AAPM task group report 314: Fault recovery in external beam radiation therapy.

Task Group (TG) 314 of the American Association of Physicists in Medicine (AAPM) was charged to develop guidance for recovering from fault states in radiation therapy, specifically regarding the delivery of photon or electron beams using a linear accelerator (linac) including ancillary systems. The fault conditions addressed may involve software, hardware, or a combination of causes. The report provides detailed recommendations for the proactive steps to be taken before a fault, the actions to be taken at the time of a fault, and the safety steps before returning a linac to clinical service, as well as the activities that device manufacturers and standard organizations can do to prevent and resolve the faults.

A case report on a novel use of intraoperative Intrabeam™ radiation therapy for a recurrent malignant peripheral nerve sheath tumor with sciatic nerve involvement.

Background: Malignant peripheral nerve sheath tumors (MPNST) are sarcomas that arise from peripheral nerves. They generally have a poor prognosis which is exacerbated by high local recurrence rates. This case report discusses the treatment of a patient with a MPNST with local recurrence.

Report of Task Group 201 of the American Association of Physicists in Medicine: Quality management of external beam therapy data transfer.

With the advancement of data-intensive technologies, such as image-guided radiation therapy (IGRT) and intensity-modulated radiation therapy (IMRT), the amount and complexity of data to be transferred between clinical subsystems have increased beyond the reach of manual checking. As a result, unintended treatment deviations (e.g.

Irradiator Commissioning and Dosimetry for Assessment of LQ α and β Parameters, Radiation Dosing Schema, and in vivo Dose Deposition.

Radiation dosimetry is critical in the accurate delivery and reproducibility of radiation schemes in preclinical models for high translational relevance. Prior to performing any in vitro or in vivo experiments, the specific dose output for the irradiator and individual experimental designs must be assessed. Using an ionization chamber, electrometer, and solid water setup, the dose output of wide fields at isocenter can be determined.

Impact of Tumor Size on Local Control and Pneumonitis After Stereotactic Body Radiation Therapy for Lung Tumors.

Purpose: Stereotactic body radiation therapy (SBRT) is commonly used to treat primary or oligometastatic malignancies in the lung, but most of the available data that describe the safety and efficacy of SBRT are for smaller tumors. The purpose of this study was to evaluate the impact of tumor size, among other factors, on local control (LC) and radiation pneumonitis (RP) in patients who received lung SBRT.

Methods And Materials: This retrospective study included 144 patients with 100 primary (57.

The dosimetric effects of limited elective nodal irradiation in volumetric modulated arc therapy treatment planning for locally advanced non-small cell lung cancer.

Objective: Contemporary radiotherapy guidelines for locally advanced non-small cell lung carcinoma (LA-NSCLC) recommend omitting elective nodal irradiation, despite the fact that evidence supporting this came primarily from older reports assessing comprehensive nodal coverage using 3D conformal techniques. Herein, we evaluated the dosimetric implications of the addition of limited elective nodal irradiation (LENI) to standard involved field irradiation (IFI) using volumetric modulated arc therapy (VMAT) planning.

Method: Target volumes and organs-at-risk (OARs) were delineated on CT simulation images of 20 patients with LA-NSCLC.

American Association of Physicists in Medicine Task Group 263: Standardizing Nomenclatures in Radiation Oncology.

A substantial barrier to the single- and multi-institutional aggregation of data to supporting clinical trials, practice quality improvement efforts, and development of big data analytics resource systems is the lack of standardized nomenclatures for expressing dosimetric data. To address this issue, the American Association of Physicists in Medicine (AAPM) Task Group 263 was charged with providing nomenclature guidelines and values in radiation oncology for use in clinical trials, data-pooling initiatives, population-based studies, and routine clinical care by standardizing: (1) structure names across image processing and treatment planning system platforms; (2) nomenclature for dosimetric data (eg, dose-volume histogram [DVH]-based metrics); (3) templates for clinical trial groups and users of an initial subset of software platforms to facilitate adoption of the standards; (4) formalism for nomenclature schema, which can accommodate the addition of other structures defined in the future. A multisociety, multidisciplinary, multinational group of 57 members representing stake holders ranging from large academic centers to community clinics and vendors was assembled, including physicists, physicians, dosimetrists, and vendors.

Lung diaphragm tracking in CBCT images using spatio-temporal MRF.

In EBRT in order to monitor the intra fraction motion of thoracic and abdominal tumors, one of the standard approaches is to use the lung diaphragm apex as an internal marker. However, tracking the position of the apex from image based observations is a challenging problem, as it undergoes both position and shape variation. The purpose of this paper is to propose an alternative method for tracking the ipsi-lateral hemidiaphragm apex (IHDA) position on Cone Beam Computed Tomography (CBCT) projection images.

Technology for Innovation in Radiation Oncology.

Radiation therapy is an effective, personalized cancer treatment that has benefited from technological advances associated with the growing ability to identify and target tumors with accuracy and precision. Given that these advances have played a central role in the success of radiation therapy as a major component of comprehensive cancer care, the American Society for Radiation Oncology (ASTRO), the American Association of Physicists in Medicine (AAPM), and the National Cancer Institute (NCI) sponsored a workshop entitled "Technology for Innovation in Radiation Oncology," which took place at the National Institutes of Health (NIH) in Bethesda, Maryland, on June 13 and 14, 2013. The purpose of this workshop was to discuss emerging technology for the field and to recognize areas for greater research investment.

Tumor control probability reduction in gated radiotherapy of non-small cell lung cancers: a feasibility study.

We studied the feasibility of evaluating tumor control probability (TCP) reductions for tumor motion beyond planned gated radiotherapy margins. Tumor motion was determined from cone-beam CT projections acquired for patient setup, intrafraction respiratory traces, and 4D CTs for five non-small cell lung cancer (NSCLC) patients treated with gated radiotherapy. Tumors were subdivided into 1 mm sections whose positions and doses were determined for each beam-on time point.

Equivalent-quality unflattened photon beam modeling, planning, and delivery.

The clinical application of the flattening filter-free photon beam (FFF) has enjoyed greater use due to its advantage of reduced treatment time because of the increased dose rate. Its unique beam characteristics, along with the very high-dose rate, require a thorough knowledge of the capability and accuracy in FFF beam modeling, planning, and delivery. This work verifies the feasibility of modeling an equivalent quality unflattened photon beam (eqUF), and the dosimetric accuracy in eqUF beam planning and delivery.

A new method of diaphragm apex motion detection from 2D projection images of mega-voltage cone beam CT.

To present a new method of estimating 3D positions of the ipsi-lateral hemi-diaphragm apex (IHDA) from 2D projection images of mega-voltage cone beam CT (MVCBCT). The detection framework reconstructs a 3D volume from all the 2D projection images. An initial estimated 3D IHDA position is determined in this volume based on an imaging processing pipeline, including Otsu thresholding, connected component labeling and template matching.

3D lung tumor motion model extraction from 2D projection images of mega-voltage cone beam CT via optimal graph search.

In this paper, we propose a novel method to convert segmentation of objects with quasi-periodic motion in 2D rotational cone beam projection images into an optimal 3D multiple interrelated surface detection problem, which can be solved by a graph search framework. The method is tested on lung tumor segmentation in projection images of mega-voltage cone beam CT (MVCBCT). A 4D directed graph is constructed based on an initialized tumor mesh model, where the cost value for this graph is computed from the point location of a silhouette outline of projected tumor mesh in 2D projection images.

Motion-compensated mega-voltage cone beam CT using the deformation derived directly from 2D projection images.

This paper presents a novel method for respiratory motion compensated reconstruction for cone beam computed tomography (CBCT). The reconstruction is based on a time sequence of motion vector fields, which is generated by a dynamic geometrical object shape model. The dynamic model is extracted from the 2D projection images of the CBCT.

Dosimetric properties of a beam quality-matched 6 MV unflattened photon beam.

The purpose of this study was to report the characteristics of an equivalent quality unflattened (eqUF) photon beam in clinical implementation and to provide a generalized method to describe unflattened (UF) photon beam profiles. An unflattened photon beam with a beam quality equivalent to the corresponding flat 6 MV photon beam (WF) was obtained by removing the flattening filter from a Siemens ONCOR Avant-Garde linear accelerator and adjusting the photon energy. A method independent from the WF beam profile was presented to describe UF beam profiles and other selected beam characteristics were examined.

SU-E-J-158: A Prototype of a Real-Time Respiratory Motion Monitoring System Using Microsoft Kinect Sensor.

Purpose: To investigate the feasibility of a low-cost respiratory motion monitoring system based on the Microsoft Xbox Kinect sensor.

Methods: We improved Kinect's inherent depth resolution from 1 cm to 1 mm via a motion magnification system. Using the Kinect software development kit, we programmed the Kinect to capture depth images and determine the average depth over a thoracic region of interest, viewed almost parallel to the subject's surface.

SU-E-T-191: PITSTOP: Process Improvement Techniques, Software Tools, and Operating Principles for a Quality Initiative Discovery Framework.

Purpose: To develop a quality initiative discovery framework using process improvement techniques, software tools and operating principles.

Methods: Process deviations are entered into a radiotherapy incident reporting database. Supervisors use an in-house Event Analysis System (EASy) to discuss incidents with staff.

MO-A-BRB-03: A Clinical Review of the Dosimetric and Temporal Impact of Unflattened X- Ray Beams.

Unlabelled: Since July of 2005, the University of Iowa has been using a conventional linear accelerator with the flattening filter removed. This presentation will focus on the factors affecting the dosimetric accuracy and total delivery time reduction found clinically of radiation therapy with an unfiattened beam, focusing on standard fractionation IMRT of the head and neck, as well as gated and hypo-fractionated liver and lung cancer treatments. The dosimetric accuracy of the unfiattened beam depends on the planning system beam model, which will be briefly reviewed.

A real-time respiratory motion monitoring system using KINECT: proof of concept.

Purpose: The purpose of this study is to investigate the feasibility of a low-cost respiratory motion monitoring system based on the Microsoft KINECT sensor.

Methods: The authors increased KINECT's inherent depth resolution from 1 cm to 1 mm via a motion magnification system. Using the KINECT software development kit, the authors programmed the KINECT to capture depth images and determine the average depth over a thoracic region of interest, viewed almost parallel to the subject's surface.

Feasibility of using respiratory correlated mega voltage cone beam computed tomography to measure tumor motion.

The purpose of this study was to test the feasibility of using respiratory correlated mega voltage cone-beam computed tomography (MVCBCT), taken during patient localization, to quantify the size and motion of lung tumors. An imaging phantom was constructed of a basswood frame embedded with six different-sized spherical pieces of paraffin wax. The Quasar respiratory motion phantom was programmed to move the imaging phantom using typical respiratory motion.

A rapid communication from the AAPM Task Group 201: recommendations for the QA of external beam radiotherapy data transfer. AAPM TG 201: quality assurance of external beam radiotherapy data transfer.

The transfer of radiation therapy data among the various subsystems required for external beam treatments is subject to error. Hence, the establishment and management of a data transfer quality assurance program is strongly recommended. It should cover the QA of data transfers of patient specific treatments, imaging data, manually handled data and historical treatment records.

Diaphragm motion quantification in megavoltage cone-beam CT projection images.

Purpose: To quantify diaphragm motion in megavoltage (MV) cone-beam computed tomography (CBCT) projections.

Methods: User identified ipsilateral hemidiaphragm apex (IHDA) positions in two full exhale and inhale frames were used to create bounding rectangles in all other frames of a CBCT scan. The bounding rectangle was enlarged to create a region of interest (ROI).