planning and safety initiatives such as checklists and time-outs reduced the RPNs of these failure modes. High-risk failure modes that could be mitigated with improved hardware and software interlocks were identified. Conclusion: The FMEA analysis identified the steps in the treatment process presenting the highest risk. The introduction of enhanced QC initiatives mitigated the risk of some of these failure modes by decreasing their probability of occurrence and increasing their detectability. This analysis demonstrates the importance of well-designed QC policies, procedures and oversight in a Xoft eBx programme for treatment of superficial skin cancers. Unresolved high risk failure modes highlight the need for non-procedural quality initiatives such as improved planning software and more robust hardware interlock systems.

60 APPLIED LIFE SCIENCES↗

MO-B-BRB-00: Optimizing the Treatment Planning Process

The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequential events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi-automatic plan evaluation, (e) quality checklist for error prevention, (f) iterative process, (g) balance of speed and quality Learning Objectives: Gain familiarity with the workflow of modern treatment planning process. Understand the scope and challenges of managing modern treatment planning processes. Gain familiarity with Lean Six Sigma approaches and their implementation in the treatment planning workflow.

60 APPLIED LIFE SCIENCES↗

MO-B-BRB-01: Optimize Treatment Planning Process in Clinical Environment

The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequential events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi-automatic plan evaluation, (e) quality checklist for error prevention, (f) iterative process, (g) balance of speed and quality Learning Objectives: Gain familiarity with the workflow of modern treatment planning process. Understand the scope and challenges of managing modern treatment planning processes. Gain familiarity with Lean Six Sigma approaches and their implementation in the treatment planning workflow.

60 APPLIED LIFE SCIENCES↗

MO-B-BRB-02: Maintain the Quality of Treatment Planning for Time-Constraint Cases

The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequential events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi-automatic plan evaluation, (e) quality checklist for error prevention, (f) iterative process, (g) balance of speed and quality Learning Objectives: Gain familiarity with the workflow of modern treatment planning process. Understand the scope and challenges of managing modern treatment planning processes. Gain familiarity with Lean Six Sigma approaches and their implementation in the treatment planning workflow.

60 APPLIED LIFE SCIENCES↗

MO-B-BRB-03: Systems Engineering Tools for Treatment Planning Process Optimization in Radiation Medicine

The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequential events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi-automatic plan evaluation, (e) quality checklist for error prevention, (f) iterative process, (g) balance of speed and quality Learning Objectives: Gain familiarity with the workflow of modern treatment planning process. Understand the scope and challenges of managing modern treatment planning processes. Gain familiarity with Lean Six Sigma approaches and their implementation in the treatment planning workflow.

60 APPLIED LIFE SCIENCES↗