Real-time analysis and display of quantitative measures to track and improve clinical workflow.

Purpose: Radiotherapy treatment planning is a complex process with multiple, dependent steps involving an interdisciplinary patient care team. Effective communication and real-time tracking of resources and care path activities are key for clinical efficiency and patient safety.

Materials And Methods: We designed and implemented a secure, interactive web-based dashboard for patient care path, clinical workflow, and resource utilization management.

AAPM Task Group 198 Report: An implementation guide for TG 142 quality assurance of medical accelerators.

The charges on this task group (TG) were as follows: (a) provide specific procedural guidelines for performing the tests recommended in TG 142; (b) provide estimate of the range of time, appropriate personnel, and qualifications necessary to complete the tests in TG 142; and (c) provide sample daily, weekly, monthly, or annual quality assurance (QA) forms. Many of the guidelines in this report are drawn from the literature and are included in the references. When literature was not available, specific test methods reflect the experiences of the TG members (e.

Quantifying risk using FMEA: An alternate approach to AAPM TG-100 for scoring failures and evaluating clinical workflow.

Purpose: Renovation of the brachytherapy program at a leading cancer center utilized methods of the AAPM TG-100 report to objectively evaluate current clinical brachytherapy workflows and develop techniques for minimizing the risk of failures, increasing efficiency, and consequently providing opportunities for improved treatment quality. The TG-100 report guides evaluation of clinical workflows with recommendations for identifying potential failure modes (FM) and scoring them from the perspective of their occurrence frequency O, failure severity S, and inability to detect them D. The current study assessed the impact of differing methods to determine the risk priority number (RPN) beyond simple multiplication.

Validation of a Monte Carlo model for multi leaf collimator based electron delivery.

Purpose: To develop and validate a Monte Carlo model of the Varian TrueBeam to study electron collimation using the existing photon multi-leaf collimators (pMLC), instead of conventional electron applicators and apertures.

Materials And Methods: A complete Monte Carlo model of the Varian TrueBeam was developed using Tool for particle simulation (TOPAS) (version 3.1.

Novel and programmatic improvements to the workflow associated with the AccuBoost breast brachytherapy procedure.

Purpose: While the noninvasive breast brachytherapy (NIBB) treatment procedure, known as AccuBoost, for breast cancer patients is well established, the treatment quality can be improved by the efficiency of the workflow delivery. A formalized approach evaluated the current workflow through failure modes and effects analysis and generated insight for developing new procedural workflow techniques to improve the clinical treatment process.

Methods And Materials: AccuBoost treatments were observed for several months while gathering details on the multidisciplinary workflow.

Performance of clinicopathologic models in men with high risk localized prostate cancer: impact of a 22-gene genomic classifier.

Background: Prostate cancer exhibits biological and clinical heterogeneity even within established clinico-pathologic risk groups. The Decipher genomic classifier (GC) is a validated method to further risk-stratify disease in patients with prostate cancer, but its performance solely within National Comprehensive Cancer Network (NCCN) high-risk disease has not been undertaken to date.

Methods: A multi-institutional retrospective study of 405 men with high-risk prostate cancer who underwent primary treatment with radical prostatectomy (RP) or radiation therapy (RT) with androgen-deprivation therapy (ADT) at 11 centers from 1995 to 2005 was performed.

NRG Oncology medical physicists' manpower survey quantifying support demands for multi-institutional clinical trials.

Purpose: A survey was created by NRG to assess a medical physicists' percent full time equivalent (FTE) contribution to multi-institutional clinical trials. A 2012 American Society for Radiation Oncology report, "Safety Is No Accident," quantified medical physics staffing contributions in FTE factors for clinical departments. No quantification of FTE effort associated with clinical trials was included.

Accuracy evaluation of a six-degree-of-freedom couch using cone beam CT and IsoCal phantom with an in-house algorithm.

Purpose: The accuracy of a six degree of freedom (6DoF) couch was evaluated using a novel method.

Methods: Cone beam CT (CBCT) images of a 3D phantom (IsoCal) were acquired with different, known combinations of couch pitch and roll angles. Pitch and roll angles between the maximum allowable values of 357 and 3 degrees were tested in one degree increments.

Measured Neutron Spectra and Dose Equivalents From a Mevion Single-Room, Passively Scattered Proton System Used for Craniospinal Irradiation.

Purpose: To measure, in the setting of typical passively scattered proton craniospinal irradiation (CSI) treatment, the secondary neutron spectra, and use these spectra to calculate dose equivalents for both internal and external neutrons delivered via a Mevion single-room compact proton system.

Methods And Materials: Secondary neutron spectra were measured using extended-range Bonner spheres for whole brain, upper spine, and lower spine proton fields. The detector used can discriminate neutrons over the entire range of the energy spectrum encountered in proton therapy.

Commissioning and initial experience with the first clinical gantry-mounted proton therapy system.

The purpose of this study is to describe the comprehensive commissioning process and initial clinical experience of the Mevion S250 proton therapy system, a gantry-mounted, single-room proton therapy platform clinically implemented in the S. Lee Kling Proton Therapy Center at Barnes-Jewish Hospital in St. Louis, MO, USA.

The impact of CT scan energy on range calculation in proton therapy planning.

The purpose of this study was to investigate the impact of tube potential (kVp) on the CT number (HU) to proton stopping power ratio (PSPR) conversion. The range and dosimetric change introduced by a mismatch in kVp used for the CT scan and the HU to PSPR table, based on a specific kVp, used to calculate dose are analyzed. Three HU to PSPR curves, corresponding to three kVp settings on the CT scanner, were created.

Monitor unit calculations for external photon and electron beams: Report of the AAPM Therapy Physics Committee Task Group No. 71.

A protocol is presented for the calculation of monitor units (MU) for photon and electron beams, delivered with and without beam modifiers, for constant source-surface distance (SSD) and source-axis distance (SAD) setups. This protocol was written by Task Group 71 of the Therapy Physics Committee of the American Association of Physicists in Medicine (AAPM) and has been formally approved by the AAPM for clinical use. The protocol defines the nomenclature for the dosimetric quantities used in these calculations, along with instructions for their determination and measurement.

Evaluation of neutron dose equivalent from the Mevion S250 proton accelerator: measurements and calculations.

Neutron production is of concern for proton therapy, especially for passive scattering proton beam delivery methods. The levels of neutron dose equivalent vary significantly with system design and treatment parameters. The purpose of this study was to examine neutron dose equivalent per therapeutic dose (H/D) around the Mevion S250 proton therapy system, a novel design of proton therapy systems.