The magnitude of H&N IMRT dose delivery errors from three ...

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The magnitude of H N IMRT dosedelivery errors from three possiblefailure modes beam quality symmetry and MLC positionJackie Tonigan M S .
Advisor David Followill Ph DUniversity of Texas M D AndersonAAPM Annual Meeting Charlotte NC August 2 2012 Motivation.
Advanced RTIncreased ComplexityNeed for Increased QM Sensitivity Analysis Goal Prioritize QM based on likelihood of error occurrence and.
severity of clinical impact Failure Modes and Effects Analysis1 Outline the process2 Identify failure modes and causes3 Determine the risk associated with each FM.
RPN Risk probability numbero O Probability of occurrence RPN O x D x So D Lack of detectabilityo S Severity4 Improve QM.
IMRT ProcessMUPositioning CT Lookup TableImmobilization LocalizationImage Transfer MeasurementsMLC Penumbra Effects.
MLC Penumbra EffectsDose Calculation Interpret ResultsSimulation MLC PositioningImaging IMRT QABeam Quality.
Gantry Angle TreatmentPlanning DeliveryPlan Save Transfer Collimator Angle DeliveryContouring MotionLocalization.
Prescription Plan Approval MonitoringCouch Angle MLC DeliveryDose Calculation MechanicalDisplacement Accessories Delivery.
Unique Study Characteristics Extensive array of measurementcapabilities RPC Availability of an accelerator Clinac 2100CD Just taken out of clinical service.
Modification of operating parameters Failure Mode MeasurementsMLC position Beam quality Symmetry Standard IMRT plan 1948 MU 90 seg 0 482 MCS Complex IMRT plan 3189 MU 216 seg 0 171 MCS .
Output Beam quality ratio of depth doses Profiles in plane and cross plane Planar IMRT QA MatriXX Phantom IMRT QA I mRT Body Phantom.
RPC IMRT H N Phantom end to end test McNiven et al Med Phys 2010 Failure Mode Measurements MLC Position Systematic 2 mm shift in one bank of leaves.
Beam Quality DD ratio increased decreased by 1 Symmetry Angular Steering In plane by 3 5 Cross plane by 3 5 Translational Steering In plane by 3 5 .
Pilot Study Results Profiles MatriXX No IMRT QA RPC IMRT H N Phantom complex plan Range of 6 PTV TLD dose differences from baseline irradiation.
DTA difference from baseline irradiation between PTV and OAR 7 4mm gamma index analysis average of axial and sagittal filmsIn plane Cross plane Beam quality MLC all MLC all Alteration 5 3 1 TMR2010 1 mm 3 mmDTLD 1 3 6 16 37.
DDTA mm 0 2 0 9 0 7 2 5 6 8g analysis5 2 0 7 23 5 20 4 33 1 difference Results MLC Offset.
2 mm shift one bank of leavesStandard Plan Complex PlanDose difference frombaseline 2 3 of TLD with sig .
difference p 0 05 2 6 4 6 Results Beam Quality DD ratio increased by 1 1 Standard Plan Complex PlanDose difference from baseline 2 4 .
of TLD with sig difference p 0 05 0 6 6 6 DD ratio decreased by 0 6 Standard Plan Complex PlanDose difference from baseline 2 2 .
of TLD with sig difference p 0 05 1 6 4 6 Results Symmetry Angular steering in plane 3 5 CROSS PLANE.
Standard Plan Complex PlanDose difference from baseline 3 3 of TLD with sig difference p 0 05 2 6 3 6 Angular steering cross plane 3 5 .
Standard Plan Complex PlanDose difference from baseline 4 4 of TLD with sig difference p 0 05 6 6 5 6 Results Symmetry.
Translational steering in plane 3 5 CROSS PLANEStandard Plan Complex PlanDose difference from baseline 4 4 of TLD with sig difference.
p 0 05 4 6 2 6 More dose difference for complex plans Beam Quality More dose difference for complex plans Symmetry.
Appears to have some dose differences film analysis required to completeassessment The impact from 3 of 9 failure modes for IMRT dose delivery havebeen measured that can be used to assist in the determination ofthe severity score for the risk probability number.
Stay tuned more data to come Thank you This work supported by DHHS grants CA10953 and CA81647Acknowledgements Dr David Followill Dr Stephen Kry.
Dr Peter Balter Dr Geoffrey IbbottAustin FaughtQuestions Joey Cheung.
Andrea Ohrt Miguel Herrera Nicholas Murray Carrie Armador Andrea Molineu.
Ryan GrantFor our adjustments in beam quality, there was up to 4% significant dose difference in all TLD for the complex plan here, and no significant differences in the standard plan. The decreased depth dose ratio delivery follows a similar trend with up to 2% dose difference from baseline in each plan, but with more TLD showing significance in the ...

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