report to the aapm radiation therapy committeerpc.mdanderson.org/rpc/publications/aa… · web...

REPORT TO THE AAPM RADIATION THERAPY COMMITTEE

Report No. 107 July 1, 2000 – September 30, 2000

PERSONNELPo (Paul) Lam Shek will be joining the Radiological Physics Center as a Computer

Programmer Analyst on October 25, 2000.We are still recruiting for a Junior Medical Physicist (MS level preferred). We are

working with an international applicant, but are still looking for a suitable candidate within the USA.

Geoffrey Ibbott, Ph.D. will join the Radiological Physics Center, as the new Section Chief of Outreach Physics, in January 2001 and will phase in as Director as Will Hanson retires on August 31, 2001.

Our move to the new office space is now scheduled for January 2001. There have been some delays with the planning and construction. We hope to move into the new space before the new Section Chief begins his tenure.

GRANT ACTIVITIESIn September, 2000 we were notified by NCI that the grant was to receive a $276,000 annual

supplement for this 5 year grant cycle. These monies will be used to pay for salary adjustments and merit increases implemented this past year, hire some new personnel and to pay for the increased rent for the new office space.

The RPC grant continuation is due October 23, 2000. We will be beginning the second year of our five year cycle. A great deal of our effort this past year was directed towards; 1) the implementation of TG-51, 2) responding to the dosimetry changes related to the low energy brachytherapy sources, 3) development of anthropomorphic phantoms, 4) continuing the development of the RPC database, and 5) continuing to offer our usual QA activities to the participating institutions.

The second year of the High Technology Subcontract with the 3-D QA Center in St. Louis began last April 1st. We just now got word of the funding for the second year. There are still problems with the award amount and we are currently working with Jim Purdy’s group to get them resolved. We will also be receiving some carryover funds from the first year.

The RPC no longer has a grant with the NEI to assist the COMS group. We will now receive funding through the chairman’s office. These funds will be used to support a graduate student to perform a reanalysis of the eye plaque dosimetry utilizing current dosimetry formalisms. We hope the new doses to critical structures will provide a better correlation with visual outcomes.

We continue to work with the Age-Related Macular Degeneration Radiotherapy Pilot Trial. We receive no funding for this, at this time, however we are hoping that the pilot trial will be successful which will lead to funding for a Physics Center similar to the set-up we had with COMS.

RPC Report to the AAPM Radiation Therapy CommitteeReport 107

STUDY GROUP ACTIVITIESThe Southwest Oncology Group (SWOG) is concerned about the radiotherapy treatments

in two of its closed studies, 1) a lung protocol consisting of 400-600 patients and 2) a prostate protocol. Both of these studies had negative results. SWOG is now interested in reestablishing a more formal relationship with the RPC to evaluate a sampling of their patient records for correctness.

We are also working with SWOG regarding TBI treatments. A survey and questionnaire were sent to the SWOG participants asking them to describe their TBI set-ups and practices. We have evaluated the responses and reported this to SWOG who is reviewing our report before discussing it with the SWOG membership.

ANTHROPOMORPHIC PHANTOMSThe RPC continues to employ and develop anthropomorphic phantoms that can be sent to

institutions to verify the dose delivery for a specific treatment site or modality. All of the phantom designs are similar in that they consist of a water fillable phantom with imaging and dosimetry inserts (exception is the breast), heterogeneous structures and use TLD and film as dosimeters. Our efforts with these phantoms continue.

1. IMRT Head and Neck Phantom: RTOG has asked us to develop this phantom as part of the QA and pre-approval process for the upcoming Radiation Therapy Oncology Group H-0022 IMRT head and neck protocol. It is a modification of the original stereotactic head phantom with target volumes near critical structures. The prototype was shipped to Medical College of Wisconsin for testing. We plan to have another four of these phantoms by the end of the year.

2. IMRT Pelvic Phantom: This phantom is in the final stages of testing. It will be able to assess absolute dose to the center of the prostate and femoral heads, field localization and dose homogeneity within the sagital and coronal planes (DAH). We are also working with Larry Reinstein to have a dosimetry insert which contains a gel dosimeter. The interest in this phantom at the AAPM meeting was astounding.

3. Heterogeneous Lung Phantom: The phantom has been built and is in the process of being tested.

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4. Breast Phantom: Physicists at MDACC have used this phantom with an ion chamber to verify their treatment planning computer. The film and TLD results have not yet been assessed.

IMPLEMENTATION OF TG-511. The RPC and Marilyn Stovall’s RDS programs indicate that approximately 6-7% of the

institutions in the USA have switched to TG-51.2. We continue to give seminars and workshops on how to implement TG-51 and areas of

potential problems. Since the Summer AAPM meeting, we have given presentations at the AAPM Summer School, to MDACC/Houston physicists, to the Southwest Chapter of the AAPM and to a group of physicists in New Orleans. (see presentations below)

3. We also continue to respond to questions about TG-51 over the phone.4. Since January 1, 2000, we have performed on-site dosimetry review visits to a total of 13

institutions. At each of these institutions, the machine outputs were evaluated using TG-51 and TG-21. The physicists at the institutions have always been extremely pleased with seeing how to implement TG-51 first hand and to see the differences between TG-21 and TG-51 outputs.

5. One can find some good information on the RPC’s website, ( http:\\rpc.mdanderson.org), about the practical considerations in implementing TG-51.

PARTICIPANT FEE

Institutions invoiced FY99-00 1117Canceled/Inactive 14Invoiced by RDS 12Institutions paid 480 (44%)

INTERNATIONAL ACTIVITIES Francisco Aguirre visited a hospital in Colombia (July 9-17, 2000), which completed the

work he had begun on a previous visit. This was part of our commitment to the contract with the IAEA to evaluate dosimetry, including performing on-site measurements, at institutions in Latin America or the Carribean where the IAEA TLD Program has detected machine output problems.

PUBLICATIONSAccepted/Published (1999-2000):Cho, S.H., Lowenstein, J.R., Balter, P.A., Wells, N.H., and Hanson, W.F. Comparison between TG-51 and TG-21: Calibration of photon and electron beams in water using cylindrical chambers. J. of Applied Clinical Medical Physics 1:108-115, 2000

Williamson, J., Coursey, B.M., DeWerd, L.A., Hanson, W.F., Nath, R., Rivard, M.J., Ibbott, G. Recommendations of the American Association of Physicists in Medicine on 103Pd interstitial source calibration and dosimetry: Implications for dose specification and prescription. Medical Physics 27:634-642, 2000.

Almond, P.R., Biggs, P.J., Coursey, B.M., Hanson, W.F., Huq, M.S., Nath, R., Rogers, D.W.O. AAPM’s TG-51 protocol for clinical reference dosimetry of high-energy photon and electron beams, Medical Physics 26:1847-1870, 1999.



Cho, S.H., Muller-Runkel, R., and Hanson W.F.: Determination of the tissue attenuation factor along two major axes of a high dose rate (HDR) Ir-192 source. Medical Physics 26:1492-1497, 1999.

Cho, S. H. and Reece, W. D. The Monte Carlo calculations of the dose backscatter factor for monoenergetic electrons. Phys. Med. Biol. 44(1):13-26, 1999.

Williamson, J.F., Coursey, B.M., DeWerd, L.A., Hanson, W.F., Nath, R., and Ibbott, G.: Guidance to users of Nycomed Amersham and North American Scientific, Inc., I-125 interstitial sources: dosimetry and calibration changes. Medical Physics 26:570-573, 1999.

TG-51 Presentations

William F. Hanson “AAPM - TG51 Protocol for Clinical Reference Dosimetry of High-Energy Photon and Electron Beams”, Southwest Chapter of the American Association of Physicists in Medicine Meeting, Dallas. TX. April 9, 1999

Jessica Lowenstein “Beta Testing of TG-51,” Southwest Chapter of the American Association of Physicists in Medicine Meeting, Dallas. TX. April 8-10, 1999

William F. Hanson “AAPM TG-51 Protocol for Clinical Reference Dosimetry of High Energy Photon and Electron Beams,” Southwest Chapter of the American Association of Physicists in Medicine, Houston, TX, April 8-10, 1999

William F. Hanson “AAPM Task Group 51 Calibration Protocol: Formalism and Beta Testing,” Penn-Ohio Chapter of the American Association of Physicists in Medicine, Cleveland, OH. September 17, 1999

William F. Hanson “Clinical Application of the AAPM Task Group 51 Protocol,” North Central Chapter of the American Association of Physicists in Medicine Madison, WI. October 6-8, 1999

David S. Followill “Implementation of TG-51,” In-service at MDACC, Radiation Dosimetry Services. November 1999

William F. Hanson “AAPM Task Group 51 Calibration Protocol: Formalism and Beta Testing,” In-service: MDACC Physics Seminar Series, Houston, TX. January 2000

William Hanson “Practical Concerns of the TG-51 Calibration Protocol,” AAPM Missouri Valley Chapter Meeting, St. Louis, MO. May 5-6, 2000

William F. Hanson "AAPM TG-51 Protocol: The Absorbed Dose Calibration Protocol" AAPM Summer School, De Kalb IL. July 29- Aug 1, 2000

William F. Hanson "Practical Applications of the TG-51 protocol" In Service for Physicists in the Houston Area. MD Anderson Cancer Center, Sept. 11, 2000



William F. Hanson "Another Visit to TG-51" Southwest Chapter of AAPM meeting San Antonio TX. Oct 6-7, 2000.

Peter Balter "TG-51 and You" Presentation to New Orleans area Physicists at East Jefferson General Hospital, New Orleans, LA. Oct. 13, 2000

TG-51 Workshops

Ramesh Tailor and “Implementation of TG-51,” In-service to physicists in the Central Texas Peter Balter Region at Baptist Hospital, San Antonio, TX. March 10 - 12, 2000

Jessica Lowenstein “AAPM Task Group 51,” Tri-County Brachytherapy Discussion group of & Peter Balter South Florida, Boca Raton, FL. June 2-3, 2000

Peter Balter, The Implementation of TG-51, Workshop at AAPM Summer School, Jessica Lowenstein, De Kalb, IL July 29 - August 1, 2000. Three workshops were presentedJose BenComo& William Hanson

David Followill In-Service to Physicists in the Houston Area, presented at M D AndersonJessica Lowenstein Cancer Center, Sept. 11, 2000. & William Hanson

William Hanson TG-51 Workshop at Southwest Chapter of AAPM meeting San Antonio Peter Balter TX. Oct 6-7, 2000. Jessica Lowenstein

David Followill TG-51 Symposium and Workshop, East Jefferson General Hospital, New & Peter Balter Orleans, LA, October 12-13, 2000

Other Presentations

William F. Hanson "Experience of the RPC with Institutions converting to TG-43” CIRMS, Gaithersburg, MD. April 29-30, 1999.

William F. Hanson “RPC Activities,” Penn-Ohio Chapter of the American Association of Physicists in Medicine, Cleveland, OH. September 18, 1999

William F. Hanson “Outreach Activities in Physics at MDACC” Southwest Chapter of the American Association of Physicists in Medicine, Houston, TX October 1-2, 1999

Sang Cho “The Monte Carlo Calculations of Organ Doses during Endovasular Brachytherapy for Coronary Arteries using High-Dose Rate (HDR) 192IR Sources” 4th Annual Symposium on Radiotherapy to Reduce Restinosis, San Diego, CA. January 13 – 15, 2000.

J. Francisco Aguirre “Radiological Physics Center TLD Network Experience”, MORQA Meeting to the European Society for Therapeutic Radiology and Oncology (ESTRO), Wurzburg, Germany, June 2-7, 2000.



Presentations (cont’d)

J. Francisco Aguirre “New Technological Developments in Equipment for External Beam Radiotherapy" at the AAPM, Pan American Health Organization, International Organization of Medical Physics, International Atomic Energy Agency, Spanish Organization of Medical Physicists, and Latin American Organization of Medical Physics (ALFIM) Summer School, Chicago, IL. July 18-23, 2000

David S. Followill “Radiation Dosimetry QA of Radiotherapy Facilities” at the AAPM, Pan American Health Organization, International Organization of Medical Physics, International Atomic Energy Agency, Spanish Organization of Medical Physicists, and Latin American Organization of Medical Physics (ALFIM) Summer School, Chicago, IL. July 18-23, 2000

José A. BenComo "Imaging modalities in the detection and localization of tumors and the simulation, planning, and follow-up of radiotherapy treatments" at the AAPM, Pan American Health Organization, International Organization of Medical Physics, International Atomic Energy Agency, Spanish Organization of Medical Physicists, and Latin American Organization of Medical Physics (ALFIM) Summer School, Chicago, IL. July 18-23, 2000

Sang Cho “Radial dose distribution at proximate distances for a high dose rate (HDR) Ir-192 source for endovascular brachytherapy applications”. American Association of Physicists in Medicine Annual Meeting / World Congress of Medical Physics 2000, Chicago, Illinois, July 22 - 27, 2000.

David Followill Radiological Physics Center: RADS Database. American Association of Physicists in Medicine Annual Meeting / World Congress of Medical Physics 2000, Chicago, Illinois, July 22 - 27, 2000.

VISITS TO INSTITUTIONS

1) David S. Followill performed radiological physics measurements and reviewed patient dosimetry at Maine Medical Center, Portland, Maine, August 21 - 24, 2000.

2) Ramesh C. Tailor performed radiological physics measurements and reviewed patient dosimetry at Ohio State University Cancer Center, Columbus, Ohio, September 22 - 28, 2000.

MEETINGS ATTENDED1) David S. Followill attended the Varian IMRT Symposium, Irving, Texas, July 11, 2000.

2) J. Francisco Aguirre attended the American Association of Physicists in Medicine Annual Meeting / World Congress of Medical Physics 2000, Chicago, Illinois, July 18, 2000 - July 26, 2000. Mr. Aguirre attended and presented at the Latin American Summer School preceeding the AAPM Meeting.



3) Peter Balter attended the American Association of Physicists in Medicine Annual Meeting / World Congress of Medical Physics 2000, Chicago, Illinois, July 22-27, 2000, 2000. Mr. Balter also presented a workshop titled “The Implementation of TG-51” at the AAPM Summer School, DeKalb, IL. July 27- August 1, 2000.

4) José A. BenComo attended the American Association of Physicists in Medicine Annual Meeting / World Congress of Medical Physics 2000. Dr. BenComo was the Director, of the Latin American Summer School, “New Techniques in Radiotherapy (Fundamental Principles, Applications, Instrumentations, and Quality Control), University of Chicago, Chicago, IL, July 18-23, 2000. Dr. BenComo also presented a workshop titled “The Implementation of TG-51” at the AAPM Summer School, DeKalb, IL. July 27- August 1, 2000. Chicago, Illinois

5) Christopher P. Cherry attended the American Association of Physicists in Medicine Annual Meeting / World Congress of Medical Physics 2000, Chicago, Illinois, July 22, 2000 - July 28, 2000. He presented a poster titled “Design of a Heterogeneous Thorax Phantom for Remote Verification of Three-Dimensional Conformal Radiotherapy”.

6) Sang Cho attended the American Association of Physicists in Medicine Annual Meeting / World Congress of Medical Physics 2000, Dr. Cho made a presentation titled “Radial dose distribution at proximate distances for a high dose rate (HDR) Ir-192 source for endovascular brachytherapy applications”. Chicago, Illinois, July 22, 2000 - July 27, 2000.

7) David S. Followill attended the American Association of Physicists in Medicine Annual Meeting / World Congress of Medical Physics 2000. Dr. Followill also presented a lecture titled, “Radiation Dosimetry QA of Radiotherapy Facilities,” at the Latin American Summer School. Chicago, Illinois, July 22, 2000 - July 28, 2000. Dr. Followill also gave an oral presentation titled “Radiological Physics Center: RADS Database” at the AAPM 2000 Meeting. Chicago, Illinois, July 22-27, 2000.

8) William F. Hanson attended the American Association of Physicists in Medicine Annual Meeting / World Congress of Medical Physics 2000, Chicago, Illinois, July 22-27, 2000. Dr. Hanson also was on the faculty, presented a lecture (twice) titled “The Implementation of TG-51”, and held a workshop on TG-51 at the AAPM Summer School, DeKalb, IL. July 27- August 1, 2000.

9) Marylou Lesseraux attended the American Association of Physicists in Medicine Annual Meeting / World Congress of Medical Physics 2000, Chicago, Illinois, July 22, 2000 - July 27, 2000. She is the recording secretary for the RTC.

10) Jessica Lowenstein attended and presented a poster titled “Implementation of TG-51: Practical Considerations”, at the American Association of Physicists in Medicine Annual Meeting / World Congress of Medical Physics 2000, Chicago, Illinois, July 22-27, 2000. Ms. Lowenstein also attended the Gynecologic Oncology Group meeting, St. Louis, MO. July 27-29, 2000. Ms. Lowenstein also presented a workshop titled “The Implementation of TG-51” at the AAPM Summer School, DeKalb, IL. July 29 - August 1, 2000.



11) Dee-Ann Radford attended the American Association of Physicists in Medicine Annual Meeting / World Congress of Medical Physics 2000, Chicago, Illinois, July 22, 2000 - July 30, 2000. She presented a poster titled “Design of an Anthropomorphic Intensity Modulated Radiation Therapy Quality Assurance Phantom”.

12) Joye Roll attended the American Association of Physicists in Medicine Annual Meeting / World Congress of Medical Physics 2000, Chicago, Illinois, July 22 - 27, 2000. Ms. Roll also attended the Gynecologic Oncology Group meeting, St. Louis, MO. July 27-29, 2000

13) Elizabeth Shears-Siller attended the American Association of Physicists in Medicine Annual Meeting / World Congress of Medical Physics 2000, Chicago, Illinois, July 22, 2000 - July 25, 2000. She worked as recording secretary for the RTC.

14) Ramesh C. Tailor attended the American Association of Physicists in Medicine Annual Meeting / World Congress of Medical Physics 2000, Chicago, Illinois, July 21, 2000 - July 28, 2000.

15) Nathan Wells attended the American Association of Physicists in Medicine Annual Meeting / World Congress of Medical Physics 2000, Chicago, Illinois, July 23, 2000 - July 29, 2000

16) David S. Followill attended the Age Related Macular Degeneration Radiotherapy Trial-Data Safety and Monitoring Committee Meeting, Philadelphia, Pennsylvania, August 29- 30, 2000.

17) José A. BenComo attended the North Central Cancer Treatment Group Meeting, Rochester, Minnesota, September 27 - 29, 2000.

STATUS SUMMARYDosimetry review visits were made to 2 institutions, at which 17 beams† were reviewed,

3921 TLD reports were evaluated, and 236 patients' charts were returned to the cooperative groups. There are two institutions that are a special high priority for a dosimetry review visit (based on TLD, chart check, etc).

A summary of cooperative groups and institutions’ participation in them are included in the attached table.

†The review of one photon energy is considered a "beam"; however, review of the whole set of electrons on one machine is considered only one "beam". Measurement of TBI and other special procedures is also considered one "beam".

Sincerely yours,

William F. Hanson, Ph.D.Director, Radiological Physics Center


EXPENDITURES OF THE RADIOLOGICAL PHYSICS CENTER(this includes the main RPC grant, the COMS grant, and the High Technology

Subcontract)July 1, 2000 – September 30, 2000

______________________________________________________________________________PERSONNEL (salaries, fringe benefits): $476,113.339 Physicists, 1 Supervisor of Quality Assurance Dosimetry Services, 4 Dosimetrists, 1 Programmer Analyst III, 1 Programmer Analyst I, 1 Radiological Physics Supervisor, 4 Radiological Physics Technicians, 1 Administrative Coordinator, 1 Administrative Assistant, 1 Administrative Clerk, 1 Departmental Buyer, 1 Secretary, and 2 Graduate Research Assistants.______________________________________________________________________________

TRAVELVisitsDavid Followill, Portland, ME 1773.16Ramesh Tailor, Columbus, OH 1528.07TOTAL $3,301.23

Meetings:David Followill, Irving, TX 191.56J. Francisco Aguirre, Chicago, IL 1904.39Peter Balter, Chicago and Decauter, IL 2012.39José BenComo, Chicago and Decauter, IL 2440.38Christopher Cherry, Chicago, IL 2094.93Sang Cho, Chicago, IL 2003.59David Followill, Chicago, IL 2484.14William Hanson, Chicago and Decauter, IL 2080.73Marylou Lesseraux, Chicago, IL 1435.44Jessica Lowenstein, Chicago and Decauter, IL and St. Louis, MO 2490.87Dee-Ann Radford, Chicago, IL 514.38Joye Roll, Chicago, IL and St. Louis, MO 2498.98Elizabeth Shears-Siller, Chicago, IL 834.55Ramesh C. Tailor, Chicago, IL 2333.99Nathan Wells, Chicago, IL 1500.21David Followill, Philadelphia, PA 0.00José BenComo, Rochester, MN 728.46TOTAL $27,548.99

CONSULTANTS:Fiscal 2001 this fund contains $10,000.00

EQUIPMENT: $ 1,666.00 Computers, printers, etc._____________________________________________________________________________SUPPLIES: $ 31,898.10Office supplies, laboratory and record keeping, TLD,TLD supplies, software, etc.______________________________________________________________________________OTHER EXPENSE: $ 23,438.83Postage, telephone, reprints, copying, computer fees, equipment repair, etc. – Database Conversion______________________________________________________________________________SPACE RENTAL: $ 28,861.74______________________________________________________________________________Total Expenditures July 1, 2000 – September 30, 2000 $592,828.22Indirect costs @ 26% $154,135 .34 TOTAL $746,963.56


RPC Report to RTC October 2000

Clinical Study Groups Office ReviewingPatient Records

Special Projects

American College of Surgeons Oncology GroupACOSOG RPC US guided Prostate

Cancer and Acute Leukemia Group BCALGB QARC

Children’s Oncology Group COG(POG, CCG, WILMS, RHABDO) QARC

Eastern Cooperative Oncology GroupECOG

QARC

Gynecologic Oncology GroupGOG RPC HDR Pre-approved

National Surgical Adjuvant Breast and Bowel Project

NSABPRPC B-06 Study revisited

North Central Cancer Treatment GroupNCCTG RPC

Radiation Therapy Oncology GroupRTOG

RTOG3D CRT by 3D CenterBrachytherapy by RPC

IMRT PhantomProstate Phantom

Prostate Pre-approvalBreast Pre-approval – HDR &

LDR

Southwest Oncology GroupSWOG

SWOG QAC (early review)

RPC (retrospective of Selected Studies)

US guided ProstateTBI evaluation

Lung & Prostate Study Review


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