How Reliable Is Pre-Treatment QA?
Are You Confident in Your Plan Second Check?
As the complexity of planning techniques has increased, the ability to conform dose to targets and spare critical structures has improved. However, this complexity has increased uncertainty in ensuring safe treatments, questioning the current state of pre-treatment QA and calling for necessary improvements.
Systematic Errors Are Left Undetected
Common second check methods do not equip you to catch errors in your base measurement data and the resulting TPS beam models, which are common causes for dose discrepancies.
Patient-Specific Plan Errors Can Slip Through Simple Calculation Based Methods
Point checks and conventional 3D methods lack the sensitivity needed to deal with complex plans involving small fields, density interfaces, or high modulation.
Measurement QA Can Also Allow Failing Plans Through
While measurement QA is able to check for delivery issues, its sensitivity to TPS calculation errors, which are very common, is found to be extremely low1.
Treatment Progress QA
Once the treatment regimen begins, most decisions to replan continue to be made based on obvious changes to patient anatomy. Care teams simply lack the time to fully utilize CBCT imaging for thorough dosimetric tracking for a host of reasons.
Poor Quality CBCTs
Quality of CBCTs often limits their usability beyond simply catching gross positioning errors or anatomy changes.
Lack of Time
A thorough assessment of daily CBCTs involving contouring, dose calculation, and analysis of resulting data can become a huge time sink for clinics dealing with large patient volumes and limited time.
Replanning Too Early or Too Late
Lack of appropriate tools for decision support can result in lower confidence in replan decisions, leading to replan decisions being made too early or too late. This can have a direct impact on patient care.
MIM SureCalc MonteCarlo
Accurate 3D Dose Calculation for Plan Second Check and Adaptive Assessments
Independent Base Data QA
A Monte Carlo simulation-based validation of your base data and TPS beam models can help prevent systematic discrepancies in dose calculation while reducing dependence on manual QA. Utilize institution-specific beam models derived from validated base data for superior plan second check accuracy.
Fast 3D Monte Carlo Calculation
The gold standard for accuracy, especially for complex and highly modulated plans. Cases typically calculate in less than 5 minutes.
Supports photon plans from most major LINACs and delivery devices. This includes all Varian Medical Systems®, Elekta®, Siemens®, Accuray TomoTherapy® and CyberKnife® treatment machines. Supports electron plans for Varian and Elekta machines and all SRS cone plans.
Unique Adaptive Assessment Tools
MIM SureCalc MonteCarlo provides industry-leading deformation algorithms to support automatic adaptation of contours to daily imaging, as well as summing of daily delivered doses over time to incorporate the cumulative effect of fractions delivered.
Automated processing of incoming daily/weekly fraction images and automated reporting of critical dose and volume trends across fractions make ART a clinical reality.
MIM SureCalc MonteCarlo allows for enhancements that drastically improve usability of CBCTs for adaptive use. Reduce artifacts, improve HU consistency, and expand field of view - all in an automated fashion. Monte Carlo dose calculation on enhanced CBCT allows for a superior representation of dose on current patient anatomy.
Customizable to every clinic’s unique needs, MIM SureCalc MonteCarlo aims to enhance confidence in decision making. Critical plan, dose, MU, and volume information can be easily summarized into structured reports or interactive MIM sessions for comprehensive assessments.
Practical Clinical Applications
Advanced Radiation Therapist Kate Stewart describes Royal Brisbane and Women’s Hospital's typical adaptive radiotherapy workflow, and how her team has utilized dosimetric assessment in MIM SureCalc MonteCarlo to make relevant replan decisions.
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1 Talcott, W.J. & Lincoln, H. & Kelly, J.R. & Tressel, L. & Wilson, L.D. & Decker, R.H. & Evans, Suzanne. (2019). A Blinded, Prospective Study of Problematic Plan Detection During Physician Chart Rounds. International Journal of Radiation Oncology*Biology*Physics. 105. S23-S24. 10.1016/j.ijrobp.2019.06.425.