The most important dosimetry quantity that is determined at radiotherapy centers is the absorbed dose to water for external beams. Fixed tolerances for absorbed doses measured under reference conditions with an ionization chamber for high-energy photon and electron beams are usually 2 and 3%, respectively, regardless of uncertainties of the input variables and other conditions during evaluation. In reality, this agreement should be evaluated considering the uncertainties of the input variables because they affect the size of the random deviations of the measurements from their true values. The aim of this work was to develop a new approach to evaluate the agreement between measured and reported values based on statistical interference rather than to use fixed tolerance levels. The proposed method considers different scenarios that can occur during the evaluation of agreement. Because the method is described in general, it can be used in all similar situations when partial uncertainties can be established.
- MeSH
- celková dávka radioterapie MeSH
- kalibrace MeSH
- lidé MeSH
- nádory radioterapie MeSH
- nejistota MeSH
- plánování radioterapie pomocí počítače metody normy MeSH
- radioterapie s modulovanou intenzitou metody normy MeSH
- statistické modely * MeSH
- vysokoenergetická radioterapie normy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Introduction: Within an International Atomic Energy Agency (IAEA) co-ordinated research project (CRP), a remote end-to-end dosimetric quality audit for intensity modulated radiation therapy (IMRT)/ volumetric arc therapy (VMAT) was developed to verify the radiotherapy chain including imaging, treatment planning and dose delivery. The methodology as well as the results obtained in a multicentre pilot study and national trial runs conducted in close cooperation with dosimetry audit networks (DANs) of IAEA Member States are presented.Material and methods: A solid polystyrene phantom containing a dosimetry insert with an irregular solid water planning target volume (PTV) and organ at risk (OAR) was designed for this audit. The insert can be preloaded with radiochromic film and four thermoluminescent dosimeters (TLDs). For the audit, radiotherapy centres were asked to scan the phantom, contour the structures, create an IMRT/VMAT treatment plan and irradiate the phantom. The dose prescription was to deliver 4 Gy to the PTV in two fractions and to limit the OAR dose to a maximum of 2.8 Gy. The TLD measured doses and film measured dose distributions were compared with the TPS calculations.Results: Sixteen hospitals from 13 countries and 64 hospitals from 6 countries participated in the multicenter pilot study and in the national runs, respectively. The TLD results for the PTV were all within ±5% acceptance limit for the multicentre pilot study, whereas for national runs, 17 participants failed to meet this criterion. All measured doses in the OAR were below the treatment planning constraint. The film analysis identified seven plans in national runs below the 90% passing rate gamma criteria.Conclusion: The results proved that the methodology of the IMRT/VMAT dosimetric end-to-end audit was feasible for its intended purpose, i.e., the phantom design and materials were suitable; the phantom was easy to use and it was robust enough for shipment. Most importantly the audit methodology was capable of identifying suboptimal IMRT/VMAT delivery.
- MeSH
- celková dávka radioterapie MeSH
- fantomy radiodiagnostické * MeSH
- jaderná energie MeSH
- kritické orgány * MeSH
- lidé MeSH
- mezinárodní agentury MeSH
- pilotní projekty MeSH
- plánování radioterapie pomocí počítače metody MeSH
- počítačová rentgenová tomografie MeSH
- radiometrie metody normy MeSH
- radioterapie s modulovanou intenzitou metody normy MeSH
- revize kvality lékařské péče metody normy MeSH
- studie proveditelnosti MeSH
- zajištění kvality zdravotní péče MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Klíčová slova
- Atezolimumab, Nivolumab, Pembrolizumab Durvalumab, Avelumab,
- MeSH
- adjuvantní chemoterapie MeSH
- antigeny CD279 antagonisté a inhibitory MeSH
- cystektomie MeSH
- humanizované monoklonální protilátky terapeutické užití MeSH
- karboplatina škodlivé účinky terapeutické užití MeSH
- lidé MeSH
- metastázy nádorů farmakoterapie MeSH
- nádory močového měchýře * epidemiologie farmakoterapie patologie MeSH
- neoadjuvantní terapie MeSH
- protokoly antitumorózní kombinované chemoterapie škodlivé účinky MeSH
- radioterapie s modulovanou intenzitou normy MeSH
- staging nádorů metody MeSH
- Check Tag
- lidé MeSH
PURPOSE: To demonstrate an efficient method for training and validation of a knowledge-based planning (KBP) system as a radiation therapy clinical trial plan quality-control system. METHODS AND MATERIALS: We analyzed 86 patients with stage IB through IVA cervical cancer treated with intensity modulated radiation therapy at 2 institutions according to the standards of the INTERTECC (International Evaluation of Radiotherapy Technology Effectiveness in Cervical Cancer, National Clinical Trials Network identifier: 01554397) protocol. The protocol used a planning target volume and 2 primary organs at risk: pelvic bone marrow (PBM) and bowel. Secondary organs at risk were rectum and bladder. Initial unfiltered dose-volume histogram (DVH) estimation models were trained using all 86 plans. Refined training sets were created by removing sub-optimal plans from the unfiltered sample, and DVH estimation models… and DVH estimation models were constructed by identifying 30 of 86 plans emphasizing PBM sparing (comparing protocol-specified dosimetric cutpoints V10 (percentage volume of PBM receiving at least 10 Gy dose) and V20 (percentage volume of PBM receiving at least 20 Gy dose) with unfiltered predictions) and another 30 of 86 plans emphasizing bowel sparing (comparing V40 (absolute volume of bowel receiving at least 40 Gy dose) and V45 (absolute volume of bowel receiving at least 45 Gy dose), 9 in common with the PBM set). To obtain deliverable KBP plans, refined models must inform patient-specific optimization objectives and/or priorities (an auto-planning "routine"). Four candidate routines emphasizing different tradeoffs were composed, and a script was developed to automatically re-plan multiple patients with each routine. After selection of the routine that best met protocol objectives in the 51-patient training sample (KBPFINAL), protocol-specific DVH metrics and normal tissue complication probability were compared for original versus KBPFINAL plans across the 35-patient validation set. Paired t tests were used to test differences between planning sets. RESULTS: KBPFINAL plans outperformed manual planning across the validation set in all protocol-specific DVH cutpoints. The mean normal tissue complication probability for gastrointestinal toxicity was lower for KBPFINAL versus validation-set plans (48.7% vs 53.8%, P<.001). Similarly, the estimated mean white blood cell count nadir was higher (2.77 vs 2.49 k/mL, P<.001) with KBPFINAL plans, indicating lowered probability of hematologic toxicity. CONCLUSIONS: This work demonstrates that a KBP system can be efficiently trained and refined for use in radiation therapy clinical trials with minimal effort. This patient-specific plan quality control resulted in improvements on protocol-specific dosimetric endpoints.
- MeSH
- klinické zkoušky jako téma normy MeSH
- kostní dřeň MeSH
- kritické orgány * MeSH
- léčba šetřící orgány metody normy MeSH
- lidé MeSH
- močový měchýř MeSH
- nádory děložního čípku patologie radioterapie MeSH
- pánevní kosti MeSH
- plánování radioterapie pomocí počítače metody normy MeSH
- radioterapie s modulovanou intenzitou metody normy MeSH
- rektum MeSH
- řízení kvality * MeSH
- střeva MeSH
- tumor burden MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- validační studie MeSH
- MeSH
- brachyterapie normy přístrojové vybavení MeSH
- kraniální ozáření normy přístrojové vybavení MeSH
- lidé MeSH
- nádory * radioterapie MeSH
- paliativní péče normy MeSH
- péče o pacienta normy MeSH
- poskytování zdravotní péče normy MeSH
- radiační onkologie * normy organizace a řízení pracovní síly přístrojové vybavení MeSH
- radiační onkologové normy MeSH
- radiochirurgie normy přístrojové vybavení MeSH
- radioterapie s modulovanou intenzitou normy přístrojové vybavení MeSH
- radioterapie * normy přístrojové vybavení MeSH
- referenční standardy MeSH
- zdravotnický personál normy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- směrnice pro lékařskou praxi MeSH
- směrnice MeSH
- Klíčová slova
- volumetric modulated arc therapy, Octavius QA system,
- MeSH
- částice - urychlovače MeSH
- chyby nastavení radioterapie prevence a kontrola MeSH
- filmová dozimetrie přístrojové vybavení MeSH
- lidé MeSH
- nádory hlavy a krku radioterapie MeSH
- nádory prostaty radioterapie MeSH
- plánování radioterapie pomocí počítače * MeSH
- radiometrie normy přístrojové vybavení MeSH
- radioterapie s modulovanou intenzitou * metody normy přístrojové vybavení MeSH
- reprodukovatelnost výsledků MeSH
- řízení kvality * MeSH
- rotace MeSH
- záření gama MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- hodnotící studie MeSH
- MeSH
- chybná zdravotní péče prevence a kontrola MeSH
- klinické kompetence MeSH
- kontrolní seznam MeSH
- kvalita zdravotní péče normy MeSH
- lidé MeSH
- radiační poranění etiologie prevence a kontrola MeSH
- radioterapie s modulovanou intenzitou normy škodlivé účinky MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- uznání odborné způsobilosti normy MeSH
- Check Tag
- lidé MeSH
- MeSH
- celková dávka radioterapie normy MeSH
- financování organizované MeSH
- lékařská onkologie metody trendy MeSH
- lidé MeSH
- nádory prostaty MeSH
- plánování radioterapie pomocí počítače metody využití MeSH
- radioterapie s modulovanou intenzitou metody normy využití MeSH
- rektum účinky záření MeSH
- Check Tag
- lidé MeSH