Sharbacha S Edward1, Paola E Alvarez2, Paige A Taylor1, H Andrea Molineu2, Christine B Peterson3, David S Followill1, Stephen F Kry4. 1. The University of Texas MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston TX 77030; IROC Houston Quality Assurance Center, The University of Texas MD Anderson Cancer Center, Houston TX 77030; Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston TX 77030. 2. IROC Houston Quality Assurance Center, The University of Texas MD Anderson Cancer Center, Houston TX 77030; Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston TX 77030. 3. The University of Texas MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston TX 77030; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston TX 77030. 4. The University of Texas MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston TX 77030; IROC Houston Quality Assurance Center, The University of Texas MD Anderson Cancer Center, Houston TX 77030; Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston TX 77030. Electronic address: sfkry@mdanderson.org.
Abstract
PURPOSE: To investigate and classify the reasons why institutions fail the Imaging and Radiation Oncology Core (IROC) SBRT spine and moving lung phantoms, which are used to credential institutions for clinical trial participation. METHODS: All IROC moving lung and SBRT spine phantom irradiation failures recorded from January 2012 to December 2018 were evaluated in this study. A failure was a case where the institution did not meet the established IROC criteria for agreement between planned and delivered dose. We analyzed the reports for all failing irradiations, including point dose disagreement, dose profiles, and gamma analyses. Classes of failure patterns were created and used to categorize each instance. RESULTS: There were 158 failing cases analyzed: 116 of 1052 total lung irradiations and 42 of 263 total spine irradiations. Seven categories were required to describe the lung phantom failures, while four were required for the spine. Types of errors present in both phantom groups included: "systematic dose" and "localization" errors. Fifty percent of lung failures were due to a superior-inferior (SI) localization error, i.e., error in the direction of major motion. Systematic dose errors however, contributed to only 22% of lung failures. In contrast, the majority (60%) of spine phantom failures were due to systematic dose errors, with localization errors (in any direction) accounting for only 14% of failures. CONCLUSION: There were two distinct patterns of failure between the IROC moving lung and SBRT spine phantoms. The majority of the lung phantom failures were due to localization errors, whereas the spine phantom failures were largely attributed to systematic dose errors. Both of these errors are clinically relevant and could manifest as errors in patient cases. These findings highlight the value of independent end-to-end dosimetry audits, and can help guide the community in improving the quality of radiation therapy by focusing attention on where errors manifest in the community.
PURPOSE: To investigate and classify the reasons why institutions fail the Imaging and Radiation Oncology Core (IROC) SBRT spine and moving lung phantoms, which are used to credential institutions for clinical trial participation. METHODS: All IROC moving lung and SBRT spine phantom irradiation failures recorded from January 2012 to December 2018 were evaluated in this study. A failure was a case where the institution did not meet the established IROC criteria for agreement between planned and delivered dose. We analyzed the reports for all failing irradiations, including point dose disagreement, dose profiles, and gamma analyses. Classes of failure patterns were created and used to categorize each instance. RESULTS: There were 158 failing cases analyzed: 116 of 1052 total lung irradiations and 42 of 263 total spine irradiations. Seven categories were required to describe the lung phantom failures, while four were required for the spine. Types of errors present in both phantom groups included: "systematic dose" and "localization" errors. Fifty percent of lung failures were due to a superior-inferior (SI) localization error, i.e., error in the direction of major motion. Systematic dose errors however, contributed to only 22% of lung failures. In contrast, the majority (60%) of spine phantom failures were due to systematic dose errors, with localization errors (in any direction) accounting for only 14% of failures. CONCLUSION: There were two distinct patterns of failure between the IROC moving lung and SBRT spine phantoms. The majority of the lung phantom failures were due to localization errors, whereas the spine phantom failures were largely attributed to systematic dose errors. Both of these errors are clinically relevant and could manifest as errors in patient cases. These findings highlight the value of independent end-to-end dosimetry audits, and can help guide the community in improving the quality of radiation therapy by focusing attention on where errors manifest in the community.
Authors: Sharbacha S Edward; Mallory C Glenn; Christine B Peterson; Peter A Balter; Julianne M Pollard-Larkin; Rebecca M Howell; David S Followill; Stephen F Kry Journal: Med Phys Date: 2020-06-23 Impact factor: 4.071
Authors: Kelsey L Corrigan; Stephen Kry; Rebecca M Howell; Ramez Kouzy; Joseph Abi Jaoude; Roshal R Patel; Anuja Jhingran; Cullen Taniguchi; Albert C Koong; Mary Fran McAleer; Paige Nitsch; Claus Rödel; Emmanouil Fokas; Bruce D Minsky; Prajnan Das; C David Fuller; Ethan B Ludmir Journal: Radiother Oncol Date: 2021-11-25 Impact factor: 6.280
Authors: Mallory C Glenn; Fre'Etta Brooks; Christine B Peterson; Rebecca M Howell; David S Followill; Julianne M Pollard-Larkin; Stephen F Kry Journal: Radiother Oncol Date: 2021-11-05 Impact factor: 6.280
Authors: Mark W Geurts; Dustin J Jacqmin; Lindsay E Jones; Stephen F Kry; Dimitris N Mihailidis; Jared D Ohrt; Timothy Ritter; Jennifer B Smilowitz; Nicholai E Wingreen Journal: J Appl Clin Med Phys Date: 2022-08-10 Impact factor: 2.243