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At least 163 records · Page 9
All sourcesNASA NTRSDOE OSTI
DOE OSTI2016

TH-B-BRC-00: How to Identify and Resolve Potential Clinical Errors Before They Impact Patients Treatment: Lessons Learned

Radiation treatment consists of a chain of events influenced by the quality of machine operation, beam data commissioning, machine calibration, patient specific data, simulation, treatment planning, imaging and treatment delivery. There is always a chance that the clinical medical physicist may make or fail to detect an error in one of the events that may impact on the patient’s treatment. In the clinical scenario, errors may be systematic and, without peer review, may have a low detectability because they are not part of routine QA procedures. During treatment, there might be errors on machine that needs attention. External reviews of some of the treatment delivery components by independent reviewers, like IROC, can detect errors, but may not be timely. The goal of this session is to help junior clinical physicists identify potential errors as well as the approach of quality assurance to perform a root cause analysis to find and eliminate an error and to continually monitor for errors. A compilation of potential errors will be presented by examples of the thought process required to spot the error and determine the root cause. Examples may include unusual machine operation, erratic electrometer reading, consistent lower electron output, variation in photon output, body parts inadvertently left in beam, unusual treatment plan, poor normalization, hot spots etc. Awareness of the possibility and detection of error in any link of the treatment process chain will help improve the safe and accurate delivery of radiation to patients. Four experts will discuss how to identify errors in four areas of clinical treatment. D. Followill, NIH grant CA 180803.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

TH-B-BRC-01: How to Identify and Resolve Potential Clinical Errors

Radiation treatment consists of a chain of events influenced by the quality of machine operation, beam data commissioning, machine calibration, patient specific data, simulation, treatment planning, imaging and treatment delivery. There is always a chance that the clinical medical physicist may make or fail to detect an error in one of the events that may impact on the patient’s treatment. In the clinical scenario, errors may be systematic and, without peer review, may have a low detectability because they are not part of routine QA procedures. During treatment, there might be errors on machine that needs attention. External reviews of some of the treatment delivery components by independent reviewers, like IROC, can detect errors, but may not be timely. The goal of this session is to help junior clinical physicists identify potential errors as well as the approach of quality assurance to perform a root cause analysis to find and eliminate an error and to continually monitor for errors. A compilation of potential errors will be presented by examples of the thought process required to spot the error and determine the root cause. Examples may include unusual machine operation, erratic electrometer reading, consistent lower electron output, variation in photon output, body parts inadvertently left in beam, unusual treatment plan, poor normalization, hot spots etc. Awareness of the possibility and detection of error in any link of the treatment process chain will help improve the safe and accurate delivery of radiation to patients. Four experts will discuss how to identify errors in four areas of clinical treatment. D. Followill, NIH grant CA 180803.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Clover: Compiler directed lightweight soft error resilience

This paper presents Clover, a compiler directed soft error detection and recovery scheme for lightweight soft error resilience. The compiler carefully generates soft error tolerant code based on idem-potent processing without explicit checkpoint. During program execution, Clover relies on a small number of acoustic wave detectors deployed in the processor to identify soft errors by sensing the wave made by a particle strike. To cope with DUE (detected unrecoverable errors) caused by the sensing latency of error detection, Clover leverages a novel selective instruction duplication technique called tail-DMR (dual modular redundancy). Once a soft error is detected by either the sensor or the tail-DMR, Clover takes care of the error as in the case of exception handling. To recover from the error, Clover simply redirects program control to the beginning of the code region where the error is detected. Lastly, the experiment results demonstrate that the average runtime overhead is only 26%, which is a 75% reduction compared to that of the state-of-the-art soft error resilience technique.

97 MATHEMATICS AND COMPUTING↗
DOE OSTI2018

Dosimetric impact of translational and rotational setup errors for spine stereotactic body radiotherapy: A phantom study

This study aimed to investigate experimentally the effect of translational and rotational setup errors on 3-dimensional dose distributions by using the gamma index and dose volumetric indices for spine stereotactic body radiotherapy. Treatment plans were designed in accordance with the Radiation Therapy Oncology Group (RTOG) 0631 protocol. Measurements were taken using a Delta4 phantom (ScandiDos, Uppsala, Sweden). Setup errors were generated using the HexaMotion 6D moving platform (ScandiDos). Dose distributions in the presence of setup errors were evaluated, according to the γ passing rate with the 3% and 2 mm criteria (γ{sub 3%/2 mm}) and dose volumetric indices (D{sub 90} for the target volume and D{sub 2} for the spinal cord), using the Delta4 device (ScandiDos). The sensitivity coefficient, which represented the correlation between the γ{sub 3%/2 mm} passing rate and dose volumetric indices, was determined to assess robustness against setup errors. Rotational setup errors of 2° were equivalent to translational setup errors of 2 mm for the γ{sub 3%/2 mm} passing rate, D{sub 90} for the target, and D{sub 2} for the spinal cord. D{sub 90} for the target had low robustness against a translational setup error in the vertical direction and a rotational setup error in the pitch direction. D{sub 2} for the spinal cord was sensitive to a translational setup error in the lateral direction and a rotational setup error in the roll direction. The positioning accuracy of the rotational setup error, corresponding to the tolerance level of image-guided radiotherapy in the RTOG 0631 protocol, was required to be ≤ 2°.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

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↗
DOE OSTI2014

SU-E-T-613: Dosimetric Consequences of Systematic MLC Leaf Positioning Errors

Purpose: The purpose of this study is to determine the dosimetric consequences of systematic MLC leaf positioning errors for clinical IMRT patient plans so as to establish detection tolerances for quality assurance programs. Materials and Methods: Dosimetric consequences were simulated by extracting mlc delivery instructions from the TPS, altering the file by the specified error, reloading the delivery instructions into the TPS, recomputing dose, and extracting dose-volume metrics for one head-andneck and one prostate patient. Machine error was simulated by offsetting MLC leaves in Pinnacle in a systematic way. Three different algorithms were followed for these systematic offsets, and are as follows: a systematic sequential one-leaf offset (one leaf offset in one segment per beam), a systematic uniform one-leaf offset (same one leaf offset per segment per beam) and a systematic offset of a given number of leaves picked uniformly at random from a given number of segments (5 out of 10 total). Dose to the PTV and normal tissue was simulated. Results: A systematic 5 mm offset of 1 leaf for all delivery segments of all beams resulted in a maximum PTV D98 deviation of 1%. Results showed very low dose error in all reasonably possible machine configurations, rare or otherwise, which could be simulated. Very low error in dose to PTV and OARs was shown in all possible cases of one leaf per beam per segment being offset (<1%), or that of only one leaf per beam being offset (<.2%). The errors resulting from a high number of adjacent leaves (maximum of 5 out of 60 total leaf-pairs) being simultaneously offset in many (5) of the control points (total 10–18 in all beams) per beam, in both the PTV and the OARs analyzed, were similarly low (<2–3%). Conclusions: The above results show that patient shifts and anatomical changes are the main source of errors in dose delivered, not machine delivery. These two sources of error are “visually complementary” and uncorrelated (albeit not additive in the final error) and one can easily incorporate error resulting from machine delivery in an error model based purely on tumor motion.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2023

Q-BEEP: Quantum Bayesian Error Mitigation Employing Poisson Modeling over the Hamming Spectrum

Quantum computing technology has grown rapidly in recent years, with new technologies being explored, error rates being reduced, and quantum processor’s qubit capacity growing. However, near-term quantum algorithms are still unable to be induced without compounding consequential levels of noise, leading to non-trivial erroneous results. Quantum Error Correction (in-situ error mitigation) and Quantum Error Mitigation (post-induction error mitigation) are promising fields of research within the quantum algorithm scene, aiming to alleviate quantum errors, increasing the overall fidelity and hence the overall quality of circuit induction. Earlier this year, a pioneering work, namely HAMMER, published in ASPLOS-22 demonstrated the existence of a latent structure regarding post-circuit induction errors when mapping to the Hamming spectrum. However, they intuitively assumed that errors occur in local clusters, and that at higher average Hamming distances this structure falls away. In this work, we show that such a correlation structure is not only local but extends certain non-local clustering patterns which can be precisely described by a Poisson distribution model taking the input circuit, the device run time status (i.e., calibration statistics) and qubit topology into consideration. Using this quantum error characterizing model, we developed an iterative algorithm over the generated Bayesian network state-graph for post-induction error mitigation. Thanks to more precise modeling of the error distribution latent structure and the new iterative method, our Q-Beep approach provides state of the art performance and can boost circuit execution fidelity by up to 234.6% on Bernstein-Vazirani circuits and on average 71.0% on QAOA solution quality, using 16 practical IBMQ quantum processors. For other benchmarks such as those in QASMBench, the fidelity improvement is up to 17.8%. Q-Beep is a light-weight post-processing technique that can be performed offline and remotely, making it a useful tool for quantum vendors to integrate and provide more reliable circuit induction results.

Stein, Samuel A.↗
DOE OSTI2025

Quantification of regional net CO 2 flux errors in the Orbiting Carbon Observatory-2 (OCO-2) v10 model intercomparison project (MIP) ensemble using airborne measurements

Inverse model intercomparison projects (MIPs) provide a chance to assess the uncertainties in inversion estimates arising from various sources. However, accurately quantifying ensemble CO 2 flux errors remains challenging and often relies on the ensemble spread. This study proposes a method for quantifying the errors in regional net surface–atmosphere CO 2 flux estimates from models taken from the Orbiting Carbon Observatory-2 (OCO-2) v10 MIP by using independent airborne CO 2 measurements for the period 2015–2017. We first calculate the root mean square error (RMSE) between the ensemble mean of posterior CO 2 concentrations and airborne observations and then isolate the CO 2 concentration errors caused solely by the ensemble mean of posterior net fluxes by subtracting the observation, representation, and transport errors from seven regions. Our analysis reveals that the flux errors projected onto CO 2 space account for 55 %–85 % of the regional average RMSE over the 3 years, ranging from 0.88 to 1.91 ppm. In five regions, the error estimates based on observations exceed those computed from the ensemble spread of posterior fluxes by a factor of 1.33–1.93, implying an underestimation of the actual flux errors, while their magnitudes are comparable in two regions. The adjoint sensitivity analysis identifies that the underestimation of flux errors is prominent where the magnitudes of fossil fuel emissions exceed those of terrestrial-biosphere fluxes by a factor of 3–31 over the 3 years. This suggests the presence of systematic biases in the inversion estimates associated with errors in the prescribed fossil fuel emissions common to all models. Our study emphasizes the value of airborne measurements for quantifying regional errors in ensemble net CO 2 flux estimates.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2015

Quantifying error of lidar and sodar Doppler beam swinging measurements of wind turbine wakes using computational fluid dynamics

Wind-profiling lidars are now regularly used in boundary-layer meteorology and in applications such as wind energy and air quality. Lidar wind profilers exploit the Doppler shift of laser light backscattered from particulates carried by the wind to measure a line-of-sight (LOS) velocity. The Doppler beam swinging (DBS) technique, used by many commercial systems, considers measurements of this LOS velocity in multiple radial directions in order to estimate horizontal and vertical winds. The method relies on the assumption of homogeneous flow across the region sampled by the beams. Using such a system in inhomogeneous flow, such as wind turbine wakes or complex terrain, will result in errors. To quantify the errors expected from such violation of the assumption of horizontal homogeneity, we simulate inhomogeneous flow in the atmospheric boundary layer, notably stably stratified flow past a wind turbine, with a mean wind speed of 6.5 m s -1 at the turbine hub-height of 80 m. This slightly stable case results in 15° of wind direction change across the turbine rotor disk. The resulting flow field is sampled in the same fashion that a lidar samples the atmosphere with the DBS approach, including the lidar range weighting function, enabling quantification of the error in the DBS observations. The observations from the instruments located upwind have small errors, which are ameliorated with time averaging. However, the downwind observations, particularly within the first two rotor diameters downwind from the wind turbine, suffer from errors due to the heterogeneity of the wind turbine wake. Errors in the stream-wise component of the flow approach 30% of the hub-height inflow wind speed close to the rotor disk. Errors in the cross-stream and vertical velocity components are also significant: cross-stream component errors are on the order of 15% of the hub-height inflow wind speed (1.0 m s &minus;1 ) and errors in the vertical velocity measurement exceed the actual vertical velocity. By three rotor diameters downwind, DBS-based assessments of wake wind speed deficits based on the stream-wise velocity can be relied on even within the near wake within 1.0 s -1 (or 15% of the hub-height inflow wind speed), and the cross-stream velocity error is reduced to 8% while vertical velocity estimates are compromised. Furthermore, measurements of inhomogeneous flow such as wind turbine wakes are susceptible to these errors, and interpretations of field observations should account for this uncertainty.

17 WIND ENERGY↗
DOE OSTI2022

Techniques for storing data to enhance recovery and detection of data corruption errors

Often there are errors when reading data from computer memory. To detect and correct these errors, there are multiple types of error correction codes. Disclosed is an error correction architecture that creates a codeword having a data portion and an error correction code portion. Swizzling rearranges the order of bits and distributes the bits among different codewords. Because the data is redistributed, a potential memory error of up to N contiguous bits, where N for example equals 2 times the number of codewords swizzled together, only affects up to, at most, two bits per swizzled codeword. This keeps the error within the error detecting capabilities of the error correction architecture. Furthermore, this can allow improved error correction and detection without requiring a change to error correcting code generators and checkers.

Mills, Peter↗
DOE OSTI2023

Techniques for storing data to enhance recovery and detection of data corruption errors

Often there are errors when reading data from computer memory. To detect and correct these errors, there are multiple types of error correction codes. Disclosed is an error correction architecture that creates a codeword having a data portion and an error correction code portion. Swizzling rearranges the order of bits and distributes the bits among different codewords. Because the data is redistributed, a potential memory error of up to N contiguous bits, where N for example equals 2 times the number of codewords swizzled together, only affects up to, at most, two bits per swizzled codeword. This keeps the error within the error detecting capabilities of the error correction architecture. Furthermore, this can allow improved error correction and detection without requiring a change to error correcting code generators and checkers.

Mills, Peter↗
DOE OSTI2013

Multifield optimization intensity-modulated proton therapy (MFO-IMPT) for prostate cancer: Robustness analysis through simulation of rotational and translational alignment errors

To evaluate the dosimetric consequences of rotational and translational alignment errors in patients receiving intensity-modulated proton therapy with multifield optimization (MFO-IMPT) for prostate cancer. Ten control patients with localized prostate cancer underwent treatment planning for MFO-IMPT. Rotational and translation errors were simulated along each of 3 axes: anterior-posterior (A-P), superior-inferior (S-I), and left-right. Clinical target-volume (CTV) coverage remained high with all alignment errors simulated. Rotational errors did not result in significant rectum or bladder dose perturbations. Translational errors resulted in larger dose perturbations to the bladder and rectum. Perturbations in rectum and bladder doses were minimal for rotational errors and larger for translational errors. Rectum V45 and V70 increased most with A-P misalignment, whereas bladder V45 and V70 changed most with S-I misalignment. The bladder and rectum V45 and V70 remained acceptable even with extreme alignment errors. Even with S-I and A-P translational errors of up to 5 mm, the dosimetric profile of MFO-IMPT remained favorable. MFO-IMPT for localized prostate cancer results in robust coverage of the CTV without clinically meaningful dose perturbations to normal tissue despite extreme rotational and translational alignment errors.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2015

SU-E-P-36: Evaluation of MLC Positioning Errors in Dynamic IMRT Treatments by Analyzing Dynalog Files

Purpose: To assess the accuracy of MLC positioning in Varian linear accelerator, in dynamic IMRT technique, from the analysis of dynalog files generated by the MLC controller. Methods: In Clinac accelerators (pre-TrueBeam technology), control system has an approximately 50ms delay (one control cycle time). Then, the system compares the measured position to the planned position corresponding to the next control cycle. As it has been confirmed by Varian technical support, this effect causes that measured positions appear in dynalogs one cycle out of phase with respect to the planned positions. Around 9000 dynalogs have been analyzed, coming from the three linear accelerators of our center (one Trilogy and two Clinac 21EX) equipped with a Millennium 120 MLC. In order to compare our results to recent publications, leaf positioning errors (RMS and 95th percentile) are calculated with and without delay effect. Dynalogs have been analyzed using a in-house Matlab software. Results: The RMS errors were 0.341, 0.339 and 0.348mm for each Linac; being the average error 0.343 mm. The 95th percentiles of the error were 0.617, 0.607 and 0.625; with an average of 0.617mm. A recent multi-institution study carried out by Kerns et al. found a mean leaf RMS error of 0.32mm and a 95th percentile error value of 0.64mm.Without delay effect, mean leaf RMS errors obtained were 0.040, 0.042 and 0.038mm for each treatment machine; being the average 0.040mm. The 95th percentile error values obtained were 0.057, 0.058 and 0.054 mm, with an average of 0.056mm. Conclusion: Results obtained for the mean leaf RMS error and the mean 95th percentile were consistent with the multi-institution study. Calculated error statistics with delay effect are significantly larger due to the speed proportional and systematic leaf offset. Consequently it is proposed to correct this effect in dynalogs analysis to determine the MLC performance.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-114: Analysis of MLC Errors On Gamma Pass Rates for Patient-Specific and Conventional Phantoms

Purpose: To evaluate whether a 3D patient-specific phantom is better able to detect known MLC errors in a clinically delivered treatment plan than conventional phantoms. 3D printing may make fabrication of such phantoms feasible. Methods: Two types of MLC errors were introduced into a clinically delivered, non-coplanar IMRT, partial brain treatment plan. First, uniformly distributed random errors of up to 3mm, 2mm, and 1mm were introduced into the MLC positions for each field. Second, systematic MLC-bank position errors of 5mm, 3.5mm, and 2mm due to simulated effects of gantry and MLC sag were introduced. The original plan was recalculated with these errors on the original CT dataset as well as cylindrical and planar IMRT QA phantoms. The original dataset was considered to be a perfect 3D patient-specific phantom. The phantoms were considered to be ideal 3D dosimetry systems with no resolution limitations. Results: Passing rates for Gamma Index (3%/3mm and no dose threshold) were calculated on the 3D phantom, cylindrical phantom, and both on a composite and field-by-field basis for the planar phantom. Pass rates for 5mm systematic and 3mm random error were 86.0%, 89.6%, 98% and 98.3% respectively. For 3.5mm systematic and 2mm random error the pass rates were 94.7%, 96.2%, 99.2% and 99.2% respectively. For 2mm systematic error with 1mm random error the pass rates were 99.9%, 100%, 100% and 100% respectively. Conclusion: A 3D phantom with the patient anatomy is able to discern errors, both severe and subtle, that are not seen using conventional phantoms. Therefore, 3D phantoms may be beneficial for commissioning new treatment machines and modalities, patient-specific QA and end-to-end testing.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Minimizing treatment planning errors in proton therapy using failure mode and effects analysis

Purpose: Failure mode and effects analysis (FMEA) is a widely used tool to evaluate safety or reliability in conventional photon radiation therapy. However, reports about FMEA application in proton therapy are scarce. The purpose of this study is to apply FMEA in safety improvement of proton treatment planning at their center. Methods: The authors performed an FMEA analysis of their proton therapy treatment planning process using uniform scanning proton beams. The authors identified possible failure modes in various planning processes, including image fusion, contouring, beam arrangement, dose calculation, plan export, documents, billing, and so on. For each error, the authors estimated the frequency of occurrence, the likelihood of being undetected, and the severity of the error if it went undetected and calculated the risk priority number (RPN). The FMEA results were used to design their quality management program. In addition, the authors created a database to track the identified dosimetric errors. Periodically, the authors reevaluated the risk of errors by reviewing the internal error database and improved their quality assurance program as needed. Results: In total, the authors identified over 36 possible treatment planning related failure modes and estimated the associated occurrence, detectability, and severity to calculate the overall risk priority number. Based on the FMEA, the authors implemented various safety improvement procedures into their practice, such as education, peer review, and automatic check tools. The ongoing error tracking database provided realistic data on the frequency of occurrence with which to reevaluate the RPNs for various failure modes. Conclusions: The FMEA technique provides a systematic method for identifying and evaluating potential errors in proton treatment planning before they result in an error in patient dose delivery. The application of FMEA framework and the implementation of an ongoing error tracking system at their clinic have proven to be useful in error reduction in proton treatment planning, thus improving the effectiveness and safety of proton therapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

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↗
DOE OSTI2016

SU-G-BRB-03: Assessing the Sensitivity and False Positive Rate of the Integrated Quality Monitor (IQM) Large Area Ion Chamber to MLC Positioning Errors

Purpose: To examine both the IQM’s sensitivity and false positive rate to varying MLC errors. By balancing these two characteristics, an optimal tolerance value can be derived. Methods: An un-modified SBRT Liver IMRT plan containing 7 fields was randomly selected as a representative clinical case. The active MLC positions for all fields were perturbed randomly from a square distribution of varying width (±1mm to ±5mm). These unmodified and modified plans were measured multiple times each by the IQM (a large area ion chamber mounted to a TrueBeam linac head). Measurements were analyzed relative to the initial, unmodified measurement. IQM readings are analyzed as a function of control points. In order to examine sensitivity to errors along a field’s delivery, each measured field was divided into 5 groups of control points, and the maximum error in each group was recorded. Since the plans have known errors, we compared how well the IQM is able to differentiate between unmodified and error plans. ROC curves and logistic regression were used to analyze this, independent of thresholds. Results: A likelihood-ratio Chi-square test showed that the IQM could significantly predict whether a plan had MLC errors, with the exception of the beginning and ending control points. Upon further examination, we determined there was ramp-up occurring at the beginning of delivery. Once the linac AFC was tuned, the subsequent measurements (relative to a new baseline) showed significant (p <0.005) abilities to predict MLC errors. Using the area under the curve, we show the IQM’s ability to detect errors increases with increasing MLC error (Spearman’s Rho=0.8056, p<0.0001). The optimal IQM count thresholds from the ROC curves are ±3%, ±2%, and ±7% for the beginning, middle 3, and end segments, respectively. Conclusion: The IQM has proven to be able to detect not only MLC errors, but also differences in beam tuning (ramp-up). Partially supported by the Susan Scott Foundation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

TH-CD-207A-11: Sensitivity Analysis of Action Limits for Real-Time EPID-Based Delivery Verification System Using Artificial Clinical Relevant Error Simulations

Purpose: A real-time patient treatment delivery verification system using EPID (Watchdog) has been developed as an advanced patient safety tool. In a pilot study data was acquired for 119 prostate and head and neck (HN) IMRT patient deliveries to generate body-site specific action limits using statistical process control. The purpose of this study is to determine the sensitivity of Watchdog to detect clinically significant errors during treatment delivery. Methods: Watchdog utilizes a physics-based model to generate a series of predicted transit cine EPID images as a reference data set, and compares these in real-time to measured transit cine-EPID images acquired during treatment using chi comparison (4%, 4mm criteria) after the initial 2s of treatment to allow for dose ramp-up. Four study cases were used; dosimetric (monitor unit) errors in prostate (7 fields) and HN (9 fields) IMRT treatments of (5%, 7%, 10%) and positioning (systematic displacement) errors in the same treatments of (5mm, 7mm, 10mm). These errors were introduced by modifying the patient CT scan and re-calculating the predicted EPID data set. The error embedded predicted EPID data sets were compared to the measured EPID data acquired during patient treatment. The treatment delivery percentage (measured from 2s) where Watchdog detected the error was determined. Results: Watchdog detected all simulated errors for all fields during delivery. The dosimetric errors were detected at average treatment delivery percentage of (4%, 0%, 0%) and (7%, 0%, 0%) for prostate and HN respectively. For patient positional errors, the average treatment delivery percentage was (52%, 43%, 25%) and (39%, 16%, 6%). Conclusion: These results suggest that Watchdog can detect significant dosimetric and positioning errors in prostate and HN IMRT treatments in real-time allowing for treatment interruption. Displacements of the patient require longer to detect however incorrect body site or very large geographic misses will be detected rapidly.

60 APPLIED LIFE SCIENCES↗