Examining credentialing criteria and poor performance indicators for IROC Houston’s anthropomorphic head and neck phantom
Purpose: To analyze the most recent results of the Imaging and Radiation Oncology Core Houston Quality Assurance Center’s (IROC-H) anthropomorphic head and neck (H&N) phantom to determine the nature of failing irradiations and the feasibility of altering credentialing criteria. Methods: IROC-H’s...
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| Veröffentlicht in: | Medical physics (Lancaster) 2016-12, Vol.43 (12), p.6491-6496 |
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| creator | Carson, Mallory E. Molineu, Andrea Taylor, Paige A. Followill, David S. Stingo, Francesco C. Kry, Stephen F. |
| description | Purpose:
To analyze the most recent results of the Imaging and Radiation Oncology Core Houston Quality Assurance Center’s (IROC-H) anthropomorphic head and neck (H&N) phantom to determine the nature of failing irradiations and the feasibility of altering credentialing criteria.
Methods:
IROC-H’s H&N phantom, used for intensity-modulated radiation therapy credentialing for National Cancer Institute–sponsored clinical trials, requires that an institution’s treatment plan agrees within ±7% of measured thermoluminescent dosimeter (TLD) doses; it also requires that ≥85% of pixels pass ±4 mm distance to agreement (7%/4 mm gamma analysis for film). The authors re-evaluated 156 phantom irradiations (November 1, 2014–October 31, 2015) according to the following tighter criteria: (1) 5% TLD and 5%/4 mm, (2) 5% TLD and 5%/3 mm, (3) 4% TLD and 4%/4 mm, and (4) 3% TLD and 3%/3 mm. Failure rates were evaluated with respect to individual film and TLD performance by location in the phantom. Overall poor phantom results were characterized qualitatively as systematic errors (correct shape and position but wrong magnitude of dose), setup errors/positional shifts, global but nonsystematic errors, and errors affecting only a local region.
Results:
The pass rate for these phantoms using current criteria was 90%. Substituting criteria 1–4 reduced the overall pass rate to 77%, 70%, 63%, and 37%, respectively. Statistical analyses indicated that the probability of noise-induced TLD failure, even at the 5% criterion, was 58% of the time (11/16 and 21/36 cases, respectively), with a greater extent due to underdosing. Setup/positioning errors were seen in 11%–13% of all failing cases (2/16 and 4/36 cases, respectively). Local errors (8/36 cases) could only be demonstrated at criteria 1. Only three cases of global errors were identified in these analyses. For current criteria and criteria 1, irradiations that failed from film only were overwhelmingly associated with phantom shifts/setup errors (≥80% of cases).
Conclusions:
This study highlighted that the majority of phantom failures are the result of systematic dosimetric discrepancies between the treatment planning system and the delivered dose. Further work is nece |
| doi_str_mv | 10.1118/1.4967344 |
| format | Article |
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To analyze the most recent results of the Imaging and Radiation Oncology Core Houston Quality Assurance Center’s (IROC-H) anthropomorphic head and neck (H&N) phantom to determine the nature of failing irradiations and the feasibility of altering credentialing criteria.
Methods:
IROC-H’s H&N phantom, used for intensity-modulated radiation therapy credentialing for National Cancer Institute–sponsored clinical trials, requires that an institution’s treatment plan agrees within ±7% of measured thermoluminescent dosimeter (TLD) doses; it also requires that ≥85% of pixels pass ±4 mm distance to agreement (7%/4 mm gamma analysis for film). The authors re-evaluated 156 phantom irradiations (November 1, 2014–October 31, 2015) according to the following tighter criteria: (1) 5% TLD and 5%/4 mm, (2) 5% TLD and 5%/3 mm, (3) 4% TLD and 4%/4 mm, and (4) 3% TLD and 3%/3 mm. Failure rates were evaluated with respect to individual film and TLD performance by location in the phantom. Overall poor phantom results were characterized qualitatively as systematic errors (correct shape and position but wrong magnitude of dose), setup errors/positional shifts, global but nonsystematic errors, and errors affecting only a local region.
Results:
The pass rate for these phantoms using current criteria was 90%. Substituting criteria 1–4 reduced the overall pass rate to 77%, 70%, 63%, and 37%, respectively. Statistical analyses indicated that the probability of noise-induced TLD failure, even at the 5% criterion, was <0.5%. Phantom failures were generally identified by TLD (≥66% failed TLD, whereas ≥55% failed film), with most failures occurring in the primary planning target volume (≥77% of cases). Results failing current criteria or criteria 1 were primarily diagnosed as systematic >58% of the time (11/16 and 21/36 cases, respectively), with a greater extent due to underdosing. Setup/positioning errors were seen in 11%–13% of all failing cases (2/16 and 4/36 cases, respectively). Local errors (8/36 cases) could only be demonstrated at criteria 1. Only three cases of global errors were identified in these analyses. For current criteria and criteria 1, irradiations that failed from film only were overwhelmingly associated with phantom shifts/setup errors (≥80% of cases).
Conclusions:
This study highlighted that the majority of phantom failures are the result of systematic dosimetric discrepancies between the treatment planning system and the delivered dose. Further work is necessary to diagnose and resolve such dosimetric inaccuracy. In addition, the authors found that 5% TLD and 5%/4 mm gamma criteria may be both practically and theoretically achievable as an alternative to current criteria.</description><identifier>ISSN: 0094-2405</identifier><identifier>EISSN: 2473-4209</identifier><identifier>DOI: 10.1118/1.4967344</identifier><identifier>PMID: 27908168</identifier><identifier>CODEN: MPHYA6</identifier><language>eng</language><publisher>United States: American Association of Physicists in Medicine</publisher><subject>anthropomorphic phantom ; Cancer ; Credentialing ; Dose‐volume analysis ; dosimetry ; Electric measurements ; Error analysis ; Failure analysis ; Feasibility Studies ; Head - anatomy & histology ; Humans ; IMRT ; Intensity modulated radiation therapy ; IROC ; measurement errors ; Measuring radiation intensity ; Medical imaging ; Medical treatment planning ; Neck - anatomy & histology ; phantoms ; Phantoms, Imaging - standards ; Probability theory, stochastic processes, and statistics ; quality assurance ; Quality assurance in radiotherapy ; Quality Control ; radiation therapy ; Radiotherapy, Intensity-Modulated - instrumentation ; Scintigraphy ; statistical analysis ; THERAPEUTIC INTERVENTIONS ; Thermal analysis ; thermoluminescent dosimeters</subject><ispartof>Medical physics (Lancaster), 2016-12, Vol.43 (12), p.6491-6496</ispartof><rights>American Association of Physicists in Medicine</rights><rights>2016 The Authors. Published by American Association of Physicists in Medicine and John Wiley & Sons Ltd.</rights><rights>2016 American Association of Physicists in Medicine. 2016 American Association of Physicists in Medicine</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5494-bfaf70b5675406c87e8b2d2b50eaf429e990d1aea7b311bf9e8a1ebb168c97963</citedby><cites>FETCH-LOGICAL-c5494-bfaf70b5675406c87e8b2d2b50eaf429e990d1aea7b311bf9e8a1ebb168c97963</cites><orcidid>0000-0001-6780-4458</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1118%2F1.4967344$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1118%2F1.4967344$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27908168$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Carson, Mallory E.</creatorcontrib><creatorcontrib>Molineu, Andrea</creatorcontrib><creatorcontrib>Taylor, Paige A.</creatorcontrib><creatorcontrib>Followill, David S.</creatorcontrib><creatorcontrib>Stingo, Francesco C.</creatorcontrib><creatorcontrib>Kry, Stephen F.</creatorcontrib><title>Examining credentialing criteria and poor performance indicators for IROC Houston’s anthropomorphic head and neck phantom</title><title>Medical physics (Lancaster)</title><addtitle>Med Phys</addtitle><description>Purpose:
To analyze the most recent results of the Imaging and Radiation Oncology Core Houston Quality Assurance Center’s (IROC-H) anthropomorphic head and neck (H&N) phantom to determine the nature of failing irradiations and the feasibility of altering credentialing criteria.
Methods:
IROC-H’s H&N phantom, used for intensity-modulated radiation therapy credentialing for National Cancer Institute–sponsored clinical trials, requires that an institution’s treatment plan agrees within ±7% of measured thermoluminescent dosimeter (TLD) doses; it also requires that ≥85% of pixels pass ±4 mm distance to agreement (7%/4 mm gamma analysis for film). The authors re-evaluated 156 phantom irradiations (November 1, 2014–October 31, 2015) according to the following tighter criteria: (1) 5% TLD and 5%/4 mm, (2) 5% TLD and 5%/3 mm, (3) 4% TLD and 4%/4 mm, and (4) 3% TLD and 3%/3 mm. Failure rates were evaluated with respect to individual film and TLD performance by location in the phantom. Overall poor phantom results were characterized qualitatively as systematic errors (correct shape and position but wrong magnitude of dose), setup errors/positional shifts, global but nonsystematic errors, and errors affecting only a local region.
Results:
The pass rate for these phantoms using current criteria was 90%. Substituting criteria 1–4 reduced the overall pass rate to 77%, 70%, 63%, and 37%, respectively. Statistical analyses indicated that the probability of noise-induced TLD failure, even at the 5% criterion, was <0.5%. Phantom failures were generally identified by TLD (≥66% failed TLD, whereas ≥55% failed film), with most failures occurring in the primary planning target volume (≥77% of cases). Results failing current criteria or criteria 1 were primarily diagnosed as systematic >58% of the time (11/16 and 21/36 cases, respectively), with a greater extent due to underdosing. Setup/positioning errors were seen in 11%–13% of all failing cases (2/16 and 4/36 cases, respectively). Local errors (8/36 cases) could only be demonstrated at criteria 1. Only three cases of global errors were identified in these analyses. For current criteria and criteria 1, irradiations that failed from film only were overwhelmingly associated with phantom shifts/setup errors (≥80% of cases).
Conclusions:
This study highlighted that the majority of phantom failures are the result of systematic dosimetric discrepancies between the treatment planning system and the delivered dose. Further work is necessary to diagnose and resolve such dosimetric inaccuracy. In addition, the authors found that 5% TLD and 5%/4 mm gamma criteria may be both practically and theoretically achievable as an alternative to current criteria.</description><subject>anthropomorphic phantom</subject><subject>Cancer</subject><subject>Credentialing</subject><subject>Dose‐volume analysis</subject><subject>dosimetry</subject><subject>Electric measurements</subject><subject>Error analysis</subject><subject>Failure analysis</subject><subject>Feasibility Studies</subject><subject>Head - anatomy & histology</subject><subject>Humans</subject><subject>IMRT</subject><subject>Intensity modulated radiation therapy</subject><subject>IROC</subject><subject>measurement errors</subject><subject>Measuring radiation intensity</subject><subject>Medical imaging</subject><subject>Medical treatment planning</subject><subject>Neck - anatomy & histology</subject><subject>phantoms</subject><subject>Phantoms, Imaging - standards</subject><subject>Probability theory, stochastic processes, and statistics</subject><subject>quality assurance</subject><subject>Quality assurance in radiotherapy</subject><subject>Quality Control</subject><subject>radiation therapy</subject><subject>Radiotherapy, Intensity-Modulated - instrumentation</subject><subject>Scintigraphy</subject><subject>statistical analysis</subject><subject>THERAPEUTIC INTERVENTIONS</subject><subject>Thermal analysis</subject><subject>thermoluminescent dosimeters</subject><issn>0094-2405</issn><issn>2473-4209</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp9kc9u1DAQhy0EokvhwAsgHwEpre3YSXxBQqtCKxUVIThbtjNpDIkd7Gz_iAuvwevxJJhmuypCcLLs-ebz_DQIPaXkgFLaHNIDLqu65PweWjFelwVnRN5HK0IkLxgnYg89SukzIaQqBXmI9lgtSUOrZoW-HV3p0Xnnz7GN0IKfnR6Wm5shOo21b_EUQsQTxC7EUXsL2PnWWT2HmHB-wycfztb4OGzSHPzP7z9Sbpr7GKYwhjj1zuIedHtj8mC_4KnP9TA-Rg86PSR4sj330ac3Rx_Xx8Xp2duT9evTwgqeA5hOdzUxoqoFJ5VtamgMa5kRBHTHmQQpSUs16NqUlJpOQqMpGJPzWVnLqtxHrxbvtDEjtDaHjHpQU3SjjtcqaKf-rHjXq_NwoQQlFWd1FjzfCmL4uoE0q9ElC8OgPeTQijZcNEywG_TFgtoYUorQ7b6hRP1elqJqu6zMPrs714683U4GigW4dANc_9uk3r3fCl8ufLJu1rMLftdzEeIdfmq7_8F_j_oLZ2C9dg</recordid><startdate>201612</startdate><enddate>201612</enddate><creator>Carson, Mallory E.</creator><creator>Molineu, Andrea</creator><creator>Taylor, Paige A.</creator><creator>Followill, David S.</creator><creator>Stingo, Francesco C.</creator><creator>Kry, Stephen F.</creator><general>American Association of Physicists in Medicine</general><scope>AJDQP</scope><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-6780-4458</orcidid></search><sort><creationdate>201612</creationdate><title>Examining credentialing criteria and poor performance indicators for IROC Houston’s anthropomorphic head and neck phantom</title><author>Carson, Mallory E. ; Molineu, Andrea ; Taylor, Paige A. ; Followill, David S. ; Stingo, Francesco C. ; Kry, Stephen F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5494-bfaf70b5675406c87e8b2d2b50eaf429e990d1aea7b311bf9e8a1ebb168c97963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>anthropomorphic phantom</topic><topic>Cancer</topic><topic>Credentialing</topic><topic>Dose‐volume analysis</topic><topic>dosimetry</topic><topic>Electric measurements</topic><topic>Error analysis</topic><topic>Failure analysis</topic><topic>Feasibility Studies</topic><topic>Head - anatomy & histology</topic><topic>Humans</topic><topic>IMRT</topic><topic>Intensity modulated radiation therapy</topic><topic>IROC</topic><topic>measurement errors</topic><topic>Measuring radiation intensity</topic><topic>Medical imaging</topic><topic>Medical treatment planning</topic><topic>Neck - anatomy & histology</topic><topic>phantoms</topic><topic>Phantoms, Imaging - standards</topic><topic>Probability theory, stochastic processes, and statistics</topic><topic>quality assurance</topic><topic>Quality assurance in radiotherapy</topic><topic>Quality Control</topic><topic>radiation therapy</topic><topic>Radiotherapy, Intensity-Modulated - instrumentation</topic><topic>Scintigraphy</topic><topic>statistical analysis</topic><topic>THERAPEUTIC INTERVENTIONS</topic><topic>Thermal analysis</topic><topic>thermoluminescent dosimeters</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Carson, Mallory E.</creatorcontrib><creatorcontrib>Molineu, Andrea</creatorcontrib><creatorcontrib>Taylor, Paige A.</creatorcontrib><creatorcontrib>Followill, David S.</creatorcontrib><creatorcontrib>Stingo, Francesco C.</creatorcontrib><creatorcontrib>Kry, Stephen F.</creatorcontrib><collection>AIP Open Access Journals</collection><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Medical physics (Lancaster)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Carson, Mallory E.</au><au>Molineu, Andrea</au><au>Taylor, Paige A.</au><au>Followill, David S.</au><au>Stingo, Francesco C.</au><au>Kry, Stephen F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Examining credentialing criteria and poor performance indicators for IROC Houston’s anthropomorphic head and neck phantom</atitle><jtitle>Medical physics (Lancaster)</jtitle><addtitle>Med Phys</addtitle><date>2016-12</date><risdate>2016</risdate><volume>43</volume><issue>12</issue><spage>6491</spage><epage>6496</epage><pages>6491-6496</pages><issn>0094-2405</issn><eissn>2473-4209</eissn><coden>MPHYA6</coden><abstract>Purpose:
To analyze the most recent results of the Imaging and Radiation Oncology Core Houston Quality Assurance Center’s (IROC-H) anthropomorphic head and neck (H&N) phantom to determine the nature of failing irradiations and the feasibility of altering credentialing criteria.
Methods:
IROC-H’s H&N phantom, used for intensity-modulated radiation therapy credentialing for National Cancer Institute–sponsored clinical trials, requires that an institution’s treatment plan agrees within ±7% of measured thermoluminescent dosimeter (TLD) doses; it also requires that ≥85% of pixels pass ±4 mm distance to agreement (7%/4 mm gamma analysis for film). The authors re-evaluated 156 phantom irradiations (November 1, 2014–October 31, 2015) according to the following tighter criteria: (1) 5% TLD and 5%/4 mm, (2) 5% TLD and 5%/3 mm, (3) 4% TLD and 4%/4 mm, and (4) 3% TLD and 3%/3 mm. Failure rates were evaluated with respect to individual film and TLD performance by location in the phantom. Overall poor phantom results were characterized qualitatively as systematic errors (correct shape and position but wrong magnitude of dose), setup errors/positional shifts, global but nonsystematic errors, and errors affecting only a local region.
Results:
The pass rate for these phantoms using current criteria was 90%. Substituting criteria 1–4 reduced the overall pass rate to 77%, 70%, 63%, and 37%, respectively. Statistical analyses indicated that the probability of noise-induced TLD failure, even at the 5% criterion, was <0.5%. Phantom failures were generally identified by TLD (≥66% failed TLD, whereas ≥55% failed film), with most failures occurring in the primary planning target volume (≥77% of cases). Results failing current criteria or criteria 1 were primarily diagnosed as systematic >58% of the time (11/16 and 21/36 cases, respectively), with a greater extent due to underdosing. Setup/positioning errors were seen in 11%–13% of all failing cases (2/16 and 4/36 cases, respectively). Local errors (8/36 cases) could only be demonstrated at criteria 1. Only three cases of global errors were identified in these analyses. For current criteria and criteria 1, irradiations that failed from film only were overwhelmingly associated with phantom shifts/setup errors (≥80% of cases).
Conclusions:
This study highlighted that the majority of phantom failures are the result of systematic dosimetric discrepancies between the treatment planning system and the delivered dose. Further work is necessary to diagnose and resolve such dosimetric inaccuracy. In addition, the authors found that 5% TLD and 5%/4 mm gamma criteria may be both practically and theoretically achievable as an alternative to current criteria.</abstract><cop>United States</cop><pub>American Association of Physicists in Medicine</pub><pmid>27908168</pmid><doi>10.1118/1.4967344</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0001-6780-4458</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Medical physics (Lancaster), 2016-12, Vol.43 (12), p.6491-6496 |
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| source | MEDLINE; Wiley Journals; Alma/SFX Local Collection |
| subjects | anthropomorphic phantom Cancer Credentialing Dose‐volume analysis dosimetry Electric measurements Error analysis Failure analysis Feasibility Studies Head - anatomy & histology Humans IMRT Intensity modulated radiation therapy IROC measurement errors Measuring radiation intensity Medical imaging Medical treatment planning Neck - anatomy & histology phantoms Phantoms, Imaging - standards Probability theory, stochastic processes, and statistics quality assurance Quality assurance in radiotherapy Quality Control radiation therapy Radiotherapy, Intensity-Modulated - instrumentation Scintigraphy statistical analysis THERAPEUTIC INTERVENTIONS Thermal analysis thermoluminescent dosimeters |
| title | Examining credentialing criteria and poor performance indicators for IROC Houston’s anthropomorphic head and neck phantom |
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