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AAPM TG113 > TG113 > Flashcards

TG113 Flashcards

1
Q

What is TG113 on?

A

guidance of physics aspects of clinical trials

-photon and electron trials

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2
Q

why do we need clinical trial QA?

A

-validate that all patients in a given arm receive the therapy as intended; or else the trial outcomes may not be valid

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3
Q

what did first head and neck IMRT trial show?

A

Study investigators reported higher clini-
cal failure rates for patients w hose treatment plans showed major deviations from the protocol
guidelines

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4
Q

what is knowledge based planning?

A

method where dose volume metrics from previous patients can be used to predict each patient’s DVH and identify plans with DVHs that differ significantly from the model

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5
Q

aims of TG113

A
  • recommend physics practises for photon/electron clinical trials to ensure a min standard
  • identify areas to improve consistency
  • guide QA organizations on how to best support the large spectrum of clinical trials
  • make suggestions for credentials to reduce inconsistencies
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6
Q

what is IROC

A

Imaging and radiation oncology core cooperative
previous clinical trial QA cen-
ters were also restructured to combine radiatio n therapy and imaging QA into a single core support
group (IROC)

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7
Q

examples of key imaging information that must be included in trial guidelines

A

contrast agents
pulse sequences
modality
minimal requirements for spatial resolution

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8
Q

recommendations regarding image acquisition

A

Clinical trial:

  • determine if imaging-specific credentialing is needed
  • design standard imaging procedure

-physicists at institution:
should implement the protocol and review scans to ensure compliance. Consider immobilization

QA centers:
specify or develop benchmarks

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9
Q

considerations for image registration

A

Clinical trial:
provide specific recommendations for landmarks
-specify rigid or deformable
-provide guidance about judging the registration

Institution:

  • use AAPM TG 132 for image registration
  • follow protocol and note moinitor settings required

QA centers:
develop benchmarks
-develope credentialing methods

manufacturers:
-make it possible to export data to assess quality of registration
-

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10
Q

when should motion be assessed?

A

-time of simulation

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11
Q

when does AAPM TG76 recommend motion management should be used

A

motion exceeds 0.5 cm if method and place and patient can tolerate it

if not, have to accept motion and use larger margins

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12
Q

recommendations for motion management

A

trial designers:

  • specify motion assessment at simulation
  • give guidance on motion management technique
  • give info on acceptable tresholds, is intra-fraction motion required etc.

institution:
-follow protocol and ensure ITV is reasonable

QA centers:
-provide benchmark or develop one

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13
Q

recommendations for patient immobilization, target definition, and treatment guidance

A

clinical trial

  • survey literature to determine suitable immobilization
  • ensure proposed accuracy limits are achievable at numerous centers
  • specify immobilization and target volumes using ICRU 83
  • review lit and define acceptable PTV margins
  • provide guidance on contouring and expansions
  • specify frequency and method for any mid-treatment contour evaluations

institution:

  • ensure you have correct immobilization
  • ensure consistency between planning and treatment (ex. flat tabletop)
  • follow protocol
  • monitor effectivness of patient localization

QA centers:

  • confirm that the level of accuracy is reasonable for precision of the device
  • ensure margins appropriate
  • credentialing for new techniques like intra-fraction motion management

manufactuers:
-make interchangeable fiducials in devices so they can be used for MRI, CT etc

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14
Q

recommendations for segmentation

A

clinical trials:

  • specify window and level values
  • use consensus atlases for target and OAR definition
  • provide training to physicians for a given trial
  • provide guidance on how to address artifacts
  • specify how much of the organ should be contoured (for DVH analysis)
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15
Q

considerations for treatment planning

A
  • use model-based algorithms rather than pencil-beam
  • give guidance on how to handle overlapping structures
  • specify extent of dose grid
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16
Q

considerations for treatment plan evaluation tours

A
  • assess DVHs at QA centers to ensure consistency (but 3D doses are not re-calculated)
  • clinical trials should specify dose constraints
17
Q

have knowledge- based methods been shown to improve plans?

A

yes, “low-quality” plans were improved

18
Q

requirements for TPS sysrtems in trials

A
  • must be capable of submitting anonymized data for dry benchmark tests
  • plan data should be submitted via DICOM
19
Q

recommendations for treatment planning- clinical trial designers

A
  • use standard structure names
  • use published info on normal tissue limits
  • specify how much of the contour should be contoured for DVH
  • specify spatial res requirements for dose and DVH calcs
  • specify use of 3D treatment planning
  • require use of more accurate alogorithms if heterogeneity is significant
  • develop credentialing for new approaches of TPS
  • specify constraints for OARs
  • specify minimization of total dose to non-contoured organs
20
Q

recommendations for treatment planning- institution

A
  • ensure TPS is adequate
  • accurately model beam and output factors
  • validate DVHs etc
  • ensure 3D info can be exported to QA center
  • implement templates to use standard names
  • end-to-end test of protocol
  • determine attenuation by immobilization system and if this should be accounted for
21
Q

recommendations for treatment planning- QA centers

A
  • enable automation as much as possible
  • compare different algorithms as revise requirements as needed
  • provide trial groups with standard template, structure names
  • ensure data can be collected elkectronically
22
Q

recommendations for treatment planning- manufacturers

A

-Include DICOM-RT export in the base purchase of a TPS rather than an add-on option with
the ability to export coded ID cases to the QA centers
-provide standard naming
-make automatic anonymization easy
-make it easy to export data etc.
-tools that can assess compliance

23
Q

recommendations for treatment delivery documentation

A

clinical trials:

  • decide what aspects of history (ex missed treatments) are important
  • require record as part of data submission
24
Q

what is credentialing of an institution

A

performance and documentation of specific processes by an
institution and its team to demonstrate their ability to accurately plan and treat patients for a particular
protocol or treatment modality.

25
Q

examples of benchmarks

A
  • institutions are asked to do an end-to-end test on a trial phantom
  • beams output is monitoried by IROC’s remote monitoring program
26
Q

recommendations for credentialing

A

clinical trial:
-state which structures must be delineated by physician
-see if benchmark is available or make new one
-Require a credentialing process with pre- or on-treatment review for at least the first few cases,
and perhaps for all cases
-Require credentialing of technologies which may be susceptible to significant inter-institu-
tional variability
-require QA centers to confirm that submitted phantom plan meets requirements
-specify who reviews case, timing of review, number of cases reviewed from each center, if whole institution or just physician is credentialled

local instution:

  • repeat credentialing if a change is made
  • complete credentialing status inquiry form and do the phantom end-to-end test
  • make end-to-end protocol

QA centers
-develop suite of benchmark phantoms
-When new planning and delivery techniques are introduced, evaluate the consistency with a
subset of centers
-determine when re-credentialing is necessary

AAPM TG113 (2 decks)

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