Author, as appears in the article.: Russo S; Saez J; Esposito M; Bruschi A; Ghirelli A; Pini S; Scoccianti S; Hernandez V
Department: Ciències Mèdiques Bàsiques
URV's Author/s: Hernandez Masgrau, Victor
Keywords: Statistical process control Retrospective studies Radiotherapy, intensity-modulated Radiotherapy planning, computer-assisted Radiotherapy dosage Quality assurance, health care Psqa Pre‐treatment verifications Pre-treatment verifications Humans
Abstract: Statistical process control (SPC) is a powerful statistical tool for process monitoring that has been highly recommended in healthcare applications, including radiation therapy quality assurance (QA). The AAPM TG-218 report described the clinical implementation of SPC for Volumetric Modulated Arc Therapy (VMAT) pre-treatment verifications, pointing out the need to adjust tolerance limits based on plan complexity. However, the quantification of plan complexity and its integration into SPC remains an unresolved challenge.The primary aim of this study is to investigate the incorporation of plan complexity into the SPC framework for VMAT pre-treatment verifications. The study explores and evaluates various strategies for this incorporation, discussing their merits and limitations, and provides recommendations for clinical application.A retrospective analysis was conducted on 309 VMAT plans from diverse anatomical sites using the PTW OCTAVIUS 4D device for QA measurements. Gamma Passing Rates (GPR) were obtained, and lower control limits were computed using both the conventional Shewhart method and three heuristic methods (scaled weighted variance, weighted standard deviations, and skewness correction) to accommodate non-normal data distributions. The 'Identify-Eliminate-Recalculate' method was employed for robust analysis. Eight complexity metrics were analyzed and two distinct strategies for incorporating plan complexity into SPC were assessed. The first strategy focused on establishing control limits for different treatment sites, while the second was based on the determination of control limits as a function of individual plan complexity. The study extensively examines the correlation between control limits and plan complexity and assesses the impact of complexity metrics on the control process.The control limits established using SPC were strongly influenced by the complexity of treatment plans. In the first strategy, a clear correlation was found between control limits and average plan complexity for each site. The second approach derived control limits based on individual plan complexity metrics, enabling tailored tolerance limits. In both strategies, tolerance limits inversely correlated with plan complexity, resulting in all highly complex plans being classified as in control. In contrast, when plans were collectively analyzed without considering complexity, all the out-of-control plans were highly complex.Incorporating plan complexity into SPC for VMAT verifications requires meticulous and comprehensive analysis. To ensure overall process control, we advocate for stringent control and minimization of plan complexity during treatment planning, especially when control limits are adjusted based on plan complexity.© 2024 The Authors. Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.
Thematic Areas: Radiology, nuclear medicine and imaging Radiology, nuclear medicine & medical imaging Medicine (miscellaneous) Medicina ii Medicina i Interdisciplinar General medicine Engenharias iv Engenharias ii Ciências biológicas iii Ciências biológicas ii Ciências biológicas i Ciência da computação Biotecnología Biophysics Astronomia / física Antropologia / arqueologia
licence for use: https://creativecommons.org/licenses/by/3.0/es/
Author's mail: victor.hernandez@urv.cat
Author identifier: 0000-0003-3770-8486
Record's date: 2024-09-07
Papper version: info:eu-repo/semantics/publishedVersion
Link to the original source: https://aapm.onlinelibrary.wiley.com/doi/10.1002/mp.17081
Licence document URL: https://repositori.urv.cat/ca/proteccio-de-dades/
Papper original source: Medical Physics. 51 (6): 3961-3971
APA: Russo S; Saez J; Esposito M; Bruschi A; Ghirelli A; Pini S; Scoccianti S; Hernandez V (2024). Incorporating plan complexity into the statistical process control of volumetric modulated arc therapy pre-treatment verifications. Medical Physics, 51(6), 3961-3971. DOI: 10.1002/mp.17081
Article's DOI: 10.1002/mp.17081
Entity: Universitat Rovira i Virgili
Journal publication year: 2024
Publication Type: Journal Publications
Repositori URV