Room: Track 5
End to End (E2E) testing is a method to determine whether some system or process performs as required in the field: the testing is performed from start to finish under real-world conditions. It has been proposed that radiation therapy (RT) could benefit from adoption of E2E testing in the clinic, since RT inherently involves complex processes with multiple interchanges and modifications at various points based on decisions by clinical staff interpreting information acquired during the patient’s treatment course. Conventional physics QA does not necessarily validate the full overall treatment process.
To date radiotherapy E2E QA is mainly practiced via external independent auditing bodies such as IROC (Imaging and Radiation Oncology Core) which credentials institutions participating in NCI funded NCTN clinical trials or the U.T. MD Anderson Cancer Center Phantom Laboratory, which performs E2E audits for fee. This testing often includes irradiation of an anthropomorphic phantom containing treatment structures and dosimeters that are then assessed by the auditing centre to confirm the dose delivery is within specific criteria. The availability of commercial anthropomorphic phantoms, the ability to manufacture and 3D print phantoms locally, the advancement in radiation dosimeters, and the development of improved data analysis environments have opened the possibility for expanded in-house clinical E2E testing. Many centres have begun E2E testing processes in order to validate treatment processes as they commission and implement novel treatment techniques and delivery systems and to perform ongoing QA of treatment protocols once adopted.
In this session established users will review the development of E2E QA in various settings from institutional credentialing, through in-house development and approaches. The results from auditing bodies will be used to present a case motivating increased E2E QA, and experience from some cancer centres that have initiated internal E2E QA will be reviewed. The speakers will include discussion of some of the barriers and challenges to implementing E2E schemas.
1. review the lessons learned from over a decade of E2E testing,
2. review issues implementing E2E testing for novel delivery systems (such as MR-linacs, Halcyon, and in proton centers)
3. review implementation of E2E testing for various clinical and pre-clinical settings (multifocal SRS, FSRT, etc.)