Technological quality requirements for stereotactic radiotherapy

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Abstract

This review details and discusses the technological quality requirements to ensure the desired quality for stereotactic radiotherapy using photon external beam radiotherapy as defined by the DEGRO Working Group Radiosurgery and Stereotactic Radiotherapy and the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The covered aspects of this review are 1) imaging for target volume definition, 2) patient positioning and target volume localization, 3) motion management, 4) collimation of the irradiation and beam directions, 5) dose calculation, 6) treatment unit accuracy, and 7) dedicated quality assurance measures. For each part, an expert review for current state-of-the-art techniques and their particular technological quality requirement to reach the necessary accuracy for stereotactic radiotherapy divided into intracranial stereotactic radiosurgery in one single fraction (SRS), intracranial fractionated stereotactic radiotherapy (FSRT), and extracranial stereotactic body radiotherapy (SBRT) is presented. All recommendations and suggestions for all mentioned aspects of stereotactic radiotherapy are formulated and related uncertainties and potential sources of error discussed. Additionally, further research and development needs in terms of insufficient data and unsolved problems for stereotactic radiotherapy are identified, which will serve as a basis for the future assignments of the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The review was group peer-reviewed, and consensus was obtained through multiple working group meetings.

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Most cited references 215

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Task Group 142 report: quality assurance of medical accelerators.

Eric Klein, Joseph Hanley, John E. Bayouth … (2009)

The task group (TG) for quality assurance of medical accelerators was constituted by the American Association of Physicists in Medicine's Science Council under the direction of the Radiation Therapy Committee and the Quality Assurance and Outcome Improvement Subcommittee. The task group (TG-142) had two main charges. First to update, as needed, recommendations of Table II of the AAPM TG-40 report on quality assurance and second, to add recommendations for asymmetric jaws, multileaf collimation (MLC), and dynamic/virtual wedges. The TG accomplished the update to TG-40, specifying new test and tolerances, and has added recommendations for not only the new ancillary delivery technologies but also for imaging devices that are part of the linear accelerator. The imaging devices include x-ray imaging, photon portal imaging, and cone-beam CT. The TG report was designed to account for the types of treatments delivered with the particular machine. For example, machines that are used for radiosurgery treatments or intensity-modulated radiotherapy (IMRT) require different tests and/or tolerances. There are specific recommendations for MLC quality assurance for machines performing IMRT. The report also gives recommendations as to action levels for the physicists to implement particular actions, whether they are inspection, scheduled action, or immediate and corrective action. The report is geared to be flexible for the physicist to customize the QA program depending on clinical utility. There are specific tables according to daily, monthly, and annual reviews, along with unique tables for wedge systems, MLC, and imaging checks. The report also gives specific recommendations regarding setup of a QA program by the physicist in regards to building a QA team, establishing procedures, training of personnel, documentation, and end-to-end system checks. The tabulated items of this report have been considerably expanded as compared with the original TG-40 report and the recommended tolerances accommodate differences in the intended use of the machine functionality (non-IMRT, IMRT, and stereotactic delivery).

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Use of image registration and fusion algorithms and techniques in radiotherapy: Report of the AAPM Radiation Therapy Committee Task Group No. 132.

Hua Li, Marc L. Kessler, Kristy Brock … (2017)

Image registration and fusion algorithms exist in almost every software system that creates or uses images in radiotherapy. Most treatment planning systems support some form of image registration and fusion to allow the use of multimodality and time-series image data and even anatomical atlases to assist in target volume and normal tissue delineation. Treatment delivery systems perform registration and fusion between the planning images and the in-room images acquired during the treatment to assist patient positioning. Advanced applications are beginning to support daily dose assessment and enable adaptive radiotherapy using image registration and fusion to propagate contours and accumulate dose between image data taken over the course of therapy to provide up-to-date estimates of anatomical changes and delivered dose. This information aids in the detection of anatomical and functional changes that might elicit changes in the treatment plan or prescription. As the output of the image registration process is always used as the input of another process for planning or delivery, it is important to understand and communicate the uncertainty associated with the software in general and the result of a specific registration. Unfortunately, there is no standard mathematical formalism to perform this for real-world situations where noise, distortion, and complex anatomical variations can occur. Validation of the software systems performance is also complicated by the lack of documentation available from commercial systems leading to use of these systems in undesirable 'black-box' fashion. In view of this situation and the central role that image registration and fusion play in treatment planning and delivery, the Therapy Physics Committee of the American Association of Physicists in Medicine commissioned Task Group 132 to review current approaches and solutions for image registration (both rigid and deformable) in radiotherapy and to provide recommendations for quality assurance and quality control of these clinical processes.

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Phase I trial of stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of oligometastatic or unresectable primary malignancies of the abdomen.

Sasa Mutic, Jeff Michalski, Olga L. Green … (2018)

SBRT is used to treat oligometastatic or unresectable primary abdominal malignancies, although ablative dose delivery is limited by proximity of organs-at-risk (OAR). Stereotactic, magnetic resonance (MR)-guided online-adaptive radiotherapy (SMART) may improve SBRT's therapeutic ratio. This prospective Phase I trial assessed feasibility and potential advantages of SMART to treat abdominal malignancies.

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Author and article information

Contributors

Daniela Schmitt:

ORCID: http://orcid.org/0000-0002-9657-0715

Daniela.Schmitt@med.uni-heidelberg.de

Journal

Journal ID (nlm-ta): Strahlenther Onkol

Journal ID (iso-abbrev): Strahlenther Onkol

Title: Strahlentherapie Und Onkologie

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0179-7158

ISSN (Electronic): 1439-099X

Publication date (Electronic): 24 March 2020

Publication date PMC-release: 24 March 2020

Publication date (Print): 2020

Volume: 196

Issue: 5

Pages: 421-443

Affiliations

[1 ]GRID grid.5253.1, ISNI 0000 0001 0328 4908, Klinik für Radioonkologie und Strahlentherapie, National Center for Radiation Research in Oncology (NCRO), Heidelberger Institut für Radioonkologie (HIRO), , Universitätsklinikum Heidelberg, ; Heidelberg, Germany

[2 ]GRID grid.412468.d, ISNI 0000 0004 0646 2097, Klinik für Strahlentherapie, , Universitätsklinikum Schleswig-Holstein, ; Kiel, Germany

[3 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Klinik für Strahlentherapie und Radioonkologie, , Universitätsklinikum Hamburg-Eppendorf, ; Hamburg, Germany

[4 ]GRID grid.5734.5, ISNI 0000 0001 0726 5157, Abteilung für Medizinische Strahlenphysik und Universitätsklinik für Radio-Onkologie, Inselspital—Universitätsspital Bern, , Universität Bern, ; Bern, Switzerland

[5 ]GRID grid.411559.d, ISNI 0000 0000 9592 4695, Universitätsklinik für Strahlentherapie, , Universitätsklinikum Magdeburg, ; Magdeburg, Germany

[6 ]GRID grid.7700.0, ISNI 0000 0001 2190 4373, Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, , Universität Heidelberg, ; Mannheim, Germany

[7 ]GRID grid.411088.4, ISNI 0000 0004 0578 8220, Klinik für Strahlentherapie und Onkologie, , Universitätsklinikum Frankfurt, ; Frankfurt am Main, Germany

[8 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Institut für Computational Neuroscience, , Universitätsklinikum Hamburg-Eppendorf, ; Hamburg, Germany

[9 ]GRID grid.413108.f, ISNI 0000 0000 9737 0454, Klinik für Strahlentherapie, , Universitätsmedizin Rostock, ; Rostock, Germany

[10 ]GRID grid.411097.a, ISNI 0000 0000 8852 305X, Klinik für Radioonkologie, CyberKnife- und Strahlentherapie, , Universitätsklinikum Köln, ; Cologne, Germany

[11 ]GRID grid.16149.3b, ISNI 0000 0004 0551 4246, Klinik für Strahlentherapie—Radioonkologie, , Universitätsklinikum Münster, ; Münster, Germany

Author information

Daniela Schmitt http://orcid.org/0000-0002-9657-0715

Article

Publisher ID: 1583

DOI: 10.1007/s00066-020-01583-2

PMC ID: 7182540

PubMed ID: 32211939

SO-VID: 026ecddf-624f-45a8-9f16-66b8df5a0496

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Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 4 January 2020

Date accepted : 13 January 2020

Funding

Funded by: Universitätsklinikum Heidelberg (8914)

Open Access :

Open Access funding provided by Projekt DEAL.

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ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: radiosurgery,recommendations,technique,srs,fsrt,sbrt

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ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: radiosurgery, recommendations, technique, srs, fsrt, sbrt

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Technological quality requirements for stereotactic radiotherapy : Expert review group consensus from the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy

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Most cited references 215

Task Group 142 report: quality assurance of medical accelerators.

Use of image registration and fusion algorithms and techniques in radiotherapy: Report of the AAPM Radiation Therapy Committee Task Group No. 132.

Phase I trial of stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of oligometastatic or unresectable primary malignancies of the abdomen.

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