(Sunday, 4/5/2020) 4:30 PM - 5:30 PM [Mountain Time (GMT-6)]
AAPM Task Group 314 – Guidance for Fault Recovery in Radiation Therapy
Presenting Author: Steven Sutlief
Contributing Authors: Courtney Buckey, Bruce Curran, Tom Dwyer, Scott Hadley, Geoffrey Ibbott, Susan Koehl, Cristina Negrut, David Perrin, Ian Robertson, Jie Shi, Ramon Alfredo Siochi, Sugata Tripathi, Cheryl Young
Abstract:
AAPM Task Group 314 is being written to address recovery from fault states in radiation therapy, especially at the time faults occur and in anticipation of potential faults. Our report will focus specifically on contemporary techniques for photon or electron beam delivery using a linear accelerator. During the presentation we will review key themes in this project. Before downtime occurs, it is important to have a policy about tests to perform before return to clinical service, to enable vendor remote access to the device consistent with local policy, and to maintain records of previous faults and periodic maintenance. At the point of down time, it is important that therapists and physicists act within their scope of practice when investigating the fault, that steps be taken to document transient messages and behaviors, and that treatment options be promptly considered should the downtime extend for an unknown duration. Before return to clinical service, it is important to follow manufacturer’s guidance, especially if changes necessitate reauthorization of beams for clinical use, and to accurately document the solution for use if the fault repeats in the future.
Learning objectives:
1) Delineate essential steps one should take to prevent and mitigate clinical disruption due to linac faults.
2) Describe essential steps one should take once a fault occurs to minimize downtime, estimate its duration, and assess best actions for recovery.
3) Review steps to ensure safe return to clinical operation, including verification of machine performance and data integrity.
AAPM Task Group 312 -- Acceptance Testing, Commissioning and Periodic Quality Assurance of Ion Chamber and Diode Detector Arrays
Presenting Author: Sotirios Stathakis
Contributing Authors: Kyle Antes, Vladimir Feygelman, Song Gao, Pamela Myers, Mary Napolitano, Ganesh Narayanasamy, Bjoern Poppe, Adam Riegel, Timothy Ritter, Jie Shi
Abstract:
Multidimensional arrays have been adopted in radiation therapy clinics by medical physicists for various types of measurements. Common applications of such devices include patient-specific plan quality assurance (QA) measurements, periodic QA measurements for constancy checks of beam flatness and symmetry, as well as dose and beam quality constancy checks. The multidimensional arrays vary in terms of their size, detector types, and usage. The task group is creating a report to provide guidelines to the users on initial and ongoing performance assessments that should be performed to ensure proper functionality. The characteristics of the most common detector arrays will be provided along with their intended use. After reading this report, the user should understand how to assess the detector array’s performance and proceed with its use. Although several different detector systems can be used for patient QA as well as for beam constancy measurements (e.g. Electronic Portal Imaging Devices, film, transmission detectors, etc), the focus is solely on detector arrays that may be placed on top of the treatment couch. The report is not intended to provide a comprehensive review of machine quality assurance procedures or patient-specific IMRT QA.
Learning objectives:
1) Understand how to assess the system’s performance
2) Testing guidelines for periodic QA of the system
3) Be familiar with the characteristics and use of the currently available systems.
Task Group No. 308 - Clinical Implementation of Data-driven Quality Control and Automated Treatment Planning
Presenting Author: Kevin Moore
Contributing Authors: Jorge Alpuche Aviles, Yves Archambault, Mariel Cornell, James Kavanaugh, Jessica Lowenstein, Martha Matuszak, Todd McNutt, Jeff Michalski, Lindsey Olsen, Thomas Purdie, Wilko Verbakel, Binbin Wu, Qing-Rong Jackie Wu
Abstract:
It is the goal of this task group to develop guidelines and recommendations for the training, validation, ongoing maintenance, and quality control of data-driven approaches to treatment planning. There will be special focus on the clinical demands of implementing automated planning. The following topics will be discussed in this session:
1) General principles behind patient-specific dose prediction
2) Recommendations for data requirements for knowledge-based modeling training sets and planning libraries.
3) Recommendations for analyzing knowledge-based dose prediction accuracy and quantifying model error.
4) Recommendations for quality assurance of model training sets.
5) Clinically implementing dose predictions for treatment plan quality control.
6) Recommendations for conversion of dose predictions into IMRT/VMAT optimization objectives and priorities, i.e. final automated planning routines.
7) Recommendations for pre-clinical validation of automated planning routines.
8) Recommendations for testing, validating, and assessing benefits/risks of externally sourced knowledge-based planning routines.
9) Recommendations for ongoing post-clinical maintenance of knowledge-based planning systems
Learning Objectives:
1) Understand the current framework around clinical implementation of data-driven plan quality control
2) Understand the testing and validation of data-driven automated planning
3) Understand how to safely clinically implement automated planning systems
AAPM Task Group 327 – Crowd-sourced solutions to the problem of wrong shift instructions
Presenting Author: Ryan Manger
Contributing Authors: Gary Ezzell, Sheri Weintraub, Deborah Schofield, Jacqueline Faught, and Gwe-Ya Kim
Abstract:
One of the most common errors in the treatment planning process is providing the wrong treatment isocenter setup information to therapists. This has been found in prospective hazard analyses (e.g., Ford et al., 2009) and in the Radiation Oncology Incident Learning System (RO-ILS) (Ezzell et al., 2018). Considering the high risk of this error, Task Group 327 was created with the purpose of crowdsourcing solutions to the problem of wrong shift instructions. TG-327 solicited solutions to the seven error pathways of an incorrect treatment isocenter:
1) Patient marked incorrectly in sim
2) IGRT reference images created with wrong isocenter
3) IGRT reference images created from wrong dataset
4) Shift instructions are not created
5) Shift instructions manually calculated or transcribed incorrectly
6) Origin/Reference point marked incorrectly in planning
7) Patient orientation label incorrect in planning CT
Solutions could be submitted via email, over the phone, or face-to-face (e.g. at a chapter meeting). Participants preferred submitting solutions via email instead of phone or face-to-face. Ultimately, 17 solutions were submitted. 12 of these were distinct solutions. Automation was a common theme among the solutions.
Learning Objectives:
1) Know some of the common error pathways leading to wrong shift instructions being sent to therapists.
2) Understand how TG-327 conducted their crowdsourcing effort – what worked and what were some of the challenges.
Note: Because many of these TGs are currently a work in progress and will be under review at the time of presentation, no finalized recommendations will be made. However, the draft key recommendations of the submitted reports will be discussed.
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