Establishing a framework for best practices for quality assurance and quality control in untargeted metabolomics.

BACKGROUND: Quality assurance (QA) and quality control (QC) practices are key tenets that facilitate study and data quality across all applications of untargeted metabolomics. These important practices will strengthen this field and accelerate its success. The Best Practices Working Group (WG) within the Metabolomics Quality Assurance and Quality Control Consortium (mQACC) focuses on community use of QA/QC practices and protocols and aims to identify, catalogue, harmonize, and disseminate current best practices in untargeted metabolomics through community-driven activities. AIM OF REVIEW: A present goal of the Best Practices WG is to develop a working strategy, or roadmap, that guides the actions of practitioners and progress in the field. The framework in which mQACC operates promotes the harmonization and dissemination of current best QA/QC practice guidance and encourages widespread adoption of these essential QA/QC activities for liquid chromatography-mass spectrometry. KEY SCIENTIFIC CONCEPTS OF REVIEW: Community engagement and QA/QC information gathering activities have been occurring through conference workshops, virtual and in-person interactive forum discussions, and community surveys. Seven principal QC stages prioritized by internal discussions of the Best Practices WG have received participant input, feedback and discussion. We outline these stages, each involving a multitude of activities, as the framework for identifying QA/QC best practices. The ultimate planned product of these endeavors is a "living guidance" document of current QA/QC best practices for untargeted metabolomics that will grow and change with the evolution of the field.

Image quality characterization of an ultra-high-speed kilovoltage cone-beam computed tomography imaging system on an O-ring linear accelerator.

PURPOSE: The quality of on-board imaging systems, including cone-beam computed tomography (CBCT), plays a vital role in image-guided radiation therapy (IGRT) and adaptive radiotherapy. Recently, there has been an upgrade of the CBCT systems fused in the O-ring linear accelerators called HyperSight, featuring a high imaging performance. As the characterization of a new imaging system is essential, we evaluated the image quality of the HyperSight system by comparing it with Halcyon 3.0 CBCT and providing benchmark data for routine imaging quality assurance. METHODS: The HyperSight features ultra-fast scan time, a larger kilovoltage (kV) detector, a more substantial kV tube, and an advanced reconstruction algorithm. Imaging protocols in the two modes of operation, treatment mode with IGRT and the CBCT for planning (CBCTp) mode were evaluated and compared with Halcyon 3.0 CBCT. Image quality metrics, including spatial resolution, contrast resolution, uniformity, noise, computed tomography (CT) number linearity, and calibration error, were assessed using a Catphan and an electron density phantom and analyzed with TotalQA software. RESULTS: HyperSight demonstrated substantial improvements in contrast-to-noise ratio and noise in both IGRT and CBCTp modes compared to Halcyon 3.0 CBCT. CT number calibration error of HyperSight CBCTp mode (1.06%) closely matches that of a full CT scanner (0.72%), making it suitable for adaptive planning. In addition, the advanced hardware of HyperSight, such as ultra-fast scan time (5.9 s) or 2.5 times larger heat unit capacity, enhanced the clinical efficiency in our experience. CONCLUSIONS: HyperSight represented a significant advancement in CBCT imaging. With its image quality, CT number accuracy, and ultra-fast scans, HyperSight has a potential to transform patient care and treatment outcomes. The enhanced scan speed and image quality of HyperSight are expected to significantly improve the quality and efficiency of treatment, particularly benefiting patients.

Application of the ESHO-QA guidelines for determining the performance of the LCA superficial hyperthermia heating system.

PURPOSE: This study aimed to assess the quality of the lucite cone applicator (LCA), the standard applicator for superficial hyperthermia at the Erasmus MC Cancer Institute, using the most recent quality assurance guidelines, thus verifying their feasibility. MATERIALS AND METHODS: The assessment was conducted on each of the six LCAs available for clinical treatments. The temperature distribution was evaluated using an infrared camera across different layers of a fat-muscle mimicking phantom. The maximum temperature increase, thermal effective penetration depth (TEPD), and thermal effective field size (TEFS) were used as quality metrics. The experimental results were validated through comparison with simulated results, using a canonical phantom model and a realistic phantom model segmented from CT imaging. RESULTS: A maximum temperature increase above 6 °C at 2 cm depth in the fat-muscle phantom for all the experiments was found. A mean negative difference between simulated and experimental data was of 1.3 °C when using the canonical phantom model. This value decreased to a mean negative difference of 0.4 °C when using the realistic model. Simulated and measured TEPD showed good agreement for both in silico scenarios, while discrepancies were present for TEFS. CONCLUSIONS: The LCAs passed all QA guidelines requirements for superficial hyperthermia delivery when used singularly or in an array configuration. A further characterization of parameters such as antenna efficiency and heat transfer coefficients would be beneficial for translating experimental results to simulated values. Implementing the QA guidelines was time-consuming and demanding, requiring careful preparation and correct setup of antenna elements.

Evaluation and improvement of angular response for a commercial 2D detector array for patient-specific QA.

PURPOSE: MatriXX ionization chamber array has been widely used for the composite dose verification of IMRT/VMAT plans. However, in addition to its dose response dependence on gantry angle, there seems to be an offset between the beam axis and measured dose profile by MatriXX for oblique beam incidence at various gantry angles, leading to unnecessary quality assurance (QA) fails. In this study, we investigated the offset at various setup conditions and how to eliminate or decrease it to improve the accuracy of MatriXX for IMRT/VMAT plan verification with original gantry angles. METHODS: We measured profiles for a narrow beam with MatriXX located at various depths in increments of 0.5 mm from the top to bottom of the sensitive volume of the array detectors and gantry angles from 0° to 360°. The optimal depth for QA measurement was determined at the depth where the measured profile had minimum offset. RESULTS: The measured beam profile offset varies with incident gantry angle, increasing from vertical direction to lateral direction, and could be over 3 cm at vendor-recommended depth for near lateral direction beams. The offset also varies with depth, and the minimum offset (almost 0 for most oblique beams) was found to be at a depth of ∼2.5 mm below the vendor suggested depth, which was chosen as the optimal depth for all QA measurements. Using the optimal depth we determined, QA results (3%/2 mm Gamma analysis) were largely improved with an average of 99.4% gamma passing rate (no fails for 95% criteria) for 10 IMRT and VMAT plans with original gantry angles compared to 94.1% using the vendor recommended depth. CONCLUSIONS: The improved accuracy and passing rate for QA measurement performed at the optimal depth with original gantry angles would lead to reduction in unnecessary repeated QA or plan changes due to QA system errors.

A hybrid method to improve efficiency of patient specific SRS and SBRT QA using 3D secondary dose verification.

PURPOSE: Patient Specific QA (PSQA) by direct phantom measurement for all intensity modulated radiation therapy (IMRT) cases is labor intensive and an inefficient use of the Medical Physicist's time. The purpose of this work was to develop a hybrid quality assurance (QA) technique utilizing 3D dose verification as a screening tool to determine if a measurement is necessary. METHODS: This study utilized Sun Nuclear DoseCHECK (DC), a 3D secondary verification software, and Fraction 0, a trajectory log IMRT QA software. Twenty-two Lung stereotactic body radiation therapy (SBRT) and thirty single isocentre multi-lesion SRS (MLSRS) plans were retrospectively analysed in DC. Agreement of DC and the TPS dose for selected dosimetric criteria was recorded. Calculated 95% confidence limits (CL) were used to establish action limits. All cases were delivered and measured using the Sun Nuclear stereotactic radiosurgery (SRS) MapCheck. Trajectory logs of the delivery were used to calculate Fraction 0 results for the same criteria calculated by DC. Correlation of DC and Fraction 0 results were calculated. Phantom measured QA was compared to Fraction 0 QA results for the cases which had DC criteria action limits exceeded. RESULTS: Correlation of DC and Fraction 0 results were excellent, demonstrating the same action limits could be used for both and DC can predict Fraction 0 results. Based on the calculated action limits, zero lung SBRT cases and six MLSRS cases were identified as requiring a measurement. All plans that passed the DC screening had a passing measurement based PSQA and agreed with Fraction 0 results. CONCLUSION: Using 95% CL action limits of dosimetric criteria, a 3D secondary dose verification can be used to determine if a measurement is required for PSQA. This method is efficient for it is part of the normal clinical workflow when verifying any clinical treatment. In addition, it can drastically reduce the number of measurements needed for PSQA.

Quality assurance and quality control reporting in untargeted metabolic phenotyping: mQACC recommendations for analytical quality management.

BACKGROUND: Demonstrating that the data produced in metabolic phenotyping investigations (metabolomics/metabonomics) is of good quality is increasingly seen as a key factor in gaining acceptance for the results of such studies. The use of established quality control (QC) protocols, including appropriate QC samples, is an important and evolving aspect of this process. However, inadequate or incorrect reporting of the QA/QC procedures followed in the study may lead to misinterpretation or overemphasis of the findings and prevent future metanalysis of the body of work. OBJECTIVE: The aim of this guidance is to provide researchers with a framework that encourages them to describe quality assessment and quality control procedures and outcomes in mass spectrometry and nuclear magnetic resonance spectroscopy-based methods in untargeted metabolomics, with a focus on reporting on QC samples in sufficient detail for them to be understood, trusted and replicated. There is no intent to be proscriptive with regard to analytical best practices; rather, guidance for reporting QA/QC procedures is suggested. A template that can be completed as studies progress to ensure that relevant data is collected, and further documents, are provided as on-line resources. KEY REPORTING PRACTICES: Multiple topics should be considered when reporting QA/QC protocols and outcomes for metabolic phenotyping data. Coverage should include the role(s), sources, types, preparation and uses of the QC materials and samples generally employed in the generation of metabolomic data. Details such as sample matrices and sample preparation, the use of test mixtures and system suitability tests, blanks and technique-specific factors are considered and methods for reporting are discussed, including the importance of reporting the acceptance criteria for the QCs. To this end, the reporting of the QC samples and results are considered at two levels of detail: "minimal" and "best reporting practice" levels.

Insensitivity of machine log files to MLC leaf backlash and effect of MLC backlash on clinical dynamic MLC motion: An experimental investigation.

PURPOSE: Multi-leaf-collimator (MLC) leaf position accuracy is important for accurate dynamic radiotherapy treatment plan delivery. Machine log files have become widely utilized for quality assurance (QA) of such dynamic treatments. The primary aim is to test the sensitivity of machine log files in comparison to electronic portal imaging device (EPID)-based measurements to MLC position errors caused by leaf backlash. The secondary aim is to investigate the effect of MLC leaf backlash on MLC leaf motion during clinical dynamic plan delivery. METHODS: The sensitivity of machine log files and two EPID-based measurements were assessed via a controlled experiment, whereby the length of the "T" section of a series of 12 MLC leaf T-nuts in a Varian Millennium MLC for a Trilogy C-series type linac was reduced by sandpapering the top of the "T" to introduce backlash. The built-in machine MLC leaf backlash test as well as measurements for two EPID-based dynamic MLC positional tests along with log files were recorded pre- and post-T-nut modification. All methods were investigated for sensitivity to the T-nut change by assessing the effect on measured MLC leaf positions. A reduced version of the experiment was repeated on a TrueBeam type linac with Millennium MLC. RESULTS: No significant differences before and after T-nut modification were detected in any of the log file data. Both EPID methods demonstrated sensitivity to the introduced change at approximately the expected magnitude with a strong dependence observed with gantry angle. EPID-based data showed MLC positional error in agreement with the micrometer measured T-nut length change to 0.07 ± 0.05 mm (1 SD) using the departmental routine QA test. Backlash results were consistent between linac types. CONCLUSION: Machine log files appear insensitive to MLC position errors caused by MLC leaf backlash introduced via the T-nut. The effect of backlash on clinical MLC motions is heavily gantry angle dependent.

Determination of the electronic portal imaging device pixel-sensitivity-map for quality assurance applications. Part 1: Comparison of methods.

PURPOSE: Calibration of a radiotherapy electronic portal imaging device (EPID) using the pixel-sensitivity-map (PSM) in place of the flood field correction improves the utility of the EPID for quality assurance applications. Multiple methods are available for determining the PSM and this study provides an evaluation to inform on which is superior. METHODS: Three different empirical methods ("Calvary Mater Newcastle" [CMN], "Varian," and "WashU") and a Monte Carlo-based method of PSM determination were investigated on a single Varian TrueBeam STx linear accelerator (linac) with an aS1200 EPID panel. PSM measurements were performed for each empirical method three successive times using the 6 MV beam. The resulting PSM from each method was compared to the Monte Carlo method as a reference using 2D percentage deviation maps and histograms plus crossplane profiles. The repeatability of generated PSMs was also assessed via 2D standard deviation (SD) maps and histograms. Additionally, the Beam-Response generated by removal of the PSM from a raw EPID image for each method was visually contrasted. Finally, the practicality of each method was assessed qualitatively and via the measured time required to acquire and export the required images. RESULTS: The median pixel-by-pixel percentage deviation between each of the empirical PSM methods and the Monte Carlo PSM was -0.36%, 0.24%, and 0.74% for the CMN, Varian, and WashU methods, respectively. Ninety-five percent of pixels were found to be repeatable to within -0.21%, 0.08%, 0.19%, and 0.35% (1 SD) for the CMN, Monte Carlo, Varian, and WashU methods, respectively. The WashU method was found to be quickest for data acquisition and export and the CMN the slowest. CONCLUSION: For the first time four methods of generating the EPID PSM have been compared in detail and strengths and weaknesses of each method have been identified. All methods are considered likely to be clinically acceptable and with similar practical requirements.

Is AI the Ultimate QA?

We are among the many that believe that artificial intelligence will not replace practitioners and is most valuable as an adjunct in diagnostic radiology. We suggest a different approach to utilizing the technology, which may help even radiologists who may be averse to adopting AI. A novel method of leveraging AI combines computer vision and natural language processing to ambiently function in the background, monitoring for critical care gaps. This AI Quality workflow uses a visual classifier to predict the likelihood of a finding of interest, such as a lung nodule, and then leverages natural language processing to review a radiologist's report, identifying discrepancies between imaging and documentation. Comparing artificial intelligence predictions with natural language processing report extractions with artificial intelligence in the background of computer-aided detection decisions may offer numerous potential benefits, including streamlined workflow, improved detection quality, an alternative approach to thinking of AI, and possibly even indemnity against malpractice. Here we consider early indications of the potential of artificial intelligence as the ultimate quality assurance for radiologists.

Evaluation of two-dimensional electronic portal imaging device using integrated images during volumetric modulated arc therapy for prostate cancer.

BACKGROUND: The aim of the study was to evaluate analysis criteria for the identification of the presence of rectal gas during volumetric modulated arc therapy (VMAT) for prostate cancer patients by using electronic portal imaging device (EPID)-based in vivo dosimetry (IVD). MATERIALS AND METHODS: All measurements were performed by determining the cumulative EPID images in an integrated acquisition mode and analyzed using PerFRACTION commercial software. Systematic setup errors were simulated by moving the anthropomorphic phantom in each translational and rotational direction. The inhomogeneity regions were also simulated by the I'mRT phantom attached to the Quasar phantom. The presence of small and large air cavities (12 and 48 cm3) was controlled by moving the Quasar phantom in several timings during VMAT. Sixteen prostate cancer patients received EPID-based IVD during VMAT. RESULTS: In the phantom study, no systematic setup error was detected in the range that can happen in clinical (< 5-mm and < 3 degree). The pass rate of 2% dose difference (DD2%) in small and large air cavities was 98.74% and 79.05%, respectively, in the appearance of the air cavity after irradiation three quarter times. In the clinical study, some fractions caused a sharp decline in the DD2% pass rate. The proportion for DD2% < 90% was 13.4% of all fractions. Rectal gas was confirmed in 11.0% of fractions by acquiring kilo-voltage X-ray images after the treatment. CONCLUSIONS: Our results suggest that analysis criteria of 2% dose difference in EPID-based IVD was a suitable method for identification of rectal gas during VMAT for prostate cancer patients.

A multi-institution study: comparison of the heating patterns of five different MR-guided deep hyperthermia systems using an anthropomorphic phantom.

INTRODUCTION: Within the hyperthermia community, consensus exists that clinical outcome of the treatment radiotherapy and/or chemotherapy plus hyperthermia (i.e. elevating tumor temperature to 40 - 44 °C) is related to the applied thermal dose; hence, treatment quality is crucial for the success of prospective multi-institution clinical trials. Currently, applicator quality assurance (QA) measurements are implemented independently at each institution using basic cylindrical phantoms. A multi-institution comparison of heating quality using magnetic resonance thermometry (MRT) and anatomical representative anthropomorphic phantoms provides a unique opportunity to obtain novel QA insights to facilitate multi-institution trial evaluation. OBJECTIVE: Perform a systematic QA procedure to compare the performance of MR-compatible hyperthermia systems in five institutions. METHODS AND MATERIALS: Anthropomorphic phantoms, including pelvic and spinal bones, were produced. Clinically relevant power of 600 watts was applied for ∼12 min to allow for 8 sequential MR-scans. The 3D-heating distribution, steering capabilities, and presence of off-target heating were analyzed. RESULTS: The evaluated devices show comparable heating profiles for centric and eccentric targets. The differences observed in the 3D-heating profiles are the result of variations in the exact phantom positioning and applicator characteristics, whereby positioning of the phantom followed current ESHO-QA guidelines. CONCLUSION: Anthropomorphic phantoms were used to perform QA-measurements of MR-guided hyperthermia systems operating in MR-scanners of different brands. Comparable heating profiles are shown for the five evaluated institutions. Subcentimeter differences in position substantially affected the results when evaluating the heating patterns. Integration of advanced phantoms and precise positioning in QA-guidelines should be evaluated to guarantee the best quality patient care.

Towards quality assurance and quality control in untargeted metabolomics studies.

We describe here the agreed upon first development steps and priority objectives of a community engagement effort to address current challenges in quality assurance (QA) and quality control (QC) in untargeted metabolomic studies. This has included (1) a QA and QC questionnaire responded to by the metabolomics community in 2015 which recommended education of the metabolomics community, development of appropriate standard reference materials and providing incentives for laboratories to apply QA and QC; (2) a 2-day 'Think Tank on Quality Assurance and Quality Control for Untargeted Metabolomic Studies' held at the National Cancer Institute's Shady Grove Campus and (3) establishment of the Metabolomics Quality Assurance and Quality Control Consortium (mQACC) to drive forward developments in a coordinated manner.

A multi-institutional evaluation of machine performance check system on treatment beam output and symmetry using statistical process control.

BACKGROUND: The automated and integrated machine performance check (MPC) tool was verified against independent detectors to evaluate its beam uniformity and output detection abilities to consider it suitable for daily quality assurance (QA). METHODS: Measurements were carried out on six linear accelerators (each located at six individual sites) using clinically available photon and electron energies for a period up to 12 months (n = 350). Daily constancy checks on beam symmetry and output were compared against independent devices such as the SNC Daily QA 3, PTW Farmer ionization chamber, and SNC field size QA phantom. MPC uniformity detection of beam symmetry adjustments was also assessed. Sensitivity of symmetry and output measurements were assessed using statistical process control (SPC) methods to derive tolerances for daily machine QA and baseline resets to account for drifts in output readings. I-charts were used to evaluate systematic and nonsystematic trends to improve error detection capabilities based on calculated upper and lower control levels (UCL/LCL) derived using standard deviations from the mean dataset. RESULTS: This study investigated the vendor's method of uniformity detection. Calculated mean uniformity variations were within ± 0.5% of Daily QA 3 vertical symmetry measurements. Mean MPC output variations were within ± 1.5% of Daily QA 3 and ±0.5% of Farmer ionization chamber detected variations. SPC calculated UCL values were a measure of change observed in the output detected for both MPC and Daily QA 3. CONCLUSIONS: Machine performance check was verified as a daily quality assurance tool to check machine output and symmetry while assessing against an independent detector on a weekly basis. MPC output detection can be improved by regular SPC-based trend analysis to measure drifts in the inherent device and control systematic and random variations thereby increasing confidence in its capabilities as a QA device. A 3-monthly MPC calibration assessment was recommended based on SPC capability and acceptability calculations.

Dosimetric and Monte Carlo verification of jaws-only IMRT plans calculated by the Collapsed Cone Convolution algorithm for head and neck cancers.

AIM: The aim of this study is to verify the Prowess Panther jaws-only intensity modulated radiation therapy (JO-IMRT) treatment planning (TP) by comparing the TP dose distributions for head-and-neck (H&N) cancer with the ones simulated by Monte Carlo (MC). BACKGROUND: To date, dose distributions planned using JO-IMRT for H&N patients were found superior to the corresponding three-dimensional conformal radiotherapy (3D-CRT) plans. Dosimetry of the JO-IMRT plans were also experimentally verified using an ionization chamber, MapCHECK 2, and Octavius 4D and good agreements were shown. MATERIALS AND METHODS: Dose distributions of 15 JO-IMRT plans of nasopharyngeal patients were recalculated using the EGSnrc Monte Carlo code. The clinical photon beams were simulated using the BEAMnrc. The absorbed dose to patients treated by fixed-field IMRT was computed using the DOSXYZnrc. The simulated dose distributions were then compared with the ones calculated by the Collapsed Cone Convolution (CCC) algorithm on the TPS, using the relative dose error comparison and the gamma index using global methods implemented in PTW-VeriSoft with 3%/3 mm, 2%/2 mm, 1%/1 mm criteria. RESULTS: There is a good agreement between the MC and TPS dose. The average gamma passing rates were 93.3 ± 3.1%, 92.8 ± 3.2%, 92.4 ± 3.4% based on the 3%/3 mm, 2%/2 mm, 1%/1 mm criteria, respectively. CONCLUSIONS: According to the results, it is concluded that the CCC algorithm was adequate for most of the IMRT H&N cases where the target was not immediately adjacent to the critical structures.

Interobserver variation in tumor delineation of liver metastases using Magnetic Resonance Imaging.

Background and purpose: Magnetic Resonance Imaging (MRI) guided stereotactic body radiotherapy (SBRT) of liver metastases is an upcoming high-precision non-invasive treatment. Interobserver variation (IOV) in tumor delineation, however, remains a relevant uncertainty for planning target volume (PTV) margins. The aims of this study were to quantify IOV in MRI-based delineation of the gross tumor volume (GTV) of liver metastases and to detect patient-specific factors influencing IOV. Materials and methods: A total of 22 patients with liver metastases from three primary tumor origins were selected (colorectal(8), breast(6), lung(8)). Delineation guidelines and planning MRI-scans were provided to eight radiation oncologists who delineated all GTVs. All delineations were centrally peer reviewed to identify outliers not meeting the guidelines. Analyses were performed both in- and excluding outliers. IOV was quantified as the standard deviation (SD) of the perpendicular distance of each observer's delineation towards the median delineation. The correlation of IOV with shape regularity, tumor origin and volume was determined. Results: Including all delineations, average IOV was 1.6 mm (range 0.6-3.3 mm). From 160 delineations, in total fourteen single delineations were marked as outliers after peer review. After excluding outliers, the average IOV was 1.3 mm (range 0.6-2.3 mm). There was no significant correlation between IOV and tumor origin or volume. However, there was a significant correlation between IOV and regularity (Spearman's ρs = -0.66; p = 0.002). Conclusion: MRI-based IOV in tumor delineation of liver metastases was 1.3-1.6 mm, from which PTV margins for IOV can be calculated. Tumor regularity and IOV were significantly correlated, potentially allowing for patient-specific margin calculation.

Neural Network Model Based on Branch Architecture for the Quality Assurance of Volumetric Modulated Arc Therapy.

Radiation therapy relies on quality assurance (QA) to verify dose delivery accuracy. However, current QA methods suffer from operation lag as well as inaccurate performance. Hence, to address these shortcomings, this paper proposes a QA neural network model based on branch architecture, which is based on the analysis of the category features of the QA complexity metrics. The designed branch network focuses on category features, which effectively improves the feature extraction capability for complexity metrics. The branch features extracted by the model are fused to predict the GPR for more accurate QA. The performance of the proposed method was validated on the collected dataset. The experiments show that the prediction performance of the model outperforms other QA methods; the average prediction errors for the test set are 2.12% (2%/2 mm), 1.69% (3%/2 mm), and 1.30% (3%/3 mm). Moreover, the results indicate that two-thirds of the validation samples' model predictions perform better than the clinical evaluation results, suggesting that the proposed model can assist physicists in the clinic.

Evaluating Peer Review of Palliative Radiation Plans at a Canadian Tertiary Care Cancer Center.

INTRODUCTION: Peer review (PR) of palliative-intent radiation plans is an important but understudied component of quality assurance. This retrospective review aims to improve our understanding of palliative PR by examining the characteristics of reviewed plans and peer feedback along with the associated time burden of two different types of PR processes. METHODS: This single-institution, quality assurance project assessed palliative PR between 2018 and 2020. Initially, the PR involved a multi-disciplinary team PR. Subsequently, it transitioned to independent PR by a single physician. Characteristics of reviewed plans and feedback on PR were captured and abstracted. Time requirements of PR were based on self-reported estimates and attendance records. RESULTS: A total of 1942 cases were reviewed, representing 85.7% (1942/2266) of all palliative-intent plans between 2018 and 2020. A total of 41.1% (n=799) were simple (2D/3D) radiation plans while 56.0% (n=1087) were complex (volumetric modulated arc therapy (VMAT) or tomotherapy) plans. Approximately one-third (30.4%, n=590) of all plans were stereotactic treatments. The rate of any peer feedback was 2.3% (n=45), while the rate of a specific recommended or implemented change was 1.2% (n=24) and 0.9% (n=18), respectively. PR before the start of treatment was associated with more frequent recommended (p=0.005) and implemented changes (p=0.008). Most other factors, including plan complexity and use of stereotactic radiation, were not predictive in this analysis. Comparing the independent versus team PR approach, there was no significant difference in recommended or implemented changes. The mean±standard deviation (SD) staff time required per plan reviewed was 36±6 and 37±6 minutes, including 21±6 and 10±6 minutes of physician time, for team and independent PR, respectively. CONCLUSION: This work highlights the high frequency of complex and stereotactic radiation in the palliative setting, along with the importance of timely PR and the potential benefit of reviewing even simple, 2D/3D radiation plans. Additionally, from a process perspective, our work showed that independent PR may require less dedicated physician time.

Feasibility study of optical imaging of the boron-dose distribution by a liquid scintillator in a clinical boron neutron capture therapy field.

BACKGROUND: Evaluation of the boron dose is essential for boron neutron capture therapy (BNCT). Nevertheless, a direct evaluation method for the boron-dose distribution has not yet been established in the clinical BNCT field. To date, even in quality assurance (QA) measurements, the boron dose has been indirectly evaluated from the thermal neutron flux measured using the activation method with gold foil or wire and an assumed boron concentration in the QA procedure. Recently, we successfully conducted optical imaging of the boron-dose distribution using a cooled charge-coupled device (CCD) camera and a boron-added liquid scintillator at the E-3 port facility of the Kyoto University Research Reactor (KUR), which supplies an almost pure thermal neutron beam with very low gamma-ray contamination. However, in a clinical accelerator-based BNCT facility, there is a concern that the boron-dose distribution may not be accurately extracted because the unwanted luminescence intensity, which is irrelevant to the boron dose is expected to increase owing to the contamination of fast neutrons and gamma rays. PURPOSE: The purpose of this research was to study the validity of a newly proposed method using a boron-added liquid scintillator and a cooled CCD camera to directly observe the boron-dose distribution in a clinical accelerator-based BNCT field. METHOD: A liquid scintillator phantom with 10 B was prepared by filling a small quartz glass container with a commercial liquid scintillator and boron-containing material (trimethyl borate); its natural boron concentration was 1 wt%. Luminescence images of the boron-neutron capture reaction were obtained in a water tank at several different depths using a CCD camera. The contribution of background luminescence, mainly due to gamma rays, was removed by subtracting the luminescence images obtained using another sole liquid scintillator phantom (natural boron concentration of 0 wt%) at each corresponding depth, and a depth profile of the boron dose with several discrete points was obtained. The obtained depth profile was compared with that of calculated boron dose, and those of thermal neutron flux which were experimentally measured or calculated using a Monte Carlo code. RESULTS: The depth profile evaluated from the subtracted images indicated reasonable agreement with the calculated boron-dose profile and thermal neutron flux profiles, except for the shallow region. This discrepancy is thought to be due to the contribution of light reflected from the tank wall. The simulation results also demonstrated that the thermal neutron flux would be severely perturbed by the 10 B-containing phantom if a relatively larger container was used to evaluate a wide range of boron-dose distributions in a single shot. This indicates a trade-off between the luminescence intensity of the 10 B-added phantom and its perturbation effect on the thermal neutron flux. CONCLUSIONS: Although a partial discrepancy was observed, the validity of the newly proposed boron-dose evaluation method using liquid-scintillator phantoms with and without 10 B was experimentally confirmed in the neutron field of an accelerator-based clinical BNCT facility. However, this study has some limitations, including the trade-off problem stated above. Therefore, further studies are required to address these limitations.

Patient specific quality assurance of volumetric modulated arc therapy of synchronous bilateral breast cancer.

Synchronous bilateral breast cancers (SBBC) present a considerable issue in external beam radiotherapy because of large fields size and large target volumes. Mono-isocentric volumetric modulated arc therapy (VMAT) appears as an appropriate irradiation technique for these types of tumors. The aim of this study was to demonstrate the utility of a 3D DVH pretreatment quality assurance program in VMAT of SBBC cases. Twenty SBBC patients who underwent radiation therapy in our department were retrospectively enrolled in this study. Fifteen patients were treated exclusively to the mammary glands. Five patients benefited from a dose boost on the tumor bed (60Gy). Nine patients were irradiated on the supraclavicular nodes (50Gy). This dose was delivered in 25 fractions and integrated boost was used when appropriate. Depending on the complexity of the treatment plans; 2 or 4 arcs VMAT plans were used in a mono-isocentric technique. The patient specific quality assurance (PSQA) was evaluated using COMPASS measured data, COMPASS reconstructed (CR) and COMPASS computed (CC) dose compared to treatment planning system (TPS) dose. Clinical evaluation was based on DVH metrics for target volumes and organ at risks. The maximum average dose deviation between TPS, CC, and CR was below 3%. The paired t-test between TPS, CC, and CR shows a strong agreement (p < 0.001). The 3DVH dose distribution comparison between TPS and COMPASS were also performed with good gamma score for global analysis. COMPASS was successfully evaluated as a 3DVH pretreatment system for SBBC despite the large fields size and complex target volumes. It allows the verification of the plan in 3D patient anatomy and the evaluation of dose discrepancies.

Direct rapid quality assurance analysis of complex matrix materials: A chemometrics enabled energy dispersive X-ray fluorescence and scattering spectrometry application.

Compared to energy dispersive X-ray fluorescence (EDXRF) that is limited to analysis of elements (Z ≥ 13) via fluorescence and which is hardly direct, energy dispersive X-ray fluorescence and scattering (EDXRFS) spectrometry exploits additionally, scatter radiation to quantify both low- and heavy-Z elements as well as predict various material properties. The goal of this work was to demonstrate proof-of-concept for chemometrics-enabled EDXRFS spectrometry utilizing a weak sample excitation source towards rapid quality assurance (QA) analysis of complex matrix materials. A109Cd source was used to analyse three types of polymer powders - polypropylene (PP), low density polyethene (LDPE) and high density polyethene (HDPE) moulded as âˆ¼ 2.5 g (∅ = 2.5 cm) pellets; and both actual as well as simulate lubricating oils spiked with trace additive metals B, Na, Ca, Mg, Fe and Zn and subjected to thermal degradation between 100 °C and 400 °C for 24 h. EDXRFS combined with principal components analysis (PCA) and soft independent modelling of class analogy (SIMCA) accurately identified polypropylene as well as differentiated it from both low density polyethene (LDPE) and high density polyethene (HDPE). LDPE and HDPE were fairly discriminated on the basis of density. In the second application partial least squares (PLS) modelling successfully determined the viscosity of lubricating oils utilizing the combination of the scatter peak and the Zn fluorescence signature, as well as correlated the lubricating oils viscosity to their thermal degradation. The reported method is applicable in industrial quality assurance due to its non-destructivity and speed.