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Results of patient specific quality assurance for patients undergoing stereotactic ablative radiotherapy for lung lesions

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Abstract

Hypofractionated image guided radiotherapy of extracranial targets has become increasingly popular as a treatment modality for inoperable patients with one or more small lesions, often referred to as stereotactic ablative body radiotherapy (SABR). This report details the results of the physical quality assurance (QA) program used for the first 33 lung cancer SABR radiotherapy 3D conformal treatment plans in our centre. SABR involves one or few fractions of high radiation dose delivered in many small fields or arcs with tight margins to mobile targets often delivered through heterogeneous media with non-coplanar beams. We have conducted patient-specific QA similar to the more common intensity modulated radiotherapy QA with particular reference to motion management. Individual patient QA was performed in a Perspex phantom using point dose verification with an ionisation chamber and radiochromic film for verification of the dose distribution both with static and moving detectors to verify motion management strategies. While individual beams could vary by up to 7 %, the total dose in the target was found to be within ±2 % of the prescribed dose for all 33 plans. Film measurements showed qualitative and quantitative agreement between planned and measured isodose line shapes and dimensions. The QA process highlighted the need to account for couch transmission and demonstrated that the ITV construction was appropriate for the treatment technique used. QA is essential for complex radiotherapy deliveries such as SABR. We found individual patient QA helpful in setting up the technique and understanding potential weaknesses in SABR workflow, thus providing confidence in SABR delivery.

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Acknowledgments

This work was supported by Cancer Australia Priority-Driven Collaborative Cancer Research Scheme grant 566813 in support of the CHISEL (TROG 09.02) clinical trial.

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Authors and Affiliations

  1. Department of Physical Sciences, Peter MacCallum Cancer Centre, St. Andrew’s Place, East Melbourne, VIC, 3002, Australia

    Nicholas Hardcastle, Natalie Clements, Jim Cramb, Derrick M. Wanigaratne & Tomas Kron

  2. Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia

    Nicholas Hardcastle

  3. Department of Radiation Therapy, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia

    Brent Chesson

  4. Radiation Oncology, Epworth Healthcare, East Melbourne, VIC, Australia

    Yolanda Aarons

  5. Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia

    Shankar Siva & David Ball

  6. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia

    Shankar Siva & David Ball

  7. Department of Applied Sciences, RMIT University, Melbourne, VIC, Australia

    Tomas Kron

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  1. Nicholas Hardcastle
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  2. Natalie Clements
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  3. Brent Chesson
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  4. Yolanda Aarons
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  5. Jim Cramb
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  6. Shankar Siva
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  7. Derrick M. Wanigaratne
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  8. David Ball
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  9. Tomas Kron
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Correspondence to Nicholas Hardcastle.

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Hardcastle, N., Clements, N., Chesson, B. et al. Results of patient specific quality assurance for patients undergoing stereotactic ablative radiotherapy for lung lesions. Australas Phys Eng Sci Med 37, 45–52 (2014). https://doi.org/10.1007/s13246-013-0239-4

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  • DOI: https://doi.org/10.1007/s13246-013-0239-4

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