An improvement in IMRT QA results and beam matching in linacs using statistical process control.
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ABSTRACT:
SUBMITTER: Gagneur JD
PROVIDER: S-EPMC5711098 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:We have automated the determination of the placement location of the dosimetry ion chamber within intensity-modulated radiotherapy (IMRT) fields, as part of streamlining the entire IMRT quality assurance process. This paper describes the mathematical image-processing techniques to arrive at the appropriate measurement locations within the planar dose maps of the IMRT fields. A specific spot within the found region is identified based on its flatness, radiation magnitude, location, area, and the avoidance of the interleaf spaces. The techniques used include applying a Laplacian, dilation, erosion, region identification, and measurement point selection based on three parameters: the size of the erosion operator, the gradient, and the importance of the area of a region versus its magnitude. These three parameters are adjustable by the user. However, the first one requires tweaking in extremely rare occasions, the gradient requires rare adjustments, and the last parameter needs occasional fine-tuning. This algorithm has been tested in over 50 cases. In about 5% of cases, the algorithm does not find a measurement point due to the extremely steep and narrow regions within the fluence maps. In such cases, manual selection of a point is allowed by our code, which is also difficult to ascertain, since the fluence map does not yield itself to an appropriate measurement point selection.
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Project description:BackgroundThe automated and integrated machine performance check (MPC) tool was verified against independent detectors to evaluate its beam uniformity and output detection abilities to consider it suitable for daily quality assurance (QA).MethodsMeasurements were carried out on six linear accelerators (each located at six individual sites) using clinically available photon and electron energies for a period up to 12 months (n = 350). Daily constancy checks on beam symmetry and output were compared against independent devices such as the SNC Daily QA 3, PTW Farmer ionization chamber, and SNC field size QA phantom. MPC uniformity detection of beam symmetry adjustments was also assessed. Sensitivity of symmetry and output measurements were assessed using statistical process control (SPC) methods to derive tolerances for daily machine QA and baseline resets to account for drifts in output readings. I-charts were used to evaluate systematic and nonsystematic trends to improve error detection capabilities based on calculated upper and lower control levels (UCL/LCL) derived using standard deviations from the mean dataset.ResultsThis study investigated the vendor's method of uniformity detection. Calculated mean uniformity variations were within ± 0.5% of Daily QA 3 vertical symmetry measurements. Mean MPC output variations were within ± 1.5% of Daily QA 3 and ±0.5% of Farmer ionization chamber detected variations. SPC calculated UCL values were a measure of change observed in the output detected for both MPC and Daily QA 3.ConclusionsMachine performance check was verified as a daily quality assurance tool to check machine output and symmetry while assessing against an independent detector on a weekly basis. MPC output detection can be improved by regular SPC-based trend analysis to measure drifts in the inherent device and control systematic and random variations thereby increasing confidence in its capabilities as a QA device. A 3-monthly MPC calibration assessment was recommended based on SPC capability and acceptability calculations.
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Project description:Beam angle configuration is a major planning decision in intensity modulated radiation treatment (IMRT) that has a significant impact on dose distributions and thus quality of treatment, especially in complex planning cases such as those for lung cancer treatment. We propose a novel method to automatically determine beam configurations that incorporates noncoplanar beams. We then present a completely automated IMRT planning algorithm that combines the proposed method with a previously reported OAR DVH prediction model. Finally, we validate this completely automatic planning algorithm using a set of challenging lung IMRT cases. A beam efficiency index map is constructed to guide the selection of beam angles. This index takes into account both the dose contributions from individual beams and the combined effect of multiple beams by introducing a beam-spread term. The effect of the beam-spread term on plan quality was studied systematically and the weight of the term to balance PTV dose conformity against OAR avoidance was determined. For validation, complex lung cases with clinical IMRT plans that required the use of one or more noncoplanar beams were re-planned with the proposed automatic planning algorithm. Important dose metrics for the PTV and OARs in the automatic plans were compared with those of the clinical plans. The results are very encouraging. The PTV dose conformity and homogeneity in the automatic plans improved significantly. And all the dose metrics of the automatic plans, except the lung V5 Gy, were statistically better than or comparable with those of the clinical plans. In conclusion, the automatic planning algorithm can incorporate non-coplanar beam configurations in challenging lung cases and can generate plans efficiently with quality closely approximating that of clinical plans.
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Project description:Modern pathology laboratories and in particular high throughput laboratories such as clinical chemistry have developed a reliable system for statistical process control (SPC). Such a system is absent from the majority of molecular laboratories and where present is confined to quantitative assays. As the inability to apply SPC to an assay is an obvious disadvantage this study aimed to solve this problem by using a frequency estimate coupled with a confidence interval calculation to detect deviations from an expected mutation frequency. The results of this study demonstrate the strengths and weaknesses of this approach and highlight minimum sample number requirements. Notably, assays with low mutation frequencies and detection of small deviations from an expected value require greater sample numbers to mitigate a protracted time to detection. Modeled laboratory data was also used to highlight how this approach might be applied in a routine molecular laboratory. This article is the first to describe the application of SPC to qualitative laboratory data.
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Project description:We present a novel real-time univariate monitoring scheme for detecting a sustained departure of a process mean from some given standard assuming a constant variance. Our proposed stopping rule is based on the total variation of a nonparametric taut string estimator of the process mean and is designed to provide a desired average run length for an in-control situation. Compared to the more prominent CUSUM fast initial response (FIR) methodology and allowing for a restart following a false alarm, the proposed two-sided taut string (TS) scheme produces a significant reduction in average run length for a wide range of changes in the mean that occur at or immediately after process monitoring begins. A decision rule for when to choose our proposed TS chart compared to the CUSUM FIR chart that takes into account both false alarm rate and average run length to detect a shift in the mean is proposed and implemented. Supplementary materials are available online.
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Project description:BackgroundGlucose control (GC) with insulin decreases morbidity and mortality of critically ill patients. In this study we investigated GC performance over time during implementation of GC strategies within three intensive care units (ICUs) and in routine clinical practice.MethodsAll adult critically ill patients who stayed for >24 h between 1999 and 2007 were included. Effects of implementing local GC guidelines and guideline revisions on effectiveness/efficiency-related indicators, safety-related indicators, and protocol-related indicators were measured.ResultsData of 17,111 patient admissions were evaluated, with 714,141 available blood glucose levels (BGL) measurements. Mean BGL, time to reach target, hyperglycemia index, sampling frequency, percentage of hyperglycemia events, and in-range measurements statistically changed after introducing GC in all ICUs. The introduction of simple rules on GC had the largest effect. Subsequent changes in the protocol had a smaller effect than the introduction of the protocol itself. As soon as the protocol was introduced, in all ICUs the percentage of hypoglycemia events increased. Various revisions were implemented to reduce hypoglycemia events, but levels never returned to those from pre-implementation. More intensive implementation strategies including the use of a decision support system resulted in better control of the process.ConclusionThere are various strategies to achieve GC in routine clinical practice but with variable success. All of them were associated with an increase in hypoglycemia events, but GC was never stopped. Instead, these events have been accepted and managed. Statistical process control is a useful tool for monitoring phenomena over time and captures within-institution changes.
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Project description:OBJECTIVE: This report provides the mathematical commissioning instructions for the evaluation of beam matching between two different linear accelerators. METHODS: Test packages were first obtained including an open beam profile, a wedge beam profile and a depth-dose curve, each from a 10×10 cm(2) beam. From these plots, a spatial error (SE) and a percentage dose error were introduced to form new plots. These three test package curves and the associated error curves were then differentiated in space with respect to dose for a first and second derivative to determine the slope and curvature of each data set. The derivatives, also known as bandwidths, were analysed to determine the level of acceptability for the beam matching test described in this study. RESULTS: The open and wedged beam profiles and depth-dose curve in the build-up region were determined to match within 1% dose error and 1-mm SE at 71.4% and 70.8% for of all points, respectively. For the depth-dose analysis specifically, beam matching was achieved for 96.8% of all points at 1%/1 mm beyond the depth of maximum dose. CONCLUSION: To quantify the beam matching procedure in any clinic, the user needs to merely generate test packages from their reference linear accelerator. It then follows that if the bandwidths are smooth and continuous across the profile and depth, there is greater likelihood of beam matching. Differentiated spatial and percentage variation analysis is appropriate, ideal and accurate for this commissioning process. ADVANCES IN KNOWLEDGE: We report a mathematically rigorous formulation for the qualitative evaluation of beam matching between linear accelerators.
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Project description:The statistical matching problem involves the integration of multiple datasets where some variables are not observed jointly. This missing data pattern leaves most statistical models unidentifiable. Statistical inference is still possible when operating under the framework of partially identified models, where the goal is to bound the parameters rather than to estimate them precisely. In many matching problems, developing feasible bounds on the parameters is equivalent to finding the set of positive-definite completions of a partially specified covariance matrix. Existing methods for characterising the set of possible completions do not extend to high-dimensional problems. A Gibbs sampler to draw from the set of possible completions is proposed. The variation in the observed samples gives an estimate of the feasible region of the parameters. The Gibbs sampler extends easily to high-dimensional statistical matching problems.
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Project description:A method for improving crystallographic phases is presented that is based on the preferential occurrence of certain local patterns of electron density in macromolecular electron-density maps. The method focuses on the relationship between the value of electron density at a point in the map and the pattern of density surrounding this point. Patterns of density that can be superimposed by rotation about the central point are considered equivalent. Standard templates are created from experimental or model electron-density maps by clustering and averaging local patterns of electron density. The clustering is based on correlation coefficients after rotation to maximize the correlation. Experimental or model maps are also used to create histograms relating the value of electron density at the central point to the correlation coefficient of the density surrounding this point with each member of the set of standard patterns. These histograms are then used to estimate the electron density at each point in a new experimental electron-density map using the pattern of electron density at points surrounding that point and the correlation coefficient of this density to each of the set of standard templates, again after rotation to maximize the correlation. The method is strengthened by excluding any information from the point in question from both the templates and the local pattern of density in the calculation. A function based on the origin of the Patterson function is used to remove information about the electron density at the point in question from nearby electron density. This allows an estimation of the electron density at each point in a map, using only information from other points in the process. The resulting estimates of electron density are shown to have errors that are nearly independent of the errors in the original map using model data and templates calculated at a resolution of 2.6 A. Owing to this independence of errors, information from the new map can be combined in a simple fashion with information from the original map to create an improved map. An iterative phase-improvement process using this approach and other applications of the image-reconstruction method are described and applied to experimental data at resolutions ranging from 2.4 to 2.8 A.
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Project description:INTRODUCTION:The run chart is one form of statistical process control chart that is particularly useful for detecting persistent shifts in data over time. The Anhøj rules test for shifts by looking for unusually long runs (L) of data points on the same side of the process centre (mean or median) and unusually few crossings (C) of the centre depending on the number of available data points (N). Critical values for C and L have mainly been studied in isolation. But what is really of interest is the joint distribution of C and L, which has so far only been studied using simulated data series. We recently released an R package, crossrun that calculates exact values for the joint probabilities of C and L that allowed us to study the diagnostic properties of the Anhøj rules in detail and to suggest minor adjustments to improve their diagnostic value. METHODS:Based on the crossrun R package we calculated exact values for the joint distribution of C and L for N = 10-100. Furthermore, we developed two functions, bestbox() and cutbox() that automatically seek to adjust the critical values for C and L to balance between sensitivity and specificity requirements. RESULTS:Based on exact values for the joint distribution of C and L for N = 10-100 we present measures of the diagnostic value of the Anhøj rules. The best box and cut box procedures improved the diagnostic value of the Anhøj rules by keeping the specificity and sensitivity close to pre-specified target values. CONCLUSIONS:Based on exact values for the joint distribution of longest run and number of crossings in random data series this study demonstrates that it is possible to obtain better diagnostic properties of run charts by making minor adjustment to the critical values for C and L.
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