• Journal of radiological science and technology
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• v.45 no.5
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• pp.439-448
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• 2022

The purpose of this study was to analyze the results from statistical process control (SPC) to recommend upper and lower control limits for planning parameters based on delivery quality assurance (DQA) results and establish our institutional guidelines regarding planning parameters for helical tomotherapy (HT). A total of 53 brain, 41 head and neck (H & N), and 51 pelvis cases who had passing or failing DQA measurements were selected. The absolute point dose difference (DD) and the global gamma passing rate (GPR) for all patients were analyzed. Control charts were used to evaluate upper and lower control limits (UCL and LCL) for all assessed treatment planning parameters. Treatment planning parameters were analyzed to provide its range for DQA pass cases. We confirmed that the probability of DQA failure was higher when the proportion of leaf open time (LOT) below 100 ms was greater than 30%. LOT and gantry period (GP) were significant predictor for DQA failure using the SPC method. We investigated the availability of the SPC statistic method to establish the local planning guideline based on DQA results for HT system. The guideline of each planning parameter in HT may assist in the prediction of DQA failure using the SPC statistic method in the future.

• Progress in Medical Physics
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• v.28 no.4
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• pp.181-189
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• 2017

The conventional delivery quality assurance (DQA) process for RapidArc (Varian Medical Systems, Palo Alto, USA), has the limitation that it measures and analyzes the dose in a phantom material and cannot analyze the dosimetric changes under the motional organ condition. In this study, a DQA method was designed to overcome the limitations of the conventional DQA process for internal target volume (ITV) based RapidArc. The dynamic DQA measurement device was designed with a moving phantom that can simulate variable target motions. The dose distribution in the real volume of the target and organ-at-risk (OAR)s were reconstructed using 3DVH with the ArcCHECK (SunNuclear, Melbourne, USA) measurement data under the dynamic condition. A total of 10 ITV-based RapidArc plans for liver-cancer patients were analyzed with the designed dynamic DQA process. The average pass rate of gamma evaluation was $81.55{\pm}9.48%$ when the DQA dose was measured in the respiratory moving condition of the patient. Appropriate method was applied to correct the effect of moving phantom structures in the dose calculation, and DVH data of the real volume of target and OARs were created with the recalculated dose by the 3DVH program. We confirmed the valid dose coverage of a real target volume in the ITV-based RapidArc. The variable difference of the DVH of the OARs showed that dose variation can occur differently according to the location, shape, size and motion range of the target. The DQA process devised in this study can effectively evaluate the DVH of the real volume of the target and OARs in a respiratory moving condition in addition to the simple verification of the accuracy of the treatment machine. This can be helpful to predict the prognosis of treatment by the accurate dose analysis in the real target and OARs.

• Journal of radiological science and technology
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• v.46 no.3
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• pp.231-238
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• 2023

This study aimed to compare the results of delivery quality assurance (DQA) using MapCHECK and OCTAVIUS for radiation therapy. Thirty patients who passed the DQA results were retrospectively included in this study. The point dose difference (DD) and gamma passing rate (GPR) were analyzed to evaluate the agreement between the measured and planned data for all cases, Plan complexity was evaluated to analyze dosimetric accuracy by quantifying the degree of modulation according to each plan. We analyzed the monitor units (MUs) and total MUs for each plan to evaluate the correlation between the MUs and plan complexity. We used a paired t-test to compare the DD and GPRs that were obtained using the two devices. The DDs and GPRs were within the tolerance range for all cases. The average GPRs difference between the two devices was statistically significant for the brain, and head and neck for gamma criteria of 3%/3 mm and 2%/2 mm. There was no significant correlation between the modulation index and total MUs for any of the cases. These DQA devices can be used interchangeably for routine patient-specific QA in radiation therapy.

• Journal of radiological science and technology
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• v.45 no.6
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• pp.491-502
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• 2022

The purpose of this study was to retrospectively investigate the upper and lower control limits of treatment planning parameters using EBT film based delivery quality assurance (DQA) results and to analyze the results of statistical process control (SPC) in helical tomotherapy (HT). A total of 152 patients who passed or failed DQA results were retrospectively included in this study. Prostate (n = 66), rectal (n = 51), and large-field cancer patients, including lymph nodes (n = 35), were randomly selected. The absolute point dose difference (DD) and global gamma passing rate (GPR) were analyzed for all patients. Control charts were used to evaluate the upper and lower control limits (UCL and LCL) for all the assessed treatment planning parameters. Treatment planning parameters such as gantry period, leaf open time (LOT), pitch, field width, actual and planning modulation factor, treatment time, couch speed, and couch travel were analyzed to provide the optimal range using the DQA results. The classification and regression tree (CART) was used to predict the relative importance of variables in the DQA results from various treatment planning parameters. We confirmed that the proportion of patients with an LOT below 100 ms in the failure group was relatively higher than that in the passing group. SPC can detect QA failure prior to over dosimetric QA tolerance levels. The acceptable tolerance range of each planning parameter may assist in the prediction of DQA failures using the SPC tool in the future.

• Progress in Medical Physics
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• v.21 no.4
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• pp.340-347
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• 2010

DQA, a patient specific quality assurance in tomotherapy, is usually performed using an ion chamber and a film. The result of DQA is analysed with the treatment planning system called Tomo Planning Station (TomoPS). The two-dimensional dose distribution of film measurement is compared with the dose distribution calculated by TomoPS using the ${\gamma}$-index analysis. In ${\gamma}$-index analysis, the criteria such as 3%/3 mm is used and we verify that whether the rate of number of points which pass the criteria (pass rate) is within tolerance. TomoPS does not provide any quantitative information regarding the pass rate. In this work, a method to get the pass rate of the ${\gamma}$-index analysis was suggested and a software PassRT which calculates the pass rate was developed. The results of patient specific QA of the intensity modulated radiation therapy measured with I'mRT MatriXX (IBA Dosimetry, Germany) and DQA of tomotherapy measured with film were used to verify the proposed method. The pass rate was calculated using PassRT and compared with the pass rate calculated by OmniPro I'mRT (IBA Dosimetry, Germany). The average difference between the two pass rates was 0.00% for the MatriXX measurement. The standard deviation and the maximum difference were 0.02% and 0.02%, respectively. For the film measurement, average difference, standard deviation and maximum difference were 0.00%, 0.02% and 0.02%, respectively. For regions of interest smaller than $24.3{\times}16.6cm^2$ the proposed method can be used to calculate the pass rate of the gamma index analysis to one decimal place and will be helpful for the more accurate DQA in tomotherapy.

• 대한방사선방어학회:학술대회논문집
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• 2011.11a
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• pp.340-341
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• 2011

• Progress in Medical Physics
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• v.26 no.2
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• pp.87-92
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• 2015

The gated RapidArc may produce a dosimetric error due to the stop-and-go motion of heavy gantry which can misalign the gantry restart position and reduce the accuracy of important factors in RapidArc delivery such as MLC movement and gantry speed. In this study, the effect of stop-and-go motion in gated RapidArc was analyzed with varying gating window time, which determines the total number of stop-and-go motions. Total 10 RapidArc plans for treatment of liver cancer were prepared. The RPM gating system and the moving phantom were used to set up the accurate gating window time. Two different delivery quality assurance (DQA) plans were created for each RapidArc plan. One is the portal dosimetry plan and the other is MapCHECK2 plan. The respiratory cycle was set to 4 sec and DQA plans were delivered with three different gating conditions: no gating, 1-sec gating window, and 2-sec gating window. The error between calculated dose and measured dose was evaluated based on the pass rate calculated using the gamma evaluation method with 3%/3 mm criteria. The average pass rates in the portal dosimetry plans were $98.72{\pm}0.82%$, $94.91{\pm}1.64%$, and $98.23{\pm}0.97%$ for no gating, 1-sec gating, and 2-sec gating, respectively. The average pass rates in MapCHECK2 plans were $97.80{\pm}0.91%$, $95.38{\pm}1.31%$, and $97.50{\pm}0.96%$ for no gating, 1-sec gating, and 2-sec gating, respectively. We verified that the dosimetric accuracy of gated RapidArc increases as gating window time increases and efforts should be made to increase gating window time during the RapidArc treatment process.

• The Journal of Korean Society for Radiation Therapy
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• v.23 no.2
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• pp.109-117
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• 2011

Purpose: To analyze the accuracy of tumor volume dose following field width change, to check the difference of dose change by using self-made moving car, and to evaluate practical delivery tumor dose when tomotherapy in the treatment of organ influenced by breathing. Materials and Methods: By using self-made moving car, the difference of longitudinal movement (0.0 cm, 1.0 cm, 1.5 cm, 2.0 cm) was applied and compared calculated dose with measured dose according to change of field width (1.05 cm, 2.50 cm, 5.02 cm) and apprehended margin of error. Then done comparative analysis in degree of photosensitivity of DQA film measured by using Gafchromic EBT film. Dose profile and Gamma histogram were used to measure degree of photosensitivity of DQA film. Results: When field width were 1.05 cm, 2.50 cm, 5.02 cm, margin of error of dose delivery coefficient was -2.00%, -0.39%, -2.55%. In dose profile of Gafchromic EBT film's analysis, the movement of moving car had greater motion toward longitudinal direction and as field width was narrower, big error increased considerably at high dose part compared to calculated dose. The more field width was narrowed, gamma index had a large considerable influence of moving at gamma histogram. Conclusion: We could check the difference of longitudinal dose of moving organ. In order to small field width and minimize organ moving due to breathing, it is thought to be needed to develop breathing control unit and fixation tool.

• Progress in Medical Physics
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• v.21 no.4
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• pp.323-331
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• 2010

The Hi-Art system for TomoTherapy allows only three (1.0 cm, 2.5 cm, 5.0 cm) field widths and this can produce different dose distribution around the end of PTV (Planning target volume) in the direction of jaw movement. In this study, we investigated the effect of field width on the dose difference around the PTV using DQA (Delivery quality assurance) phantom and real clinical patient cases. In the analysis with DQA phantom, the calculated dose and irradiated films showed that the more dose was widely spreaded out in the end region of PTV as increase of field width. The 2.5 cm field width showed a 1.6 cm wider dose profile and the 5.0 cm field width showed a 4.2 cm wider dose profile compared with the 1.0 cm field width in the region of 50% of maximum dose. The analysis with four patient cases also showed the similar results with the DQA phantom which means that more dose was irradiated around the superior and inferior end of PTV as an increase of field width. The 5.0 cm field width produced the remarkable high dose distribution around the end region of PTV and we could evaluate the effect quantitatively with the calculation of DVH (Dose volume histogram) of the virtual PTVs which were delineated around the end of PTV in the direction of jaw variation. From these results, we could verify that the margin for PTV in the direction of table movement should be reduced compared with the conventional margin for PTV when the large field such as 5.0 cm was used in TomoTherapy.

• The Journal of Korean Society for Radiation Therapy
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• v.32
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• pp.53-59
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• 2020

Purpose: The purpose of this study is to compare and analyze the difference between the MLC log file-based software (Mobius) and the conventional phantom-ionization chamber (ArcCheck) dose verification method according to the change of target volume. Material and method: Radius 0.25cm, 0.5cm, 1cm, 2cm, 3cm, 4cm, 5cm, 6cm, 7cm, 8cm, 9cm, 10cm with a Sphere-shaped target Twelve plans were created and dose verification using Mobius and ArcCheck was conducted three times each. The irradiated data were compared and analyzed using the point dose error value and the gamma passing rate (3%/3mm) as evaluation indicators. Result: Mobius point dose error values were -9.87% at a radius of 0.25cm and -4.39% at 0.5cm, and the error value was within 3% at the remaining target volume. The gamma passing rate was 95% at a radius of 9cm and 93.9% at 10cm, and a passing rate of more than 95% was shown in the remaining target volume. In ArcCheck, the average error value of the point dose was about 2% in all target volumes. The gamma passing rate also showed a pass rate of 98% or more in all target volumes. Conclusion: For small targets with a radius of 0.5cm or less or a large target with a radius of 9cm or more, considering the uncertainty of DQA based on MLC log files, phantom-ionized DQA is used in complementary ways to include point dose, gamma index, DVH, and target coverage. It is believed that it is desirable to verify the dose delivery through a comprehensive analysis.