REPORT TO AAPM RADIATION THERAPY COMMITTEE



REPORT TO THE AAPM RADIATION THERAPY COMMITTEE

Report No. 111 November 1, 2001 – March 31, 2002

Personnel

Robert Pinney began work on January 22, 2002 as a TLD technician. He replaces an employee who left at the end of last year.

Paola Alvarez, M.S. has been recruited to take the vacant Medical Physicist position. She is expected to arrive in Houston in July. She will be leaving positions at the Universidad Nacional de General San Martín and at the Comision Nacional de Energia Atomica in Buenos Aires, Argentina. The latter position involves work at the Secondary Standard Dosimetry Laboratory in Buenos Aires. Ms. Alvarez completed a six month practical training experience at the RPC several years ago.

GRANT ACTIVITIES

The RPC major grant began its third year of the current five year cycle on January 1, 2002.

The Advanced Technology Subcontract with the Image Guided Therapy QA Center (ITC) in St. Louis will end on March 31, 2002. The ITC has submitted an application for continuation of this contract for an additional five-year period. The RPC will again be a subcontractor on this contract.

The Advanced Technology QA Consortium (ATC) has met twice since our previous report, on November 19, 2001 and on March 8, 2002. The groups participating in the conference calls included the RPC, the ITC, the Quality Assurance Review Center (QARC), the Resource Center for Emerging Technologies (RCET) and the Physics Committee of the Radiation Therapy Oncology Group (RTOG). These groups all exist to support NCI funded clinical trials in radiation therapy because the efficacy of the treatments is directly dependent upon the use of correct physics methods and data. The purpose of these meetings has been to enhance the interaction among the various QA offices, to collaborate on issues having similar requirements among the study groups, and to plan further activities in light of the increasing complexity of radiation therapy due to new technologies.

The RPC continues to interact frequently with the Cancer Trials Support Unit (CTSU) on conference calls and by email. In response to suggestions and requests from CTSU, the RPC has made available on its web site a list of all monitored institutions. The list is searchable, and can also be downloaded in alphabetical or zip code order. In addition, some information regarding the treatment equipment available at each institution is available. Another significant feature is the assignment of a unique radiotherapy facility number (RTF#) to help uniquely identify participating institutions. This unique identifier will help all groups distinguish among institutions with similar or confusing names.

The COMS grant has been converted to a subcontract with the COMS PI (University of Pennsylvania). Dr. Followill has been named PI on this subcontract. The subcontract supports a student who recalculated the dose to critical structures for patients treated with eye plaques. This work is completed, and the RPC is pursuing funding for additional projects.

A contract has been developed with Amgen Corporation to provide support for a study of total body irradiation. Dr. Followill is PI of this contract. It is expected that 220 patients will be treated at 16 institutions under this protocol. The RPC will conduct TLD dosimetry for these patients and will review the charts.

Study Group Activities

Radiation Therapy Oncology Group

Credentialing processes:

• We continue to credential institutions to participate in the RTOG Protocol P-0019, radioactive implants for prostate. The protocol has closed but institutions continue to pursue credentialing in anticipation of a phase III study to come in the near future. The RPC credentialing process also is used for ACOSOG protocol Z0070 and NCCTG protocol N0052.

• We continue to credential institutions to participate in the RTOG Protocol H-0022, IMRT for head and neck cancer. Institutions are required to transmit radiotherapy data electronically to the ITC in St. Louis. They are also required to successfully image, plan and treat the RPC’s IMRT Head and Neck Phantom. The IMRT phantom has been sent to 11 institutions. The TLD results available to date are given in the table below.

|Institution |Primary PTV sup |Primary PTV inf |Secondary PTV |Critical Structure |

|1 |0.96 |1.03 |1.09 |0.98 |

|2 |0.92 |0.95 |0.92 |0.81 |

|3 |1.03 |-- |1.00 |1.15 |

|4 |0.95 |0.99 |0.97 |-- |

|5 |1.08 |1.06 |1.10 |1.34 |

|6 |1.00 |1.02 |0.98 |1.09 |

|7 |1.00 |0.98 |1.00 |2.24 |

|8 |0.97 |0.97 |0.96 |0.87 |

|9 |1.03 |1.03 |1.05 |1.08 |

|average |0.99 |1.00 |1.01 |1.05* |

|std dev |4.9% |3.7% |6.0% |17.1%* |

*The mean and standard deviation values exclude institution #7.

The phantom also contains radiochromic film that is used to determine the dose profile in three orthogonal directions. A representative comparison of film data with the institution’s treatment plan is shown in the figure below.

• We have held discussions with the study chairs of two additional RTOG protocols to consider conducting credentialing activities for their protocols.

- Dr. I-Chow Joe Hsu at UCSF has written a protocol for HDR brachytherapy boost for prostate.

- Dr. Robert R. Kuske, Jr. is planning a Phase III study of breast therapy, allowing a variety of treatments including external beam and brachytherapy.

• RTOG protocol 9406, Conformal therapy for prostate treatment. The RPC has reviewed the records of MDACC patients entered onto the study and are able to evaluate the doses delivered. We anticipate writing a proposal to RTOG for an ancillary study to evaluate the correctness of the data through the ITC for these patients.

Southwest Oncology Group

• SWOG Intergroup Protocol S9927: Breast treatment allowing everything from simple parallel opposed, through electron treatments, to conformal therapy. SWOG has agreed to have us review these patients. Several patients have been entered onto the study, and we have received 3 charts. We anticipate up to 1500 patients, so will consider a method of sampling.

• SWOG TBI Survey: We have received data on TBI procedures for 25 SWOG institutions. The data are under review and will be presented at the spring SWOG meeting, summarizing the way that TBI is done and attempting to answer the question from SWOG concerning the diversity of treatments used. This may lead to SWOG guidelines for future protocols.

• SWOG: The RPC reviewed proposed protocol S0122, a phase two trial of patients with limited stage small cell lung cancer. The RPC has proposed that it participate in the evaluation of patients submitted to this protocol, particularly because the protocol calls for a comparison of heterogeneity corrected and uncorrected treatment plans. The RPC submitted a number of other comments on this protocol.

Gynecologic Oncology Group

• GOG has two new proposals that we are dealing with. (1)They wish to include Syed applications as acceptable replacements for conventional tandem and ovoid treatment for GYN patients. (2) They also wish to implement image based 3-D treatment planning for GYN implants. We are participating in a subcommittee that will investigate image-based protocols.

North Central Cancer Treatment Group

• The RPC commented on proposed protocol N0028, phase I/II study of escalating radiotherapy for non-small cell lung cancer. The RPC made a number of suggestions regarding the use of 3D terminology and calculation procedures, and offered to participate in the review of cases submitted to this protocol.

INTERACTION WITH THE SUBCOMMITTEE ON LOW-ENERGY INTERSTITIAL BRACHYTHERAPY

The RPC was identified as principal contact for questions about low-energy brachytherapy sources in the AAPM’s advice to physicists on 125I or 103Pd brachytherapy sources. Soon after publications of the advice, the RPC received many calls and e-mails. More recently, the rate of contacts on this issue has decreased to one or two each week.

The RPC maintains a page on its web site titled “Joint AAPM/RPC Registry of Low-energy Brachytherapy Seeds Meeting the AAPM Dosimetric Prerequisites”. The registry presently lists 10 seeds of which all but two were placed on the registry when it was created in March 2001. The original 8 seeds are being required by the subcommittee to be re-registered so that the subcommittee can exert the same review on these seeds as was given to seeds added subsequently.

IMPLEMENTATION OF TG-51

The RPC continues to monitor the transition of institutions to the TG-51 protocol. We have asked institutions to notify us, on specially prepared forms, of their efforts to implement the TG-51 protocol. To date, 163 of 1,296 megavoltage therapy sites we monitor have submitted their forms. However, our TLD data indicate that 293 of these institutions appear to have implemented TG-51.

The RPC has prepared and submitted a publication listing the frequent errors and areas of confusion that we have detected through our review of these forms and through conversations with institutions. The publication is presently in review.

We continue to conduct or participate in seminars and workshops throughout the USA regarding the implementation of the TG-51 protocol. We receive phone calls frequently from institutions seeking advice. On-line assistance is available on our web page at . The web site contains instructional videos, PowerPoint presentations, a dry lab exercises with answers, abstracts and publications from the RPC.

PARTICIPANT FEE:

Institutions invoiced FY02 1295

No XRT/Canceled/Inactive 112

Invoiced by RDS 13

Institutions paid 938

PRESENTATIONS

Geoffrey Ibbott: “Radiological Physics Center Credentialing Programs”

Radiation Therapy Oncology Group, IMRT Symposium

Amanda Krintz: “Reanalysis of the COMS Medium Tumor Trial Dosimetry”

Collaborative Ocular Melanoma Study Annual Technical Meeting

INTERNATIONAL ACTIVITIES

Geoffrey Ibbott attended and served as an invited speaker on “IMRT Quality Assurance by the Radiological Physics Center,” for the Asia Oceania Congress of Medical Physics Meeting, Bangkok, Thailand, November 11-17, 2001.

Geoffrey Ibbott attended the International Workshop on Gel Dosimetry, Brisbane, Australia, November 18-22, 2001.

William Hanson met with the International Atomic Energy Agency (IAEA) in order to establish procedures for on-site review visits for quality assurance in radiotherapy treatment planning, Vienna, Austria, December 4-11, 2001.

Francisco Aguirre delivered lectures at the 27th Central American and Caribbean Physics Course (CURCCAF), Panama City, Panama, December 9-14, 2001.

William Hanson met with representatives of the European Society for Therapeutic Radiology and Oncology (ESTRO-EQUAL) to discuss monitoring of European institutions participating in protocols based in the United States and Paris, France, December 12-15, 2001.

Geoffrey Ibbott met with representatives of the European Society for Therapeutic Radiology and Oncology (ESTRO-EQUAL) to discuss monitoring of European institutions participating in protocols based in the United States and Paris, France, December 12-15, 2001.

Geoffrey Ibott attended as an observer and rapporteur for the Advisory Group Meeting of the IAEA, SSC-10, concerning the Evaluation and the Recommendations on the Dosimetry Program (10th Meeting of the Scientific Committee SCC-10), Vienna, Austria, February 23 – March 2, 2002.

VISITS TO INSTITUTIONS

1. David Followill performed radiological physics measurements and reviewed patient dosimetry at the University of Minnesota and Fairview Southdale Medical Center, Minneapolis, MN, November 12-16, 2001.

2. Andrea Nelson performed radiological physics measurements and reviewed patient dosimetry at the University of Minnesota and Fairview Southdale Medical Center, Minneapolis, MN, November 12-16, 2001.

3. Ramesh Tailor performed radiological physics measurements and reviewed patient dosimetry at Duke University Medical Center, Durham, NC, December 8-14, 2001.

4. Jessica Lowenstein performed radiological physics measurements and reviewed patient dosimetry at East Carolina University, Greenville, NC, January 6-11, 2002.

5. David Followill performed radiological physics measurements and reviewed patient dosimetry at Naval Medical Center, Portsmouth, VA, January 7-9, 2002.

6. Andrea Nelson performed radiological physics measurements and reviewed patient dosimetry at Harrington Cancer Center, Amarillo, TX, January 7-10, 2002.

7. J. Francisco Aguirre performed radiological physics measurements and reviewed patient dosimetry at Massachusetts General Hospital, Boston, MA, January 21-25, 2002.

8. Geoffrey Ibbott performed radiological physics measurements and reviewed patient dosimetry at Massachusetts General Hospital, Boston, MA, January 21-25, 2002.

9. Jessica Lowenstein performed radiological physics measurements and reviewed patient dosimetry at Overton Brooks Cancer Center, Shreveport, LA, February 6-7, 2002.

10. David Followill performed radiological physics measurements and reviewed patient dosimetry at Emory Clinic and Grady Memorial Hospital, Atlanta, GA, February 11-14, 2002.

11. J. Francisco Aguirre performed radiological physics measurements and reviewed patient dosimetry at Rutland Regional Medical Center, Rutland, VT and Atlantic City Medical Center, Pomona, NJ, February 22 – March 2, 2002.

12. Jessica Lowenstein performed radiological physics measurements and reviewed patient dosimetry at Glen Falls Hospital, Glen Falls, NY and Samaritan Hospital, Troy, NY, February 24 – March 1, 2002.

13. Andrea Nelson performed radiological physics measurements and reviewed patient dosimetry at VA Hospital Memphis, Memphis, TN and Haley VA Hospital, Tampa, FL, February 25 – March 1, 2002

14. David Followill performed radiological physics measurements and reviewed patient dosimetry at Stanford University, Palo Alto, CA and Santa Clara Valley Center, San Jose, CA, March 11-14, 2002.

15. Jessica Lowenstein performed radiological physics measurements and reviewed patient dosimetry at Stanford University, Palo Alto, CA and Santa Clara Valley Center, San Jose, CA, March 11-14, 2002.

16. Andrea Nelson performed radiological physics measurements and reviewed patient dosimetry at University of Mississippi, Jackson, MS, March 16-20, 2002.

17. Sang Cho performed radiological physics measurements and reviewed patient dosimetry at University of Southern California Medical Center, Los Angeles, CA, March 17-21, 2002.

MEETINGS ATTENDED

1. Sang Cho attended the American Society for Therapeutic Radiology and Oncology (ASTRO) Meeting. San Francisco, CA, November 3-8, 2001.

1. Geoffrey Ibbott attended the American Society for Therapeutic Radiology and Oncology (ASTRO) Meeting and participated in meetings of the AAPM QA Subcommittee, the LEIBS Subcommittee, the Radiation Therapy Committee and the ACR Practice Accreditation Committee. San Francisco, CA, November 3-8, 2001.

2. David Followill attended the American Society for Therapeutic Radiology and Oncology (ASTRO) Meeting and participated in a meeting of the ASTRO Physics Committee and the AAPM QA Subcommittee. San Francisco, CA, November 4-8, 2001.

3. José BenComo attended the National Institute of Biomedical Imaging Bioengineering (NIBIB), Bethesda, MD, November 9, 2001

4. Sang Cho attended the Eastern Cooperative Oncology Group Meeting and represented the RPC at the Radiation Oncology Committee. Miami, FL, November 11, 2001.

5. J. Francisco Aguirre attended the Cancer and Acute Leukemia Group B Meeting, Jacksonville, FL, November 16-18, 2001

6. Geoffrey Ibbott attended the Radiological Society of North America Meeting (RSNA) where he chaired a poster session and participated in meetings of the AAPM ADCL Subcommittee, the Newsletter Editorial Committee, and the RSNA Program Committee. Chicago, IL, November 24-26, 2002.

7. Amanda Krintz attended the Collaborative Ocular Melanoma Study Data Analysis Group Meeting, Baltimore, MD, December 5-7, 2001.

8. José BenComo attended the DICOM Working Group #18 Meeting, Philadelphia, PA, December 11, 2001

9. Geoffrey Ibbott attended the American Board of Radiology Radiation Oncology Written Exam Committee Meeting. Tucson, AZ, January 13-14, 2002.

10. Geoffrey Ibbott attended the Gynecologic Oncology Group Meeting and represented the RPC at the Radiation Oncology Committee meeting, the Cervix Committee meeting, and the Chart Review. New Orleans, LA, January 17-19, 2002.

11. Joye Roll attended the Gynecologic Oncology Group Meeting, New Orleans and represented the RPC at the Radiation Oncology Committee meeting, the Cervix Committee meeting, and the Chart Review. LA, January 17-19, 2002.

12. Jessica Lowenstein attended the Gynecologic Oncology Group Meeting and represented the RPC at the Radiation Oncology Committee meeting, the Cervix Committee meeting, and the Chart Review. New Orleans, LA, January 17-19, 2002.

13. José BenComo attended the Third National Forum on Biomedical Imaging in Oncology, Arlington, VA, January 30 – February 1, 2002.

14. David Followill attended the Radiation Therapy Oncology Group Semi-annual Meeting, Tampa, FL, January 31, 2002 – February 3, 2002.

15. Geoffrey Ibbott attended the Radiation Therapy Oncology Group Semi-annual Meeting and served as a member of the Quality Control and Medical Physics Committees. He also gave a talk at an IMRT symposium on “Radiological Physics Center Credentialing Programs.” Tampa, FL, January 31, 2002 – February 3, 2002.

16. Irene Harris attended the Radiation Therapy Oncology Group Semi-annual Meeting, Tampa, FL, January 31, 2002 – February 3, 2002.

17. José BenComo attended the Semi-annual Meeting of ACRIN, and also served as a member of the Quality Assurance Committee, New Orleans, LA, February 28 – March 3, 2002.

18. José BenComo attended the Three Dimensional (3D) Quality Assurance Center Meeting, St. Louis, MO, March 15-16, 2002.

19. David Followill attended the Collaborative Ocular Melanoma Study Annual Technical Meeting and served as a member of the Executive Committee and represented the RPC at the Plaqued Eyes Committee and Cataract Working Group. Baltimore, MD, March 17-19, 2002.

20. Geoffrey Ibbott attended the Collaborative Ocular Melanoma Study Annual Technical Meeting and represented the RPC at the Plaqued Eyes Committee and Cataract Working Group. Baltimore, MD, March 17-19, 2002.

21. Amanda Krintz attended the Collaborative Ocular Melanoma Study Annual Technical Meeting and presented a talk on “Reanalysis of the COMS Medium Tumor Trial Dosimetry” Baltimore, MD, March 17-19, 2002.

STATUS SUMMARY

Dosimetry review visits were made to 20 institutions, at which 112 beams† were reviewed, 1,965 TLD reports were evaluated, and 448 patients' charts were evaluated. There is one institution that is 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 a cadre of electrons on one machine is considered only one "beam". Measurement of TBI and other special procedures are also considered one "beam".

Respectfully submitted,

Geoffrey S. Ibbott, Ph.D.

Chief, Section of Outreach Physics

EXPENDITURES OF THE RADIOLOGICAL PHYSICS CENTER

(RPC Grant, the COMS Subcontract, and the High Technology Subcontract)

November 1, 2001 – March 31, 2002

______________________________________________________________________________

PERSONNEL (salaries, fringe benefits): $ 893,568.09

9 Physicists, 1 Supervisor of Quality Assurance Dosimetry Services, 4 Dosimetrists, 1 Information Manager, 1 Database Administrator, 1 Programmer Analyst I, 1 Radiological Physics Supervisor, 4 Radiological Physics Technicians, 1 Department Administrator, 1 Administrative Assistant, 1 Administrative Clerk, 1 Departmental Buyer, 2 Secretaries, and 2 Graduate Research Assistants.

TRAVEL

Visits

|David Followill – Minneapolis, MN |$1622.93 |

|Andrea Nelson – Minneapolis, MN |1178.92 |

|Ramesh Tailor – Durham, NC |1493.03 |

|Jessica Lowenstein – Greenville, NC |807.37 |

|David Followill – Portsmouth, VA |924.75 |

|Andrea Nelson – Amarillo, TX |693.79 |

|J. Francisco Aguirre – Boston, MA |1378.68 |

|Geoffrey Ibbott – Boston, MA |1285.53 |

|Jessica Lowenstein – Shreveport, LA |712.04 |

|David Followill – Altanta, GA |1133.42 |

|J. Francisco Aguirre – Rutland, VT and Pomona, NJ |1641.00 |

|Jessica Lowenstein – Glen Falls, NY and Troy, NY |1025.06 |

|Andrea Nelson – Memphis, TN and Tampa, FL |1833.51 |

|David Followill – Palo Alto and San Jose, CA |1451.50 |

|Jessica Lowenstein - Palo Alto and San Jose, CA |1451.50 |

|Andrea Nelson – Jackson, MS |966.00 |

|Sang Cho – Los Angeles, CA |1327.00 |

|TOTAL: |$20,926.03 |

Meetings:

|Sang Cho – San Francisco, CA |$2,015.48 |

|Geoffrey Ibbott – San Francisco, CA |1,818.08 |

|David Followill – San Francisco, CA |1,576.10 |

|José BenComo – Bethesda, MD |649.12 |

|Sang Cho – Miami, FL |814.37 |

|Geoffrey Ibbott – Bangkok, Thailand and Brisbane, Australia |2,920.89 |

|J. Francisco Aguirre – Jacksonville, FL |787.50 |

|Geoffrey Ibbott – Chicago, IL |1,134.00 |

|William Hanson – Vienna, Austria and Paris, France |0.00 |

|Amanda Krintz – Baltimore, MD |717.76 |

|J. Francisco Aguirre – Panama City, Panama |0.00 |

|José BenComo – Philadelphia, PA |779.75 |

|Geoffrey Ibbott – Paris, France |0.00 |

|Geoffrey Ibbott – Tucscon, AZ |0.00 |

|Geoffrey Ibbott – New Orleans, LA |857.00 |

|Joye Roll – New Orleans, LA |625.66 |

|Jessica Lowenstein – New Orleans, LA |655.23 |

|José BenComo – Arlington, VA |769.08 |

|David Followill – Tampa, FL |942.02 |

|Geoffrey Ibbott – Tampa, FL |888.02 |

|Irene Harris – Tampa, FL |844.95 |

|José Bencomo – New Orleans, LA |1,037.00 |

|José BenComo – St. Louis, MO |720.50 |

|David Followill – Baltimore, MD |1,438.00 |

|Geoffrey Ibbott – Baltimore, MD |1,438.00 |

|TOTAL: |$ 23,428.51 |

|CONSULTANTS | |

|Fiscal 2002 this funds contains $9,700 | |

| | |

|Saiful Huq - ASTRO |$ 775.52 |

|EQUIPMENT: | |

|Computers, printers, etc. |$ 32,485.95 |

|SUPPLIES: |$ 26,471.56 |

|Office supplies, laboratory and record keeping, TLD, | |

|TLD supplies, software, etc. | |

| | |

|OTHER EXPENSE: |$ 4,598.90 |

|Postage, telephone, reprints, copying, computer fees, | |

|equipment repair, etc. – Database Conversion | |

| | |

|SPACE RENTAL: |$ 83,035.05 |

| | |

|Total Expenditures November 1, 2001 – March 31, 2002 |$1,085,289.61 |

|Indirect costs @ 25% | 271,322.40 |

|TOTAL |$1,356,612.01 |

RPC Report to RTC March 2002

|Clinical Study Groups |Office Reviewing |Special Projects |

| |Patient Records | |

| | | |

|American College of Surgeons Oncology Group |QARC | |

|ACOSOG | |US guided Prostate |

| | |RPC Institution List |

|Cancer and Acute Leukemia Group B |QARC | |

| | | |

|Children’s Oncology Group COG | |3D Benchmark Case |

|(POG, CCG, WILMS, RHABDO) |QARC |IMRT Benchmark Case |

|Eastern Cooperative Oncology Group |QARC | |

|ECOG | | |

|Gynecologic Oncology Group |RPC | |

|GOG | |HDR Pre-approval |

| | |Electron Transfer of |

| | |Patient Records |

| | |Image Based Treatment Planning |

|National Surgical Adjuvant Breast |RPC | |

|and Bowel Project | | |

|NSABP | |Breast phantom |

|North Central Cancer Treatment Group |RPC |Early Review of Lung Study |

|NCCTG | |TRUS guided Prostate |

| | |Pre-approval |

|Radiation Therapy Oncology Group |RTOG |IMRT Phantom /pre-approval |

|RTOG |3D CRT by ITC Center |Prostate Phantom |

| |Brachytherapy by RPC |Prostate Implant |

| | |Pre-approval LDR/HDR |

| | |Stereotactic Phantom |

| | |Lung Phantom |

| | |Cervix HDR Pre-approval |

| | |Patient Calculation Program |

|Southwest Oncology Group |SWOG QAC (early review) |US guided Prostate |

|SWOG |RPC (retrospective review |Lung & Breast Study Review |

| |of Selected Studies) | |

|Clinical Trial Support Unit |QARC, RPC, RTOG |RPC Institution List |

|CTSU | |RTF Numbers |

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