REPORT TO AAPM RADIATION THERAPY COMMITTEE



REPORT TO THE AAPM RADIATION THERAPY COMMITTEE

Report No. 114 October 1, 2002, - February 28, 2003

Personnel

Mary Lou Lesseraux, the Department Administrator for the Section of Outreach Physics, retired from M.D. Anderson at the end of January 2003. Mary Lou has been with Outreach Physics and with the RPC with many years and has made enormous contributions. She will be missed, but her presence at the RPC will be felt for a long time.

Dorene Biagas, MBA, began as the Department Administrator for Outreach Physics as of March 3, 2003. Ms. Biagas brings a wealth of experience with the Department of Radiation Physics, where she has been Office Manager for three years. She also has training and experience in financial management.

A medical physicist, Paola Alvarez, MS began working with the RPC in September 2002. She has undergoing several months of training with other RPC physicists, and has made one supervised visit to a participating institution. The RPC presently is fully staffed.

Jackeline Esteban, Malcom Heard, Gary Fisher and Joao Borges are graduate students who began working with the RPC during the last year. Seungsoo Lee, Ph.D. is a post-doctoral fellow who joined us last summer.

GRANT ACTIVITIES

The RPC major grant began its fourth year of the current five year cycle on January 1, 2003. We anticipate preparing the application for competing renewal later this year, and anticipate an NCI site visit early next year.

The Advanced Technology for Radiation Therapy grant to Washington University in St. Louis has been renewed. The grant period will be five years and began July 1, 2002. Funding to the RPC is reduced somewhat from previous years. In addition, the grant is structured differently than before, with five entities as subcontractors: the RPC, ITC, RCET, QARC, and the RTOG QA office. These subcontractors form the Advanced Technology Consortium (ATC). The ATC last met face-to-face in Providence, Rhode Island on November 19-20, 2002. Recent meetings have been by monthly conference calls.

The ATC continues to function according to the following structure: the RPC, QARC and RTOG are the principal points of contact for the study groups. ITC and RCET function as developers of tools that facilitate interaction with the study groups by the other three subcontractors. An Executive Committee has been formed and is expected to meet in April.

Recent activities of the RPC with regard to the ATC include implementation of ITC-RCET software tools for electronic transmission of images and treatment plan information for external beam and brachytherapy. In particular, we are investigating the use of these tools for HDR treatment plans and for LDR GYN plans. Both RPC and QARC credential institutions to participate in prostate brachytherapy trials. We have agreed on reference cases to be performed by the institutions, as well as a procedure for evaluating the information provided by the institution. We are holding ongoing discussions on specific issues regarding the maintenance of these credentials. In addition, discussions have been held regarding the use of the QARC IMRT benchmark plan. The RPC has recently performed the bench mark plan and also has reviewed the procedures for evaluating an institutions submission.

The ATC will support a phase III protocol under development at NSABP for partial breast irradiation. This protocol will compare conventional tangential beam treatment with conformal/IMRT external beam therapy and HDR brachytherapy.

Last summer the NCI published guidelines addressing the use of IMRT in clinical trials. The guidelines stated that IMRT may not be used to treat patients on clinical trials unless the protocol specifically permits or requires the use of IMRT. IMRT may not be used to treat lung cancer patients on clinical trials. Protocols that required IMRT, such as the RTOG H-0022 protocol, may require that institutions irradiate a phantom provided by the RPC. The guidelines can be found on the RPC website.

As part of the ATC discussions, the proposal was made that RPC include on its website each participating institution’s credentialing status. A list of monitored institutions is available on our website. Clicking an institution’s name brings up a list of equipment. An additional page lists details of the institutions protocol credentials. We anticipate that a password would be required to view these details. Our clinical advisory committee is presently reviewing this proposal.

The COMS subcontract has been continued. The RPC has had discussions with COMS regarding our participation with one or two new projects concerning the relationship between dosimetry and clinical outcomes.

The RPC continues contracts with AMGEN Corporation to support a study of total body irradiation. Contracts have also been received from Imagyn Medical Technologies and ATI Medical Corporation for evaluation of prostate brachytherapy seeds.

BUDGET STATUS

In October, we reported that the M. D. Anderson Grants and Contracts Department indicated to us that they would begin charging indirect costs on the funds generated by the yearly quality assurance program fee. However, that decision has been reversed and the institution will not charge overhead.

Additional increased costs have made it necessary for us to approach NCI to request an increase on the quality assurance program fee. The NCI approved our raising the fees to $500 per institution per year as has been previously proposed and approved by RTC. The increased fee went into effect when invoices were mailed to institutions last October.

COMMUNICATIONS

The RPC webpage continues to be enhanced. We are continuing to post monthly newsletters announcing items of importance, or answering common questions posed to the RPC. The AAPM distributes an e-mail burst for us each month to announce the availability of the latest newsletter.

General QA activities

The RPC is presently monitoring 1,315 megavoltage therapy sites. Effective January 1, 2003, we have reduced the mailing frequency to annually for most institutions. We will continue to monitor all photon beams with each mailing, but will monitor three electron beams, rather than two. This will ensure that in most cases, each electron beam is checked no less than biannually. During 2002 we visited 44 institutions and audited 248 megavoltage beams.

At the end of December, approximately 450 institutions had converted to the TG-51 protocol; this is roughly 35% of the institutions we monitor. The rate of conversion has been steady for the last 2 years.

Study Group Activities

The RPC continues to send one or more representatives to meetings of every cancer trials study groups. We are most heavily involved with NSABP, NCCTG, COMS, GOG, and RTOG. Through coordinated activities with QARC, we are actively involved in protocols or credentialing activities at several other study groups. In addition, we participate in the QA committee of ACRIN, the ACR imaging network. Through the Cancer Trials Support Unit (CTSU) we participate by assuring that institutions that participate in clinical trials through CTSU are properly monitored and credentialed where necessary.

Radiation Therapy Oncology Group

Prostate brachytherapy credentialing

Through the efforts of the RPC and QARC we have issued prostate brachytherapy credentials to 64 institutions. We are conducting a survey of credentialed institutions to confirm that the conditions leading to their credentialing are still in place. In anticipation of the P-0232 protocol, we are advising institutions that they need to be credentialed for any seed models they propose to use on the protocol. Seeds must meet the AAPM prerequisites to be used in RTOG protocols. There are presently 15 seeds that meet the AAPM prerequisites and are listed on the RPC website.

RPC anthropomorphic phantoms

1. Stereotactic brain phantom

The SRS brain phantom has been sent to approximately 60 institutions. ACOSOG has recently informed participating institutions that they are expected to obtain the RPC brain phantom as part of their participation in stereotactic brain protocols.

2. Pelvis Phantom

The RPC pelvis phantom is currently undergoing experiments to evaluate heterogeneity correction capabilities. The phantom has been fitted with a hip prosthesis for this test. The phantom will be available for credentialing institutions to participate in IMRT trials.

3. RPC lung phantom

On the advice of a physician the RPC lung phantom is presently being modified with a new dosimetry/imaging insert to reposition the target. Both designs will be available so either can be used. We are initiating a series of tests to evaluate heterogeneity corrections provided by four treatment planning system.

4. Head and Neck IMRT phantom

The RPC has considerable experience with the head and neck IMRT phantom. This phantom has now been sent to the institutions listed in table 1. The table also indicates the treatment machine manufacturer, the delivery device, the technique used, the beam energy used and the institution’s treatment planning system.

Results from the initial 10 institutions to receive the phantom were presented previously. Since that time, the RPC has used the web tools provided by the ITC to reevaluate the institution’s calculations of doses to the TLDs. Our evaluation has resulted in a few small changes, and the revised data appear in Table 2. The data for institution #5 (institutions are not listed in the same order in these two tables) have been deleted as institution #5 irradiated the phantom at a time when our experience was limited and our instructions were not clear. Therefore the data were not submitted to the ITC webpage.

The new analysis indicates that the average dose delivered to the TLDs and the PTVs is unchanged and still very close to unity with a standard deviation of 5% or less. The dose delivered to the critical structure is on average close to unity, but the standard deviation is large.

Included in Table 2 are data for five institutions who have received the phantom in the last few months and for whom the data analysis is complete.

The RPC has expended considerable effort on appropriate procedures for analyzing the dose to the organ at risk in this phantom. We now conclude that rather than relying on the ratio of TLD reading to institution calculation, we should also consider the data provided by the radiochromic film (See Figure 2). Therefore, the RPC has proposed the following criteria to the RTOG Physics Committee:

Agreement between the TLD readings and the institution’s stated dose to the TLDs should be within 7%.

Agreement between the institution’s stated dose and the RPC’s determination of dose from radiochromic film should be within 4 mm, in the region of high dose gradient between the primary PTV and the critical structure.

The RPC is proposing a number of small changes to the IMRT head and neck phantom to improve its functionality. Projects are presently underway to reduce the size of the TLD capsules in the phantom, as well as to move the TLDs closer to the radiochromic film. It is believed that doing so will both improve spacial resolution of the TLDs and improve our ability to normalize the film doses to the TLD readings.

In addition, significant progress has been made in implementing a gel dosimeter with the RPC phantom. Preliminary data are available indicating that gel dosimeter can be used effectively to record and display IMRT dose distributions. (See Figure 3).

Lateral profiles from the absolute comparison between the gel 1 measured dose distribution and the computed dose distribution on the third day of evaluation (10 days after gel manufacture)

Southwest Oncology Group

SWOG has to made a decision to contract with QARC for all their QA services. We are in the process of returning charts that were sent to us for review to SWOG so they can be forwarded to QARC.

Gynecological Oncology Group

The RPC review many charts from the GOG and participates extensively in the semi-annual meetings at which clinical reviews are conducted. The GOG is proposing to open one or more of their protocols internationally. In particular, they are considering opening GOG 191 in Scandinavia. The RPC has been discussing procedures for assuring quality in international institutions that participate in US clinical trials. We are in contact with QA offices in Europe and also with the NCI.

North Central Cancer Treatment Group

The RPC is participating in the rapid review of cases submitted to N0028, a phase I/II study of escalating doses of radiotherapy for non-small cell lung cancer.

Health Insurance Portability and Accountability Act (HIPAA)

Provisions in HIPAA are going to impact on the conduct of clinical trials. Several of the study groups have already distributed instructions to their member institutions informing them that they must pay attention to requirements of HIPAA when registering patients to clinical trials. The RPC has received training in the consent/authorization requirements of HIPAA and has determined that no new procedures are required of us at present. In the future however, it appears that the security requirements of HIPAA may impact us. These will not go into effect for some time and we expect to receive training from M.D. Anderson in advance.

PARTICIPANT FEE:

Institutions invoiced FY02 1303

No XRT/Canceled/Inactive 90

Invoiced by RDS 11

Institutions paid 745

PUBLICATIONS AND ABSTRACTS

Publications Accepted/Published (2001-2003):

1. Melia, Sc.M., Michele; Abramson, M.D., David; Albert, M.D., Daniel; Boldt, M.D. Culver; Earle, M.D., John; Hanson, Ph.D., William; Montague, Paul; Moy, Ph.D., Claudia; Schachat, M.D., Andrew; Simpson, M.D., Rand; Straatsma, M.D., Bradley; Vine, M.D., Andrew; and Weingeist, M.D., Ph.D., Thomas: Collaborative Ocular Melanoma Study (COMS) Randomized Trial of I-125 Brachytherapy for Medium Choroidal Melanoma I. Visual Acuity after 3 Years, COMS Report No. 16”, Opthalmology, 108(2):348-366, 2001.

2. Kirsner, S.M., Prado, K.L., Tailor, R.D., and BenComo, J.A.: Verification of the accuracy of 3D calculations of breast dose during tangential irradiation: measurements in a breast phantom. J. Applied Clinical Medical Physics 2(3):149-156, 2001.

3. Villarruel, S., Ibbott, G.S., and Lai-Fook, S.J.: Effect of concentration and hydration on restriction of albumin by lung interstitium. Microvascular Research 63, 27-40, 2002.

4. Diener-West, M., Albert, D.M., Byrne, S.F., Davidorf, F.H., Followill, D.S., Green, R.L., Hawkins, B.S., Kaiser, P.K., Kline, R.W., Robertson, D.M., Straatsma, B.R: Comparison of clinical, echographic and histopathologic measurements of medium-sized choroidal melanoma: 644 eyes in the Collaborative Ocular Melanoma Study, COMS Report No. 21. Arch Ophthalmol, 119:961-965, 2001.

5. Urie, M., FitzGerald, T.J., Followill, D.S., Laurie, F., Marcus, R., Michalski, J: Current calibration, treatment, and treatment planning techniques among institutions participating in the Childrens Oncology Group. Int. J. Radiat. Onc. Biol. Phys., 55:245–260, 2002.

6. Cadman, P., Bassalow, R., Sidhu, N.P.S., Ibbott, G. and Nelson, A., Dosimetric considerations for validation of a sequential IMRT process with a commercial treatment planning system, Physics in Medicine and Biology, 47: 3001-3010, 2002.

7. Gifford, K.A., Followill, D.S., Liu, H.H., Starkschall, G., Verification of the accuracy of a photon dose-calculation algorithm, J. Appl. Clin. Med. Phys., 3:26-45, 2002.

8. Tailor, R.C., Hanson, W.F. Calculated absorbed-dose ratios, TG-51/TG-21, for most widely used cylindrical and parallel-plate ion chambers over a range of photon and electron energies. Med. Phys. 29: 1464-1472 (2002)

9. Ibbott, G.S., Meigooni, A. S., Gearheart, D. M. (Letter to Editor) Monte Carlo determination of dose rate constant. Med Phys., 29 (7) 1637-8, 2002

10. Rivard, M.J., Coursey, B.M., DeWerd, L.A., Hanson, W.F., Huq, M.S., Ibbott, G.S., Nath, R., Williamson, J.F.: (Letter to Editor) Comment on “Let’s abandon geometry factors other than that of a point source in brachytherapy dosimetry,” Medical Physics 29, 1917-1918, 2002.

11. Aguirre, J.F., Tailor, R., Ibbott, G., Stovall, M. Hanson, W. TLD as a tool for remote verification of output for radiotherapy beams: 25 years of experience. Accepted by International Atomic Energy Agency, November, 2002.

12. Ibbott, G., Beach, M., Maryanski, M. An anthropomorphic head phantom with a BANG® polymer gel insert for dosimetric evaluation of IMRT treatment delivery. Accepted by International Atomic Energy Agency, November, 2002.

13. Ibbott, G., Nelson, A., Followill, D., Balter, P., Hanson, W. An anthropomorphic head and neck phantom for evaluation of intensity modulated radiation therapy. Accepted by International Atomic Energy Agency, November, 2002.

14. Izewska, J., Svensson, H., Ibbott, G. Worldwide QA networks for radiotherapy dosimetry. Accepted by International Atomic Energy Agency, November, 2002.

15. Tailor, R.C., Hanson, W.F., Ibbott, G.S. TG-51: Experience from 150 institutions, common errors, and helpful hints. Appl. Clin. Med. Phys. Accepted November 2002.

16. Hanson, W. F., Tailor, R. C., Ibbott, G.S. (Letter to Editor) ‘‘Comment on ‘Calculated absorbed-dose ratios, TG51/TG21, for most widely used cylindrical and parallel-plate ion chambers over a range of photon and electron energies’ ’’ Accepted by Med. Phys. 30, XXX December 2002

17. Nag, S., Quivey, J.M., Earle, J.D., Followill, D.S., Fontanesi, J., and Finger, P. The American Brachytherapy Society Recommendations for Brachytherapy of Uveal Melanomas, accepted Int. J. Radiat. Oncol. Biol. Phys., 2003.

18. Krintz, A.L., Hanson, W.F., Ibbott, G.I. and Followill, D.S., Recalculation of Eye Plaque Dosimetry for the Collaborative Ocular Melanoma Study Medium Tumor Trial. Accepted Int. J. Radiat. Oncol. Biol. Phys., 2003.

19. Followill, D.S., Hanson, W.F., Eglezopoulos, L.R.E., Chui, C.S. and Ibbott, G.I., Differences in electron beam dosimetry using two commercial ionization chambers and the TG-21 protocol: Another reason to switch to TG-51. Accepted by the Journal of Applied Clinical Medical Physics, 2003.

20. Tailor, R.C., Followill, D.S., Hernandez, N., Ibbott, G.I., and Hanson, W.F., Predictability of electron cone ratios with respect to linac make and model. Accepted by the Journal of Applied Clinical Medical Physics, 2003.

21. Followill, D.S., Stovall, M.S., Kry, S.F., and Ibbott, G.S., Neutron source strength measurements for Varian, Siemens, Elekta, and General Electric linear accelerators. Accepted by the Journal of Applied Clinical Medical Physics., 2003.

Manuscripts in Preparation

1. Diener-West, M., Albert, D.M., Frazier Byrne, S., Davidorf, F.H., Followill, D.S., Green, R.L., Hawkins, B.S., Kaiser, P.K., Robertson, D.M., and Straatsma, B.R., Comparison of Clinical, Echographic and Histopathologic Measurements from Eyes with Medium-Sized Choroidal Melanoma: in the Collaborative Ocular Melanoma Study. COMS Report No. 21, The Collaborative Ocular Melanoma Study Group, submitted to Archives of Ophthalmology 2002.

2. Krintz, A.L., Hanson, W.F., Ibbott, G.I. and Followill, D.S., Verification of Plaque Simulator Dose Distribution Using Radiochromic Film., submitted/rejected to Medical Physics, 2002. Will address reviewers concerns and resubmit.

3. Nelson, A., Followill, D.S., Balter, P.A., Hanson, W.F., and Ibbott, G.S., Design and Implementation of an Anthropomorphic Quality Assurance Phantom for Intensity Modulated Radiation Therapy, Sixth draft under review, 2003.

4. Neblesky, A., Tatcher, M., Davis, D.S., Followill, D.S. and Ibbott, G.S., Specification of Electron Beam Energies for Radiotherapy, second draft under review, 2003.

5. Olch, A., Ibbott, G., Followill, D., et. al, Quality Assurance for Clinical Trials: A Primer for Physicists. Prepared by AAPM Subcommittee on QA for Clinical Trials. Second draft under review, 2003.

Published Abstracts:

1. Krintz, A., Followill, D., Melia, M., and Hanson W.F.: A Reanalysis of the Collaborative Ocular Melanoma Study Medium Tumor Trial Eye Plaque Dosimetry. Medical Physics, Vol. 28: 1192, 2001.

2. Radford, D.A., Followill, D.S., Hanson, and W.F.: A Standard Method of Quality Assurance for Intensity Modulated Radiation Therapy of the Prostate. Medical Physics, Vol. 28: 1211, 2001.

3. Gluckman, G., Foraci, J, Meek, A., Reinstein, L., Radford, D., Followill, D.: Adaptation of the RPC IMRT Prostate Phantom for Full 3D Dose Verification Using Polymer Gel and Multiple-plane Radiochromic Film Inserts. Medical Physics, Vol. 28: 1269, 2001.

4. Rogers, D.W.O., Followill, D.: TG-51: A Review of the Background and Implementation Issues. Medical Physics, Vol. 28: 1223, 2001.

5. Followill, D.S., Hernandez, N., and Hanson, W.F.: Standard Wedge and Tray Transmission Values for Varian, Siemens, Elekta/Philips Accelerators; A Quality Assurance Tool. Medical Physics, Vol. 28:1211, 2001.

6. Followill, D. and Gifford, K: A Measured Data Set for Photon Dose Calculation Verification. Medical Physics, Vol. 28: 1290, 2001.

7. Tailor, R.C. and Hanson, W.F.: Estimated Absorbed - Dose Ratios "TG51/TG21" for Most Commonly Used Cylindrical and Parallel-Plate Ion Chambers over a Range of Photon and Electron Energies. Medical Physics, Vol. 28: 1192, 2001.

8. BenComo, J.A., Hernandez, N., and Hanson, W.F.: Problems and Shortcomings of the RPC Remote Monitoring Program of Institutions Dosimetry Data. Medical Physics, Vol. 28: 1212, 2001.

9. Balter, P.A., Lowenstein, J.R., and Hanson, W.F.: Electron Calibrations: Parallel Plate Chambers vs. Cylindrical Chambers Using TG-51. Medical Physics, Vol. 28: 1214, 2001.

10. Hanson, W.F., Martin, B., Kuske, R., Arthur, D., Rabinovitch, R., White, J., Wilenzick, R. Harris, I., Tailor, R., and Davis, D.: Dose Specification and Quality Assurance of RTOG Protocol 95-17, A Cooperative Group Study of 192Ir Breast Implants as Sole Therapy. Medical Physics, Vol. 28: 1297, 2001.

11. Duzenli, C., Baldock, C., Ibbott, G., Schreiner, L.J., Jordan, K., Oldham, M., Short, K., CCPM/COMP Symposium on Gel Dosimetry, Medical Physics, Vol. 29: 1313, 2002.

12. Nath, R., Rivard, M., Coursey, B., DeWerd, Hanson, W., Huq, M., Ibbott, G., Williamson, J., Status of the American Association of Physicists in Medicine Radiation Therapy Committee’s Subcommittee on Low-Energy Interstitial Brachytherapy Source Dosimetry: Procedure for the Development of Consensus Single-Source Dose-Distribution. Medical Physics, Vol. 29: 1349, 2002.

13. Nelson, A., Balter, P., Hanson, W., Ibbott, G., Experience with an IMRT head and neck QA phantom. Medical Physics, Vol. 29: 1366, 2002.

14. Ibbott, Geoffrey S. and BenComo, José A., Quality Assurance Measurements of Beam Parameters of a Linear Accelerator using MOSFET Dosimeters: A Feasibility Study, Medical Physics, Vol. 29: 1201, 2002.

15. Krintz, Amanda, Hanson, William F., Ibbott, Geoffrey S., and Followill, David, Verification of PLAQUE SIMULATOR Dose Distributions Using Radiochromic Film Medical Physics, Vol. 29: 1220, 2002.

PRESENTATIONS

INTERNATIONAL ACTIVITIES

Geoffrey Ibbott attended the International Atomic Energy Agency International Symposium on Standards and Codes of Practice in Medical Radiation Dosimetry, Vienna, Austria, November 23- 29, 2002.

J. Francisco Aguirre attended the International Atomic Energy Agency International Symposium on Standards and Codes of Practice in Medical Radiation Dosimetry, Vienna, Austria, November 23- December 2, 2002.

Dr. Cho presented seminars on quality assurance and quality control in radiation therapy devices, as well as, recommendations regarding the regulatory programs on the Korea Institute of Nuclear Safety, Seoul and Daejeon, South Korea, December 14-22, 2002.

VISITS TO INSTITUTIONS

1. Sang Cho performed radiological physics measurements and reviewed patient dosimetry at the University of Chicago, Chicago, IL, October 20-25/2002.

2. Jessica Lowenstein performed radiological physics measurements and reviewed patient dosimetry at Mercy Hospital, Scranton, PA and Hershey Medical Center, Hershey, PA, October 21-29, 2002.

3. Geoffrey S. Ibbott performed radiological physics measurements and reviewed patient dosimetry at Thomas Jefferson University Hospital, Philadelphia, PA, November 4-8, 2002.

4. Jessica Lowenstein performed radiological physics measurements and reviewed patient dosimetry at Fox Chase Cancer Center, Philadelphia, PA, November 11-14, 2002.

5. David Followill performed radiological physics measurements and reviewed patient dosimetry at Fox Chase Cancer Center, Philadelphia, PA, November 11-14, 2002.

6. Andrea Nelson performed radiological physics measurements and reviewed patient dosimetry at UT Medical Branch in Galveston, TX, November 18-21, 2002.

7. Jessica Lowenstein performed radiological physics measurements and reviewed patient dosimetry at Virginia Mason Medical Center, Seattle, WA, December 9-15, 2002.

8. Ramesh Tailor performed radiological physics measurements and reviewed patient dosimetry at University of Alabama, Birmingham, AL, December 13-23, 2002.

9. Geoffrey S. Ibbott performed radiological physics measurements and reviewed patient dosimetry at the Medical College of Virginia, Richmond, VA, December 15-19, 2002.

10. Andrea Nelson performed radiological physics measurements and reviewed patient dosimetry at Medical College of Virginia, Richmond, VA, December 15-26, 2002.

11. David Followill performed radiological physics measurements and reviewed patient dosimetry at Central Wisconsin Cancer Program, Fond du Luc, WI, January 13-16, 2003.

12. Paola Alvarez performed radiological physics measurements and reviewed patient dosimetry at Central Wisconsin Cancer Program, Fond du Luc, WI, January 13-16, 2003.

13. Francisco Aguirre performed radiological physics measurements and reviewed patient dosimetry at Central Wisconsin Cancer Program, Fond de Luc, WI, January 13-16, 2003.

14. Jessica Lowenstein performed radiological physics measurements and reviewed patient dosimetry at Mayo Clinic - Jacksonville, Jacksonville, FL, January 15-20, 2003.

15. Francisco Aguirre performed radiological physics measurements and reviewed patient dosimetry at Veterans Administrative Hospital, Minneapolis, MN, January 22-26, 2003.

16. Geoffrey Ibbott performed radiological physics measurements and reviewed patient dosimetry at Memorial Hospital in Colorado Springs, and Poudre Valley Radiation Oncology in Fort Collins, CO. February 3-7, 2003.

10. David Followill performed radiological physics measurements and reviewed patient dosimetry at Cancer Center of Northern Wyoming, Sheridan, WY and Swedish Medical Center, Englewood, CA, February 23-27, 2003.

MEETINGS ATTENDED

Geoffrey Ibbott attended the American Society for Therapeutic Radiology and Oncology (ASTRO) Meeting, New Orleans, October 4-9, 2002.

Francisco Aguirre attended the American Society for Therapeutic Radiology and Oncology (ASTRO) Meeting, New Orleans, LA, October 5-9, 2002.

David Followill attended the American Society for Therapeutic Radiology and Oncology (ASTRO) Meeting, New Orleans, LA, October 5-9, 2002.

Ramesh Tailor attended the American Society for Therapeutic Radiology and Oncology (ASTRO) Meeting, New Orleans, LA, October 5-9, 2002.

Jessica Lowenstein attended the American Society for Therapeutic Radiology and Oncology (ASTRO) Meeting, New Orleans, LA, October 5-9, 2002.

José BenComo attended the North Central Cancer Treatment Group (NCCTG) Meeting, Rochester, MN, October 9-11, 2002.

Geoffrey Ibbott attended the North Central Cancer Treatment Group (NCCTG) Meeting, Rochester MN, October 9-10, 2002.

Geoffrey Ibbott attended the Council on Ionizing Radiation Measurements and Standards (CIRMS) and American College of Radiology Imaging Network (ACRIN), Washington, DC and Gaithersburg, MD, October 17-23, 2002.

José Bencomo attended the American College of Radiology Imaging Network (ACRIN), Gaithersburg, MD, October 17-23, 2002.

David Followill attended the Children's Oncology Group (COG) Meeting, St. Louis, MO, October 23-26, 2002.

Irene Harris attended the Southwest Oncology Group (SWOG) Meeting, San Antonio, TX, October 26, 2002.

Geoffrey Ibbott attended the Southwest Oncology Group (SWOG) Meeting, San Antonio, TX, October 25-26, 2002.

Francicsco Aguirre attended the Southwest Oncology Group (SWOG) Meeting, San Antonio, TX, October 25-26, 2002.

José BenComo attended the Southwest Chapter of the American Association of Physicists in Medicine (SWAAPM) Meeting, Austin, TX, November 1-2, 2002.

Geoffrey Ibbott attended the Southwest Chapter of the American Association of Physicists in Medicine (SWAAPM) Meeting, Austin, TX, November 1-2, 2002.

Francisco Aguirre attended the Cancer and Acute Leukemia Group (CALGB) Meeting, Tampa, FL, November 8-9, 2002.

Sang Cho attended the Eastern Cooperative Oncology Group (ECOG) Meeting, Miami, FL, November 16-17, 2002.

David Followill attended the Advanced Technology Consortium (ATC) Meeting, Providence, RI, November 19-20, 2002.

David Followill attended the American College of Surgeons Oncology Group (ACOSOG) Meeting, Scottsdale, AZ, November 22, 2002.

Geoffrey Ibbott attended the Food and Drug Administration Radiology Devices Panel Meeting, Gaithersburg, MD, December 9-10, 2002.

Geoffrey Ibbott attended the Gynecologic Oncology Group (GOG) Meeting, Savannah, GA, January 15-18, 2003.

Jessica Lowenstein attended the Gynecologic Oncology Group (GOG) Meeting, Savannah, GA, January 15-18, 2003.

Joye Roll attended the Gynecologic Oncology Group (GOG) Meeting, Savannah, GA, January 15-18, 2003.

David Followill attended the RSS 2.0 Training & Radiotherapy Committee Meeting for the Cancer Trials Support Unit, Rockville, MD, January 29-30, 2003.

Geoffrey Ibbott attended the RSS 2.0 Training & Radiotherapy Committee Meeting for the Cancer Trials Support Unit, Rockville, MD, January 29-30, 2003.

Joye Roll attended the RSS 2.0 Training & Radiotherapy Committee Meeting for the Cancer Trials Support Unit, Rockville, MD, January 29-30, 2003.

STATUS SUMMARY

Dosimetry review visits were made to 21 institutions, at which 127 beams† were reviewed, 3,248 TLD reports were evaluated, and 362 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)

October 1, 2002 - February 28, 2003

____________________________________________________________________________

PERSONNEL (salaries, fringe benefits): $1,025,843.00

10 Physicists, 1 Supervisor of Quality Assurance Dosimetry Services, 4 Dosimetrists, 1 Information Manager, 1 Database Administrator, 1 Programmer Analyst I, 1 Radiological Physics Supervisor, 6 Radiological Physics Technicians, 1 Department Administrator, 1 Sr. Administrative Assistant, 1 Departmental Buyer, 3 Secretaries, and 4 Graduate Research Assistants.

TRAVEL

Visits

|Sang Cho - Chicago, IL |1253.04 |

|Jessica Lowenstein - Scranton and Hershey, PA |1409.42 |

|Geoffrey Ibbott- Philadelphia, PA |1246.56 |

|Jessica Lowenstein - Philadelphia, PA |917.18 |

|David Followill - Philadelphia, PA |971.57 |

|Andrea Nelson - Galveston, TX |364.77 |

|Jessica Lowenstein - Seattle, WA |1516.61 |

|Ramesh Tailor - Birmingham, AL |1671.60 |

|Geoffrey Ibbott - Richmond, VA |867.30 |

|Andrea Nelson - Richmond, VA |893.04 |

|David Followill - Fond du Luc, WI |857.87 |

|Paola Alvarez - Fond du Luc, WI |589.52 |

|Francisco Aguirre - Fond du Luc, WI |589.52 |

|Jessica Lowenstein - Jacksonville, FL |1459.10 |

|Francisco Aguirre - Minneapolis, MN |942.86 |

|Geoffrey Ibbott – Colorado Springs and Fort Collins, CO |1138.81 |

|David Followill - Sheridan, WY and Englewood, CA |1152.76 |

|TOTAL: |$17,841.53 |

Meetings:

|Geoffrey Ibbott - New Orleans, LA |1,351.03 |

|Francisco Aguirre - New Orleans, LA |1,339.90 |

|David Followill - New Orleans, LA |1,633.57 |

|Ramesh Tailor - New Orleans, LA |1,076.95 |

|Jessica Lowenstein - New Orleans, LA |1,633.57 |

|José Bencomo - Rochester, MN |810.33 |

|Geoffrey Ibbott - Rochester, MN |736.24 |

|Geoffrey Ibbott - Washington, DC and Gaithersburg, MD |1,302.78 |

|José Bencomo - Gaithersburg, MD |0.00 |

|David Followill - St. Louis, MO |683.55 |

|Irene Harris - San Antonio, TX |160.35 |

|Geoffrey Ibbott - San Antonio, TX |568.93 |

|Francisco Aguirre- San Antonio, TX |420.77 |

|José BenComo - Austin, TX |261.17 |

|Francisco Aguirre - Tampa, FL |729.34 |

|Sang Cho - Miami, FL |757.09 |

|David Followill - Providence, RI |581.27 |

|David Followill - Scottsdale, AZ |451.67 |

|Geoffrey Ibbott - Vienna, Austria |1739.54 |

|Francisco Aguirre - Vienna, Austria |1658.57 |

|Geoffrey Ibbott - Gaithersburg, MD |363.50 |

|Sang Cho - Seoul and Daejeon, South Korea |0.00 |

|Geoffrey Ibbott - Savannah, GA |1459.10 |

|Jessica Lowenstein - Savannah, GA |1140.92 |

|Joye Roll - Rockville, MD |0.00 |

|David Followill - Rockville, MD |0.00 |

|Geoffrey Ibbott - Rockville, MD |0.00 |

|TOTAL: |$ 20,860.14 |

|SUPPLIES: |$ 10,642.17 |

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

|TLD supplies, software, etc. | |

| | |

|OTHER EXPENSE: |$ 6,472.86 |

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

|equipment repair, etc. | |

| | |

|SPACE RENTAL: |$ 34,017.78 |

| | |

|Total Expenditures October 1, 2002 - February 28, 2003 |$1,115,677.48 |

|Indirect costs @ 25% |270,414.93 |

|TOTAL |$1,386,092.41 |

RPC Report to RTC September 2002

|Clinical Study Groups |Office Reviewing |Special Projects |

| |Patient Records | |

| | | |

|American College of Radiology Imaging Network |N/A |Participate in the development of guidelines for |

|ACRIN | |quality assurance of institution participating in |

| | |ACRIN |

| | |CT Dose Measurements |

|American College of Surgeons Oncology Group |QARC | |

|ACOSOG | |TRUS Prostate Approval Collaboration |

| | |RPC Institution List |

| | |Stereotactic Phantom |

|Cancer and Acute Leukemia Group B |QARC |TRUS Prostate Approval Collaboration |

|CALGB | | |

|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 | |Radiotherapy manual |

| | |HDR Pre-approval |

| | |Electronic Transfer of |

| | |Patient Records |

| | |Image Based Treatment Planning |

| | |IMRT Guidelines |

|National Surgical Adjuvant Breast |RPC | |

|and Bowel Project | |IMRT Guidelines |

|NSABP | |Breast phantom |

| | |Pre-approval discussion |

|North Central Cancer Treatment Group |RPC |Rapid 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 |QARC | |

|SWOG | | |

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

|CTSU | |RTF Numbers |

| | |TLD Monitoring |

|Collaborative Ocular Melanoma Study |RPC |Cataracts follow-up |

|COMS | |Visual acuity dose response |

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