Journal Article

DKFZ-2022-00099

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Quality assurance for on-table adaptive magnetic resonance guided radiation therapy: A software tool to complement secondary dose calculation and failure modes discovered in clinical routine.

Rippke, C. ; Schrenk, O. ; Renkamp, C. K. ; Buchele, C. ; Hörner-Rieber, J.DKFZ* ; Debus, J.DKFZ* ; Alber, M. ; Klüter, S.

2022
ACMP Reston, Va.

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Please use a persistent id in citations: doi:10.1002/acm2.13523

Abstract: Online adaption of treatment plans on a magnetic resonance (MR)-Linac enables the daily creation of new (adapted) treatment plans using current anatomical information of the patient as seen on MR images. Plan quality assurance (QA) relies on a secondary dose calculation (SDC) that is required because a pretreatment measurement is impossible during the adaptive workflow. However, failure mode and effect analysis of the adaptive planning process shows a large number of error sources, and not all of them are covered by SDC. As the complex multidisciplinary adaption process takes place under time pressure, additional software solutions for pretreatment per-fraction QA need to be used. It is essential to double-check SDC input to ensure a safe treatment delivery. Here, we present an automated treatment plan check tool for adaptive radiotherapy (APART) at a 0.35 T MR-Linac. It is designed to complement the manufacturer-provided adaptive QA tool comprising SDC. Checks performed by APART include contour analysis, electron density map examinations, and fluence modulation complexity controls. For nine of 362 adapted fractions (2.5%), irregularities regarding missing slices in target volumes and organs at risks as well as in margin expansion of target volumes have been found. This demonstrates that mistakes occur and can be detected by additional QA measures, especially contour analysis. Therefore, it is recommended to implement further QA tools additional to what the manufacturer provides to facilitate an informed decision about the quality of the treatment plan.

Keyword(s): MR-guided radiation therapy ; adaptive radiotherapy ; failure mode and effect analysis (FMEA) ; image-guided radiotherapy ; on-table adaptive ; online adaptive ; quality assurance ; risk management

Note: 2022 Mar;23(3):e13523

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Contributing Institute(s):

1. E050 KKE Strahlentherapie (E050)
2. DKTK HD zentral (HD01)

Research Program(s):

1. 315 - Bildgebung und Radioonkologie (POF4-315) (POF4-315)

Appears in the scientific report 2022

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Database coverage:
; ; ; Article Processing Charges ; Clarivate Analytics Master Journal List ; DOAJ Seal ; Essential Science Indicators ; Fees ; IF < 5 ; JCR ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

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