Engineering topics

Dieterich, S

Publications and source records attributed to Dieterich, S.

6 records

DOE OSTI2016

TU-D-201-04: Veracity of Data Elements in Radiation Oncology Incident Learning Systems

Purpose: Incident learning systems encompass volumes, varieties, values, and velocities of underlying data elements consistent with the V’s of big data. Veracity, the 5th V however exists only if there is high inter-rater reliability (IRR) within the data elements. The purpose of this work was to assess IRR in the nationally deployed RO-ILS: Radiation Oncology-Incident Learning System (R) sponsored by the American Society for Radiation Oncology (ASTRO) and the American Association of Physicists in Medicine (AAPM). Methods: Ten incident reports covering a wide range of scenarios were created in standardized narrative and video formats and disseminated to 67 volunteers of multiple disciplines from 26 institutions along with two published narratives from the International Commission of Radiological Protection to assess IRR on a nationally representative level. The volunteers were instructed to independently enter the associated data elements in a test version of RO-ILS over a 3-week period. All responses were aggregated into a spreadsheet to assess IRR using free-marginal kappa metrics. Results: 48 volunteers from 21 institutions completed all reports in the study period. The average kappa score for all raters across all critical data elements was 0.659 [range 0.326–1.000]. Statistically significant differences (p <0.05) were noted between reporters of different disciplines and raters with varying levels of experience. Kappa scores were high for event classification (0.781) and contributory factors (0.777) and low for likelihood-of-harm (0.326). IRR was highest among AAPM-ASTRO members (0.672) and lowest among trainees (0.463). Conclusion: A moderate-to-substantial level of IRR in RO-ILS was noted in this study. Although the number of events reviewed in this study was small, opportunities for improving the taxonomy for the lower scoring data elements as well as specific educational targets for training were identified by assessing data veracity quantitatively. This is expected to improve the quality of the data garnered from RO-ILS.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-E-03: Shared Space Fosters Didactic and Professional Learning Across Professions for Medical and Physics Residents

Purpose: Medical Physicists and Radiation Oncologists are two professions who should be working as a team for optimal patient care, yet lack of mutual understanding about each others respective role and work environment creates barriers To improve collaboration and learning, we designed a shared didactic and work space for physics and radiation oncology residents to maximize interaction throughout their professional training. Methods: Physician and Physics residents are required to take the same didactic classes, including journal clubs and respective seminars. The residents also share an office environment among the seven physician and two physic residents. Results: By maximizing didactic overlap and sharing office space, the two resident groups have developed a close professional relationship and supportive work environment. Several joint research projects have been initiated by the residents. Awareness of physics tasks in the clinic has led to a request by the physician residents to change physics didactics, converting the physics short course into a lab-oriented course for the medical residents which is in part taught by the physics residents. The physics seminar is given by both residency groups; increased motivation and interest in learning about physics has led to several medical resident-initiated topic selections which generated lively discussion. The physics long course has changed toward including more discussion among residents to delve deeper into topics and study beyond what passing the boards would require. A supportive work environment has developed, embedding the two physics residents into a larger residents group, allowing them to find mentor and peers more easily. Conclusion: By creating a shared work and didactic environment, physician and physics residents have improved their understanding of respective professional practice. Resident-initiated changes in didactic practice have led to improved learning and joint research. A strong social support system has developed, embedding physics residents into a larger peer group.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-133: Assessing IMRT Treatment Delivery Accuracy and Consistency On a Varian TrueBeam Using the SunNuclear PerFraction EPID Dosimetry Software

Purpose: To assess if the TrueBeam HD120 collimator is delivering small IMRT fields accurately and consistently throughout the course of treatment using the SunNuclear PerFraction software. Methods: 7-field IMRT plans for 8 canine patients who passed IMRT QA using SunNuclear Mapcheck DQA were selected for this study. The animals were setup using CBCT image guidance. The EPID fluence maps were captured for each treatment field and each treatment fraction, with the first fraction EPID data serving as the baseline for comparison. The Sun Nuclear PerFraction Software was used to compare the EPID data for subsequent fractions using a Gamma (3%/3mm) pass rate of 90%. To simulate requirements for SRS, the data was reanalyzed using a Gamma (3%/1mm) pass rate of 90%. Low-dose, low- and high gradient thresholds were used to focus the analysis on clinically relevant parts of the dose distribution. Results: Not all fractions could be analyzed, because during some of the treatment courses the DICOM tags in the EPID images intermittently change from CU to US (unspecified), which would indicate a temporary loss of EPID calibration. This technical issue is still being investigated. For the remaining fractions, the vast majority (7/8 of patients, 95% of fractions, and 96.6% of fields) are passing the less stringent Gamma criteria. The more stringent Gamma criteria caused a drop in pass rate (90 % of fractions, 84% of fields). For the patient with the lowest pass rate, wet towel bolus was used. Another patient with low pass rates experienced masseter muscle wasting. Conclusion: EPID dosimetry using the PerFraction software demonstrated that the majority of fields passed a Gamma (3%/3mm) for IMRT treatments delivered with a TrueBeam HD120 MLC. Pass rates dropped for a DTA of 1mm to model SRS tolerances. PerFraction pass rates can flag missing bolus or internal shields. Sanjeev Saini is an employee of Sun Nuclear Corporation. For this study, a pre-release version of PerFRACTION 1.1 software from Sun Nuclear Corporation was used.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

WE-B-19A-01: SRT II: Uncertainties in SRT

SRS delivery has undergone major technical changes in the last decade, transitioning from predominantly frame-based treatment delivery to imageguided, frameless SRS. It is important for medical physicists working in SRS to understand the magnitude and sources of uncertainty involved in delivering SRS treatments for a multitude of technologies (Gamma Knife, CyberKnife, linac-based SRS and protons). Sources of SRS planning and delivery uncertainty include dose calculation, dose fusion, and intra- and inter-fraction motion. Dose calculations for small fields are particularly difficult because of the lack of electronic equilibrium and greater effect of inhomogeneities within and near the PTV. Going frameless introduces greater setup uncertainties that allows for potentially increased intra- and interfraction motion, The increased use of multiple imaging modalities to determine the tumor volume, necessitates (deformable) image and contour fusion, and the resulting uncertainties introduced in the image registration process further contribute to overall treatment planning uncertainties. Each of these uncertainties must be quantified and their impact on treatment delivery accuracy understood. If necessary, the uncertainties may then be accounted for during treatment planning either through techniques to make the uncertainty explicit, or by the appropriate addition of PTV margins. Further complicating matters, the statistics of 1-5 fraction SRS treatments differ from traditional margin recipes relying on Poisson statistics. In this session, we will discuss uncertainties introduced during each step of the SRS treatment planning and delivery process and present margin recipes to appropriately account for such uncertainties. Learning Objectives: To understand the major contributors to the total delivery uncertainty in SRS for Gamma Knife, CyberKnife, and linac-based SRS. Learn the various uncertainties introduced by image fusion, deformable image registration, and contouring variation. Learn a variety of strategies for dealing with uncertainty, including margin recipes and explicit visualization of uncertainty. Understand how the assessment of PTV margins differs from regular fractionation (van Herk recipe) for 1–5 fraction deliveries.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

TH-C-9A-01: Lean Tools and Methods

Lean thinking has revolutionized the manufacturing industry. Toyota has pioneered and leveraged this aspect of Lean thinking. Application of Lean thinking and Lean Six Sigma techniques into Healthcare and in particular in Radiation Oncology has its merits and challenges. To improve quality, safety and patient satisfaction with available resources or reducing cost in terms of time, staff and resources is demands of today's healthcare. Radiation oncology treatment involves many processes and steps, identifying and removing the non-value added steps in a process can significantly improve the efficiency. Real projects undertaken in radiation oncology department in cutting down the procedure time for MRI guided brachytherapy to 40% less using lean thinking will be narrated. Simple Lean tools and techniques such as Gemba walk, visual control, daily huddles, standard work, value stream mapping, error-proofing, etc. can be applied with existing resources and how that improved the operation in a Radiation Oncology department's two year experience will be discussed. Lean thinking focuses on identifying and solving the root-cause of a problem by asking “Why” and not “Who” and this requires a culture change of no blame. Role of leadership in building lean culture, employee empowerment and trains and develops lean thinkers will be presented. Why Lean initiatives fail and how to implement lean successfully in your clinic will be discussed. Learning Objectives: Concepts of lean management or lean thinking. Lean tools and techniques applied in Radiation Oncology. Implement no blame culture and focus on system and processes. Leadership role in implementing lean culture. Challenges for Lean thinking in healthcare.

54 ENVIRONMENTAL SCIENCES↗

DOE OSTI2014

SU-E-J-160: Comparing the Setup Accuracy of Non-Ionizing Patient Localization Systems with CBCT to Reduce Imaging Dose in Prone Breast Treatments

Purpose: CBCT is the current gold standard to verify prone breast patient setup. We investigated in a phantom if non-ionizing localization systems can replace ionizing localization systems for prone breast treatments. Methods: An anthropomorphic phantom was positioned on a prone breast board. Electromagnetic transponders were attached on the left chest surface. The CT images of the phantom were imported to the treatment planning system. The isocenter was set to the center of the transponders. The positions of the isocenter and transponders transferred to the transponder tracking system. The posterior phantom surface was contoured and exported to the optical surface tracking system. A CBCT was taken for the initial setup alignment on the treatment machine. Using the electromagnetic and optical localization systems, the deviation of the phantom setup from the original CT images was measured. This was compared with the difference between the original CT and kV-CBCT images. Results: For the electromagnetic localization system, the phantom position deviated from the original CT in 1.5 mm, 0.0 mm and 0.5 mm in the anterior-posterior (AP), superior-inferior (SI) and left-right (LR) directions. For the optical localization system, the phantom position deviated from the original CT in 2.0 mm, −2.0 mm and 0.1 mm in the AP, SI and LR directions. For the CBCT, the phantom position deviated from the original CT in 4.0 mm, 1.0 mm and −1.0 mm in the AP, SI and LR directions. The measured values from the non-ionizing localization systems differed from those with the CBCT less than 3.0 mm in all directions. Conclusions: This phantom study showed the feasibility of using a combination of non-ionizing localization systems to achieve a similar setup accuracy as CBCT for prone breast patients. This could potentially eliminate imaging dose. As a next step, we are expanding this study to actual patients. This work has been in part supported by Departmental Research Award RODEPT1-JS001, Department of Radiation Oncology, UC Davis Medical Center.

60 APPLIED LIFE SCIENCES↗