Journal ArticleDOI
A method for evaluating treatment quality using in vivo EPID dosimetry and statistical process control in radiation therapy
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TLDR
The authors have demonstrated the capability of the method for both treatment specific QA and continuing quality improvement for continuous quality improvement of radiation treatment for cancer patients.Abstract:
Purpose
Due to increasing complexity, modern radiotherapy techniques require comprehensive quality assurance (QA) programmes, that to date generally focus on the pre-treatment stage. The purpose of this paper is to provide a method for an individual patient treatment QA evaluation and identification of a “quality gap” for continuous quality improvement.
Design/methodology/approach
A statistical process control (SPC) was applied to evaluate treatment delivery using in vivo electronic portal imaging device (EPID) dosimetry. A moving range control chart was constructed to monitor the individual patient treatment performance based on a control limit generated from initial data of 90 intensity-modulated radiotherapy (IMRT) and ten volumetric-modulated arc therapy (VMAT) patient deliveries. A process capability index was used to evaluate the continuing treatment quality based on three quality classes: treatment type-specific, treatment linac-specific, and body site-specific.
Findings
The determined control limits were 62.5 and 70.0 per cent of the χ pass-rate for IMRT and VMAT deliveries, respectively. In total, 14 patients were selected for a pilot study the results of which showed that about 1 per cent of all treatments contained errors relating to unexpected anatomical changes between treatment fractions. Both rectum and pelvis cancer treatments demonstrated process capability indices were less than 1, indicating the potential for quality improvement and hence may benefit from further assessment.
Research limitations/implications
The study relied on the application of in vivo EPID dosimetry for patients treated at the specific centre. Sampling patients for generating the control limits were limited to 100 patients. Whilst the quantitative results are specific to the clinical techniques and equipment used, the described method is generally applicable to IMRT and VMAT treatment QA. Whilst more work is required to determine the level of clinical significance, the authors have demonstrated the capability of the method for both treatment specific QA and continuing quality improvement.
Practical implications
The proposed method is a valuable tool for assessing the accuracy of treatment delivery whilst also improving treatment quality and patient safety.
Originality/value
Assessing in vivo EPID dosimetry with SPC can be used to improve the quality of radiation treatment for cancer patients.read more
Citations
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Journal ArticleDOI
Control chart applications in healthcare: a literature review
Gaurav Suman,D.R. Prajapati +1 more
TL;DR: This paper presents the review of literature on the application of SPC and control chart in healthcare sector and shows the gap of deploying controlchart in different departments and different countries as well.
Journal ArticleDOI
Estimating dose delivery accuracy in stereotactic body radiation therapy: A review of in-vivo measurement methods.
Marco Esposito,E. Villaggi,Sara Bresciani,Savino Cilla,Maria Daniela Falco,Cristina Garibaldi,Serenella Russo,Cinzia Talamonti,Michele Stasi,Pietro Mancosu +9 more
TL;DR: In order to minimize errors in SBRT dose delivery, it is recommended using synergic combinations of two or more of the systems described in the review: on-line tumor position and patient information should be combined with MLC position and linac output detection accuracy, in this way the effects of SBRt dose delivery errors will be reduced.
Journal ArticleDOI
Clinical implementation of 3D in vivo dosimetry for abdominal and pelvic stereotactic treatments
Marco Esposito,A. Ghirelli,S. Pini,P. Alpi,R. Barca,S. Fondelli,Barbara Grilli Leonulli,L. Paoletti,Francesca Rossi,Paolo Bastiani,Serenella Russo +10 more
TL;DR: The application of local tolerance levels to EPID in vivo dosimetry proved to be useful for detecting extra-lung SBRT treatment errors and for establishing tolerance levels for routine clinical use.
Journal ArticleDOI
Setup in a clinical workflow and impact on radiotherapy routine of an in vivo dosimetry procedure with an electronic portal imaging device.
Jie Li,Angelo Piermattei,Pei Wang,Shengwei Kang,Mingyong Xiao,Bin Tang,Xiongfei Liao,Xin Xin,Mattia Grusio,L.C. Orlandini +9 more
TL;DR: This work shows that IVD performed with an electronic portal imaging device is feasible in an overloaded department and enables the timely realignment of the treatment quality indices in order to achieve a patient’s final treatment compliant with the one prescribed.
Journal ArticleDOI
Assessment of Statistical Process Control Based DVH Action Levels for Systematic Multi-Leaf Collimator Errors in Cervical Cancer RapidArc Plans
TL;DR: In 3D quality assurance of cervical cancer RapidArc plans, process-based tolerance limits showed greater advantages in distinguishing plans introduced with systematic MLC errors more than 1mm, and reasonable DVH-based action levels can be acquired through statistical process control.
References
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Journal ArticleDOI
Statistical process control as a tool for research and healthcare improvement
TL;DR: This paper provides an overview of SPC and several practical examples of the healthcare applications of control charts, and a method of better understanding and communicating data from healthcare improvement efforts.
Journal ArticleDOI
Evaluation of the gamma dose distribution comparison method
Daniel A. Low,James F. Dempsey +1 more
TL;DR: The gamma distribution behavior in two dimensions is examined and the gamma quantity, calculated independently for each reference point, is the minimum distance in the renormalized multidimensional space between the evaluated distribution and the reference point.
Journal ArticleDOI
The Taguchi capability index
TL;DR: The process capability indices Cp and Cpk are widely used to provide unitless measures of process potential and performance as mentioned in this paper, but these indices do not adequately address the issue of process centering.
Journal ArticleDOI
In vivo dosimetry in external beam radiotherapy
TL;DR: The rationale for in vivo measurements is to provide an accurate and independent verification of the overall treatment procedure and enable the identification of potential errors in dose calculation, data transfer, dose delivery, patient setup, and changes in patient anatomy.
Journal ArticleDOI
Catching errors with in vivo EPID dosimetry
Anton Mans,M. Wendling,L. N. McDermott,Jan-Jakob Sonke,R. Tielenburg,R. Vijlbrief,Ben J. Mijnheer,M. van Herk,Joep Stroom +8 more
TL;DR: The importance of in vivo (EPID) dosimetry for all treatment plans as well as the ability of the method to assess the dosimetric impact of deviations found are shown.