Nelson C, Gifford K, Kisling K, Bloom E, Kirsner S
UT MD Anderson Cancer Center, Houston, TX.
Med Phys. 2012 Jun;39(6Part12):3745. doi: 10.1118/1.4735244.
Treatment planning for high dose rate (HDR) brachytherapy requires many user inputs, all of which are potential sources of error. The goal of quality assurance (QA) is to ensure that errors are not made. In this study, we developed a software program to analyze the treatment printout from the HDR treatment planning computer and flag any suspected errors.
The treatment printout from the HDR planning computer is imported by the software. The software then performs the following checks: (1) verifies that the correct source was chosen (we have multiple in our database), (2) performs an independent decay of the Ir-192 source, (3) verifies source step size, (4) verifies the offsets and indexer lengths in the catheter definitions based upon expected values for the applicator used, (4) performs an independent 2nd check of dose to a cloud of dose points surrounding the treatment region, (5) verifies that the dose per fraction and the number of fractions were entered correctly in the planning computer, and (6) verifies that the dose volume histogram (DVH) metrics were within acceptable tolerances. The software then prints this information to a PDF file, which is appended to the original treatment printout and placed in the patient's medical record.
This QA tool has now been implemented for six months in our clinic, and is a critical QA tool in our HDR program. Although each plan is checked by an independent 2nd physicist, this tool provides an additional independent check on the treatment plan.
A simple series of automatic 2nd checks helps reduce the risk of errors occurring in the treatment planning portion of HDR brachytherapy and can easily be implemented.
高剂量率(HDR)近距离放射治疗的治疗计划需要许多用户输入,所有这些都是潜在的误差来源。质量保证(QA)的目标是确保不出现误差。在本研究中,我们开发了一个软件程序来分析HDR治疗计划计算机生成的治疗打印输出,并标记任何可疑误差。
该软件导入HDR计划计算机生成的治疗打印输出。然后软件执行以下检查:(1)验证是否选择了正确的源(我们的数据库中有多个源),(2)对Ir-192源进行独立衰变计算,(3)验证源步长,(4)根据所用施源器的预期值验证导管定义中的偏移量和分度器长度,(4)对治疗区域周围剂量点云的剂量进行独立的二次检查,(5)验证计划计算机中输入的每次分割剂量和分割次数是否正确,以及(6)验证剂量体积直方图(DVH)指标是否在可接受的公差范围内。然后软件将此信息打印到一个PDF文件中,该文件附加到原始治疗打印输出中并放入患者的病历中。
这个QA工具现已在我们诊所实施了六个月,并且是我们HDR计划中的关键QA工具。尽管每个计划都由另一位独立的物理学家进行检查,但这个工具为治疗计划提供了额外的独立检查。
一系列简单的自动二次检查有助于降低HDR近距离放射治疗治疗计划部分出现误差的风险,并且可以轻松实施。