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Small beam dosimetry: A multi-center multi-detector italian project
Abstracts et al. / Physica Medica 32 (2016) 175–178
effectiveness, safety and efficiency of clinical services. The Maltese Ministry of Health and University of Malta together partnered a project the objective of which was to produce an Education and Training scheme for the Clinically Qualified Medical Physicist which followed the recommendations of the ‘European Guidelines on the Medical Physics Expert’ project, EFOMP Policy Statement 12.1 and IAEA Training Course Series 37, 47 and 50 whilst optimizing costs and ensuring future-proofing. We present the innovative scheme as a model of academic and public administration cooperation in the service of patients. The project was part financed by the European Social Fund. It is hoped that the model will help other countries in Europe where Medical Physics Education and Training is not yet developed to set up similar cost-effective schemes. http://dx.doi.org/10.1016/j.ejmp.2016.07.289
TECHNICAL DEVELOPMENTS IN HIGH PRECISION RADIOTHERAPY Carlo Cavedon. Medical Physics Unit, University Hospital of Verona, Italy Introduction. Modern Radiotherapy techniques demand high spatial accuracy and precision in order to guarantee the necessary quality and safety of high-dose, often hypo-fractionated treatments. This need prompted the development of refined in-room imaging and tracking techniques that allow correction of patient position and even real-time compensation of organ motion to be performed. In this presentation, some examples of technological solutions and related methods are analysed with the aim of providing an overview of the evolving field of image-guided and signal-guided Radiotherapy techniques. Technology and methods. High precision techniques in Radiotherapy can be categorized in image-guided methods, nonconventional system architectures, signal-guidance by means of non-imaging techniques used to track a surrogate signal in real time, and combinations of these approaches. The theory and technology underlying these techniques come both from the imaging and therapy realms, with interesting examples that will be presented in this talk. From the standpoint of a Medical Physicist, a strong need of reference guidance is generally felt as specialised systems show peculiarities that make standard protocols often non-applicable. Furthermore, the increasing sensibility to the organized approach to quality and safety in Radiation Oncology asks for more standardization. Final considerations. The Medical Physicist has the opportunity to play an important role in the management of safety and quality of precision techniques in Radiotherapy, especially in view of the inherent multi-disciplinarity of Medical Physics that benefits from competences acquired in the diverse fields that embrace our profession. It will be the task of our scientific societies to provide members with sufficient resources – education and scientific support, above all – so that this opportunity is fully understood. http://dx.doi.org/10.1016/j.ejmp.2016.07.290
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SMALL BEAM DOSIMETRY: A MULTI-CENTER MULTI-DETECTOR ITALIAN PROJECT C. Talamonti, S. Russo, Tonghi L. Barone, G. Benecchi, G. Borzi, S. Bresciani, E Cagni, C. Carbonino, M. Casale, S. Clemente, R. Consorti, V. D’Alessio, E. Dicastro, G. Donofrio, M.D. Falco, D. Fedele, C. Fiandra, C. Frassanito, C. Gasperi, F.R. Giglioli, C. Iervolino, E. Infusino, S. Linsalata, G. Loi, E. Lorenzini, C. Marino, S. Martinotti, L. Masi, E. Menghi, R. Miceli, E. Moretti, B. Nardiello, R. Nigro, G. Pastore, M.C. Pressello, M. Pimpinella, G. Raza, F. Rosica, R. Ruggeri, L. Spiazzi, M. Stasi, L. Strigari, V. Tremolada, A. Vaiano, S. Vigorito, E. Villaggi, F. Vittorini, P. Mancosu. Università di Firenze, AOU Careggi, Firenze, Italy; Azienda USL Toscana Centro, Firenze, Italy ; Policlinico San Donato, S. Donato M.se (MI), Italy; A.R.N.A.S. Garibaldi di Catania, Italy; AO Parma, Italy; Centro REM Radioterapia Catania, Italy ; IRCCS Candiolo Torino, Italy ; Arcispedale S.Maria Nuova –IRCCS Reggio Emilia, Italy ; A.O. Ospedale Niguarda, Milano, Italy; AO ‘‘Santa Maria” Terni, Italy; IRCCS CROB Potenza, Italy ; AO San Filippo Neri, Roma, Italy ; Malzoni Radiosurgery Center – Agropoli SA, Italy ; Umberto I – Policlinico di Roma, Italy; AUSL Pescara, Italy; Policlinico SS. Annunziata, Chieti, Italy; Casa di Cura S.Rossore, Pisa, Italy ; Molinette, Torino, Italy; Centro Cyberknife di Bari, Italy; Istituto Besta di Milano, Italy; Usl8 Arezzo, Italy; Molinette, Torino, Italy; A.0 ‘‘S.G.MOSCATI” Avellino, Italy; Università Campus Bio-Medico, Roma, Italy; USL 2 Lucca, Italy; AOU Maggiore delle Carità Novara, Italy ; Asl 1 Carrara, Italy; Humanitas Catania, Italy; CDI Milano, Italy ; IFCA Firenze, Italy ; I.R.S.T., Meldola (FC), Italy ; AOU TorVergata, Roma, Italy ; AOU ‘‘Santa Maria della Misericordia” Udine, Italy ; UPMC San Pietro FBF, Roma, Italy; O.G. P. S.Camillo de Lellis, Rieti, Italy ; Ecomedica Empoli, Italy; AO San Camillo Forlanini, Roma, Italy ; ENEA, Italy; Ospedale San Pietro Fatebenefratelli, Roma, Italy ; ASL di Teramo, Italy ; Ospedale sacro Cuore don Calabria, Negra, Italy ; Spedali Civili, Brescia, Italy; A.O. Ordine Mauriziano di Torino, Italy ; IFO, Roma, Italy; Spedali Civili, Brescia, Italy; USL 3 Pistoia, Italy; Istituto Europeo Oncologia Milano, Italy; AUSL Piacenza, Italy; L’Aquila, Italy; Humanitas Milano, Italy A project dedicated to stereotactic body radiotherapy (SBRT) dosimetric aspects started in the framework of the Italian Association of Medical Physics (AIFM) SBRT working group. Its main objectives are manifold but sharing the knowledge between different clinics is the one of the most important. More than 30 centres, equipped with Varian, Elekta, Siemens or CyberKnife linac were enrolled. The project was divided in several work-packages, the first one evaluated the relative measurements with detectors routinely used by individual centers and in the following different detectors run in various centre. Each centre in the same work-package performed dose profile of field size ranging from 0.6 0.6 cm2 to 5.0 5.0 cm2, and relative output factors (ROF) measurements with a diamond or silicon diode or scintillator detector. In workpackage-1 ROF values measured in the first phase were compared with the ones measured with a microdiamond showing a higher inter-center consistency with this dosimeter compared to routine detectors. In workpackage-2 a silicon diode of new generation was used also to develop a mathematical relation from multicentric experimental data, which describes and predicts the ROF as a function of effective field size for TrueBeam Varian and Elekta linacs. Workpackage-3 used a plastic scintillator for TPR20, 10 and ROF; the latter showed
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a greater variability. Workpackage-4 used diamond and plastic scintillator with Cyberknife beams, to evaluate if microDiamond could be a suitable alternative to silicon diodes for OF determination and to validate the feasibility of using the scintillator as a reference detector in consideration of the CˇerenkovLightRatio and experimental uncertainties. The results of the study for all the detectors emphasized the usefulness of a multi-center validation over a single center approach. http://dx.doi.org/10.1016/j.ejmp.2016.07.291
MULTIINSTITUTIONAL NATIONAL STUDY FOR PLANNING COMPARISON ON DIFFERENT ANATOMICAL SITES Carmelo Marino a, Elisa Bonanno a, Giuseppina R. Borzı` b, Laura Bottalico c, Elisabetta Cagni d, Claudia Carbonini e, Michelina Casale f, Marta Casati g, Stefania Clemente h, Rita Consorti i, Valentina D’Alesio c, Marco Esposito j, Maria D. Falco k, David Fedele l, Christian Fiandra m, Maria C. Frassanito n, Randa E. Gawhary o, Francesca R. Giglioli p, Isidora Ielo q, Valeria Landoni g, Gianfranco Loi r, Elena Lorenzini s, Giulia Maggi t, Tiziana Malatesta o, Maria R. Malisan u, Anna Martinotti v, Enrico Menghi w, Barbara Nardiello x, Roberta Nigro y, Caterina Oliviero h, Gabriella Pastore z, Mariagrazia Quattrocchi aa, Riccardo Ragona m, Irene Redaelli ab, Giacomo Reggiori t, Ruggero Ruggieri ac, Serenella Russo j, Michele Stasi ad, Lidia Strigari g, Elena Villaggi ae, Pietro Mancosu t. aHumanitas C.C.O., Catania, Italy ; bREM Radioterapia, Catania, Italy ; cMalzoni Radiosurgery Center Salerno, Agropoli, Italy; dIRCCS – Arcispedale Santa Maria Nuova, Reggio Emilia, Italy ; eASST ‘‘Grande Ospedale Metropolitano Niguarda”, Milano, Italy ; fAzienda Ospedaliera Santa Maria Terni, Terni, Italy; gRegina Elena Cancer Center IFO, Roma, Italy; h Azienda Ospedaliera Universitaria Federico II Napoli, Italy ; iACO San Filippo Neri, Roma, Italy; jAzienda Sanitaria Firenze, Italy; kFondazione Policlinico Tor Vergata, Roma, Italy; lCasa di Cura Privata San Rossore, Pisa, Italy; mUniversità di Torino, Torino, Italy; nMater Dei Hospital, C.B. H. Città di Bari Hospital, Bari, Italy; oO.San Pietro Fatebenefratelli, Roma, Italy; pA.O.U. Città della Salute e della Scienza di Torino, Torino, Italy; qA. O.U. Policlinico G. Martino, Messina, Italy; rA.O.U. Maggiore della Carità di Novara, Italy ; sAzienda USL 1 Massa e Carrara, Italy ; tHumanitas
Clinical and Research Hospital, Rozzano (MI), Italy ; uA.O.U. di Udine, Udine, Italy ; vCentro Diagnostico Italiano, Milano, Italy ; wIRCCS–IRST, Istituto S.Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy; x UPMC San Pietro FBF, Roma, Italy; yOspedale S.Camillo de Lellis, Rieti, Italy; zEcomedica Empoli, Italy; aaUSL 2 Lucca, Italy; abA.O. San Gerardo di Monza, Italy ; acOspedale Sacro Cuore – don Calabria, Negrar (VR), Italy; adA.O. Ordine Mauriziano di Torino, Torino, Italy; aeAUSL Piacenza, Italy Purpose. The SBRT working group of Italian Association of Medical Physics (AIFM) performed 4 multicenter planning studies on patients who were candidates for SBRT in the treatments of prostate, liver, lung and spine cancer with the aim of evaluating the dosimetric consistency among the different hospitals. Methods and materials. Plans were performed following the dose prescription of 35 Gy in five fractions for the planning target volume (PTV) on prostate, 54 Gy in 3 fractions for liver, 75 Gy in 3 fractions for lung and 3 fractions of 10 Gy for spine. Different techniques were used (3D-CRT, fixed-Field IMRT, VMAT, TomoTherapy, CyberKnife) and plans were compared in terms of dose-volume histogram (DVH) parameters. Results. For prostate, important differences were found in terms of the HI. Doses to OARs were heterogeneous. For Liver, no significant correlations between technological factors and DVH for target and OARs were observed; the optimisation strategies selected by the planners played a key role in the planning procedure. For lung, significant correlations for PTV-gEUD2 versus PTV-HI, and MLD2 versus PTV-GI, were observed. Conclusions. Important dosimetric differences with possible clinical implications, in particular related to OARs, were found. Multicenter clinical trials on SBRT should require a preplanning study to standardize the optimization procedure. The differences both in terms of target coverage and OAR sparing suggest intercomparison of DVH could be a useful tool to standardize treatment planning of stereotactic treatments before starting multicentric clinical trial. http://dx.doi.org/10.1016/j.ejmp.2016.07.292
effectiveness, safety and efficiency of clinical services. The Maltese Ministry of Health and University of Malta together partnered a project the objective of which was to produce an Education and Training scheme for the Clinically Qualified Medical Physicist which followed the recommendations of the ‘European Guidelines on the Medical Physics Expert’ project, EFOMP Policy Statement 12.1 and IAEA Training Course Series 37, 47 and 50 whilst optimizing costs and ensuring future-proofing. We present the innovative scheme as a model of academic and public administration cooperation in the service of patients. The project was part financed by the European Social Fund. It is hoped that the model will help other countries in Europe where Medical Physics Education and Training is not yet developed to set up similar cost-effective schemes. http://dx.doi.org/10.1016/j.ejmp.2016.07.289
TECHNICAL DEVELOPMENTS IN HIGH PRECISION RADIOTHERAPY Carlo Cavedon. Medical Physics Unit, University Hospital of Verona, Italy Introduction. Modern Radiotherapy techniques demand high spatial accuracy and precision in order to guarantee the necessary quality and safety of high-dose, often hypo-fractionated treatments. This need prompted the development of refined in-room imaging and tracking techniques that allow correction of patient position and even real-time compensation of organ motion to be performed. In this presentation, some examples of technological solutions and related methods are analysed with the aim of providing an overview of the evolving field of image-guided and signal-guided Radiotherapy techniques. Technology and methods. High precision techniques in Radiotherapy can be categorized in image-guided methods, nonconventional system architectures, signal-guidance by means of non-imaging techniques used to track a surrogate signal in real time, and combinations of these approaches. The theory and technology underlying these techniques come both from the imaging and therapy realms, with interesting examples that will be presented in this talk. From the standpoint of a Medical Physicist, a strong need of reference guidance is generally felt as specialised systems show peculiarities that make standard protocols often non-applicable. Furthermore, the increasing sensibility to the organized approach to quality and safety in Radiation Oncology asks for more standardization. Final considerations. The Medical Physicist has the opportunity to play an important role in the management of safety and quality of precision techniques in Radiotherapy, especially in view of the inherent multi-disciplinarity of Medical Physics that benefits from competences acquired in the diverse fields that embrace our profession. It will be the task of our scientific societies to provide members with sufficient resources – education and scientific support, above all – so that this opportunity is fully understood. http://dx.doi.org/10.1016/j.ejmp.2016.07.290
177
SMALL BEAM DOSIMETRY: A MULTI-CENTER MULTI-DETECTOR ITALIAN PROJECT C. Talamonti, S. Russo, Tonghi L. Barone, G. Benecchi, G. Borzi, S. Bresciani, E Cagni, C. Carbonino, M. Casale, S. Clemente, R. Consorti, V. D’Alessio, E. Dicastro, G. Donofrio, M.D. Falco, D. Fedele, C. Fiandra, C. Frassanito, C. Gasperi, F.R. Giglioli, C. Iervolino, E. Infusino, S. Linsalata, G. Loi, E. Lorenzini, C. Marino, S. Martinotti, L. Masi, E. Menghi, R. Miceli, E. Moretti, B. Nardiello, R. Nigro, G. Pastore, M.C. Pressello, M. Pimpinella, G. Raza, F. Rosica, R. Ruggeri, L. Spiazzi, M. Stasi, L. Strigari, V. Tremolada, A. Vaiano, S. Vigorito, E. Villaggi, F. Vittorini, P. Mancosu. Università di Firenze, AOU Careggi, Firenze, Italy; Azienda USL Toscana Centro, Firenze, Italy ; Policlinico San Donato, S. Donato M.se (MI), Italy; A.R.N.A.S. Garibaldi di Catania, Italy; AO Parma, Italy; Centro REM Radioterapia Catania, Italy ; IRCCS Candiolo Torino, Italy ; Arcispedale S.Maria Nuova –IRCCS Reggio Emilia, Italy ; A.O. Ospedale Niguarda, Milano, Italy; AO ‘‘Santa Maria” Terni, Italy; IRCCS CROB Potenza, Italy ; AO San Filippo Neri, Roma, Italy ; Malzoni Radiosurgery Center – Agropoli SA, Italy ; Umberto I – Policlinico di Roma, Italy; AUSL Pescara, Italy; Policlinico SS. Annunziata, Chieti, Italy; Casa di Cura S.Rossore, Pisa, Italy ; Molinette, Torino, Italy; Centro Cyberknife di Bari, Italy; Istituto Besta di Milano, Italy; Usl8 Arezzo, Italy; Molinette, Torino, Italy; A.0 ‘‘S.G.MOSCATI” Avellino, Italy; Università Campus Bio-Medico, Roma, Italy; USL 2 Lucca, Italy; AOU Maggiore delle Carità Novara, Italy ; Asl 1 Carrara, Italy; Humanitas Catania, Italy; CDI Milano, Italy ; IFCA Firenze, Italy ; I.R.S.T., Meldola (FC), Italy ; AOU TorVergata, Roma, Italy ; AOU ‘‘Santa Maria della Misericordia” Udine, Italy ; UPMC San Pietro FBF, Roma, Italy; O.G. P. S.Camillo de Lellis, Rieti, Italy ; Ecomedica Empoli, Italy; AO San Camillo Forlanini, Roma, Italy ; ENEA, Italy; Ospedale San Pietro Fatebenefratelli, Roma, Italy ; ASL di Teramo, Italy ; Ospedale sacro Cuore don Calabria, Negra, Italy ; Spedali Civili, Brescia, Italy; A.O. Ordine Mauriziano di Torino, Italy ; IFO, Roma, Italy; Spedali Civili, Brescia, Italy; USL 3 Pistoia, Italy; Istituto Europeo Oncologia Milano, Italy; AUSL Piacenza, Italy; L’Aquila, Italy; Humanitas Milano, Italy A project dedicated to stereotactic body radiotherapy (SBRT) dosimetric aspects started in the framework of the Italian Association of Medical Physics (AIFM) SBRT working group. Its main objectives are manifold but sharing the knowledge between different clinics is the one of the most important. More than 30 centres, equipped with Varian, Elekta, Siemens or CyberKnife linac were enrolled. The project was divided in several work-packages, the first one evaluated the relative measurements with detectors routinely used by individual centers and in the following different detectors run in various centre. Each centre in the same work-package performed dose profile of field size ranging from 0.6 0.6 cm2 to 5.0 5.0 cm2, and relative output factors (ROF) measurements with a diamond or silicon diode or scintillator detector. In workpackage-1 ROF values measured in the first phase were compared with the ones measured with a microdiamond showing a higher inter-center consistency with this dosimeter compared to routine detectors. In workpackage-2 a silicon diode of new generation was used also to develop a mathematical relation from multicentric experimental data, which describes and predicts the ROF as a function of effective field size for TrueBeam Varian and Elekta linacs. Workpackage-3 used a plastic scintillator for TPR20, 10 and ROF; the latter showed
178
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a greater variability. Workpackage-4 used diamond and plastic scintillator with Cyberknife beams, to evaluate if microDiamond could be a suitable alternative to silicon diodes for OF determination and to validate the feasibility of using the scintillator as a reference detector in consideration of the CˇerenkovLightRatio and experimental uncertainties. The results of the study for all the detectors emphasized the usefulness of a multi-center validation over a single center approach. http://dx.doi.org/10.1016/j.ejmp.2016.07.291
MULTIINSTITUTIONAL NATIONAL STUDY FOR PLANNING COMPARISON ON DIFFERENT ANATOMICAL SITES Carmelo Marino a, Elisa Bonanno a, Giuseppina R. Borzı` b, Laura Bottalico c, Elisabetta Cagni d, Claudia Carbonini e, Michelina Casale f, Marta Casati g, Stefania Clemente h, Rita Consorti i, Valentina D’Alesio c, Marco Esposito j, Maria D. Falco k, David Fedele l, Christian Fiandra m, Maria C. Frassanito n, Randa E. Gawhary o, Francesca R. Giglioli p, Isidora Ielo q, Valeria Landoni g, Gianfranco Loi r, Elena Lorenzini s, Giulia Maggi t, Tiziana Malatesta o, Maria R. Malisan u, Anna Martinotti v, Enrico Menghi w, Barbara Nardiello x, Roberta Nigro y, Caterina Oliviero h, Gabriella Pastore z, Mariagrazia Quattrocchi aa, Riccardo Ragona m, Irene Redaelli ab, Giacomo Reggiori t, Ruggero Ruggieri ac, Serenella Russo j, Michele Stasi ad, Lidia Strigari g, Elena Villaggi ae, Pietro Mancosu t. aHumanitas C.C.O., Catania, Italy ; bREM Radioterapia, Catania, Italy ; cMalzoni Radiosurgery Center Salerno, Agropoli, Italy; dIRCCS – Arcispedale Santa Maria Nuova, Reggio Emilia, Italy ; eASST ‘‘Grande Ospedale Metropolitano Niguarda”, Milano, Italy ; fAzienda Ospedaliera Santa Maria Terni, Terni, Italy; gRegina Elena Cancer Center IFO, Roma, Italy; h Azienda Ospedaliera Universitaria Federico II Napoli, Italy ; iACO San Filippo Neri, Roma, Italy; jAzienda Sanitaria Firenze, Italy; kFondazione Policlinico Tor Vergata, Roma, Italy; lCasa di Cura Privata San Rossore, Pisa, Italy; mUniversità di Torino, Torino, Italy; nMater Dei Hospital, C.B. H. Città di Bari Hospital, Bari, Italy; oO.San Pietro Fatebenefratelli, Roma, Italy; pA.O.U. Città della Salute e della Scienza di Torino, Torino, Italy; qA. O.U. Policlinico G. Martino, Messina, Italy; rA.O.U. Maggiore della Carità di Novara, Italy ; sAzienda USL 1 Massa e Carrara, Italy ; tHumanitas
Clinical and Research Hospital, Rozzano (MI), Italy ; uA.O.U. di Udine, Udine, Italy ; vCentro Diagnostico Italiano, Milano, Italy ; wIRCCS–IRST, Istituto S.Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy; x UPMC San Pietro FBF, Roma, Italy; yOspedale S.Camillo de Lellis, Rieti, Italy; zEcomedica Empoli, Italy; aaUSL 2 Lucca, Italy; abA.O. San Gerardo di Monza, Italy ; acOspedale Sacro Cuore – don Calabria, Negrar (VR), Italy; adA.O. Ordine Mauriziano di Torino, Torino, Italy; aeAUSL Piacenza, Italy Purpose. The SBRT working group of Italian Association of Medical Physics (AIFM) performed 4 multicenter planning studies on patients who were candidates for SBRT in the treatments of prostate, liver, lung and spine cancer with the aim of evaluating the dosimetric consistency among the different hospitals. Methods and materials. Plans were performed following the dose prescription of 35 Gy in five fractions for the planning target volume (PTV) on prostate, 54 Gy in 3 fractions for liver, 75 Gy in 3 fractions for lung and 3 fractions of 10 Gy for spine. Different techniques were used (3D-CRT, fixed-Field IMRT, VMAT, TomoTherapy, CyberKnife) and plans were compared in terms of dose-volume histogram (DVH) parameters. Results. For prostate, important differences were found in terms of the HI. Doses to OARs were heterogeneous. For Liver, no significant correlations between technological factors and DVH for target and OARs were observed; the optimisation strategies selected by the planners played a key role in the planning procedure. For lung, significant correlations for PTV-gEUD2 versus PTV-HI, and MLD2 versus PTV-GI, were observed. Conclusions. Important dosimetric differences with possible clinical implications, in particular related to OARs, were found. Multicenter clinical trials on SBRT should require a preplanning study to standardize the optimization procedure. The differences both in terms of target coverage and OAR sparing suggest intercomparison of DVH could be a useful tool to standardize treatment planning of stereotactic treatments before starting multicentric clinical trial. http://dx.doi.org/10.1016/j.ejmp.2016.07.292