REPORT TO AAPM RADIATION THERAPY COMMITTEE



REPORT TO THE AAPM RADIATION THERAPY COMMITTEE

Report No. 110 July 1, 2001 – October 31, 2001

Personnel

Geoffrey S. Ibbott, Ph.D. has been on staff since early January as Chief of the Section of Outreach Physics. On August 1, 2001, Geoff became Director of the RPC and P.I. of the grant. William F. Hanson, Ph.D. retired on August 31, 2001, and returned to the institution on a part-time basis effective October 1, 2001.

Dr. Hanson’s principal activities include remaining as Director of the ADCL, maintaining the animal irradiation facilities, and continuing his teaching responsibilities. His office is located in the hospital, convenient to the ADCL facilities. He is continuing his involvement with the RPC in a consultant capacity.

The RPC is presently recruiting an M.S. Medical Physicist to begin work shortly after the first of the year. A candidate has been identified but negotiations are not yet complete. Once this physicist is on staff, we will be fully staffed.

GRANT ACTIVITIES

The RPC major grant began its second year of the current five year cycle on January 1, 2001. A non-competing renewal was submitted for institution review on October 10, 2001, well in advance of the NCI deadline.

The Advanced Technology Subcontract with the Image Guided Therapy Quality Assurance Center (ITC) in St. Louis began the last year of its three-year term on April 1, 2001. Upon Dr. Hanson’s retirement, Dr. Ibbott has been named P.I. for this sub-contract. A meeting of the consortium was held at the RPC offices on August 23-24, 2001. It was attended by representatives of the four quality assurance offices and a lively and valuable discussion was held. The focus of this meeting was on communication with the study groups and influence over protocol design. The groups represented 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 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 and to discuss further activities in light of the increasing complexity of radiation therapy due to new technologies.

The RPC continues to interact frequently with the Clinical Trials Support Unit (CTSU) on conference calls and by e-mail. Together with the CTSU, QARC, and the RTOG QA Office, it was decided that the RPC was the best entity to develop and maintain a current list of radiotherapy facilities participating in cooperative group studies, and to make that list available.

The list of institutions is presently available on the RPC website, with some limited search capabilities. To ensure security and confidentiality, we have developed a unique numbering system for the participating institutions, that is independent of any other numbering system including the RPC numbers, the CTEP numbers, and any existing codes such as zip code. It is anticipated that CTSU and the study groups will be able to use this unique radiotherapy facility number (RTF number) to help uniquely identify participating institutions. Such unique indentification is not possible at present.

The COMS grant has been converted to a subcontract with the COMS PI (University of Pennsylvania). Upon Dr. Hanson’s retirement, Dr. Followill was named PI on this subcontract. The subcontract is supporting a graduate student who is recalculating the dose to critical structures for patients treated with 125I implants.

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

Study Group Activities

Credentialing processes:

• RTOG protocol P-0019, radioactive implants for prostate therapy. The RPC participates in the credentaling of institutions to participate in this protocol. Since February, credentialing activity is as follows:

• New forms can be downloaded from our web site. In addition, a list of the sources meeting the AAPM prerequisites and therefore acceptable for use with this protocol is published on our web site. The list is maintained through collaboration with the Brachytherapy Subcommittee.

• Institutions not previously approved must go through the same pre-approval process as was used for protocol 98-05.

• Institutions previously approved do not need to reapply unless they plan to use a new source model, a new physician is performing the implants, or a new physicist will be involved.

• Since July, pre-approval activity is as follows:

6 Institutions have applied for pre-approval for P-0019

5 have been approved (each requested a different seed model)

7. have been requested to submit additional/revised information

Since it inception, approximately 50 institutions have been credentialed.

• Dr. Alan Pollack has left M.D. Anderson. Dr. Deborah Kuban will review the pre-approval submissions in the future. Drs. Pollack and Kuban reviewed several cases together recently to introduce Dr. Kuban to the process.

• ACOSOG is conducting a similar protocol involving radioactive implants for prostate therapy. ACOSOG has asked QARC to develop a credentialing process similar to the RPC process for RTOG. Through conference calls with QARC and the ITC, we have developed a consistent set of forms and procedures to be used for both RTOG and ACOSOG. There are only slight differences in the requirements for the two study groups, and it is hoped that this process may serve as a model for further collaborations on credentialing procedures.

• RTOG protocol 99-11 may soon be modified to allow institutions to use IMRT. It has been agreed that the RPC Head & Neck phantom will be used to credential institutions to participate in this protocol.

• RTOG protocol H-0022, IMRT for head and neck cancer. This credentialing process is underway, and consists of the following two components:

• The institution is required to transmit radiotherapy data electronically to the ITC in St. Louis.

• The institution is required to successfully plan and treat the IMRT Head and Neck phantom from the RPC. The RPC IMRT phantom has been sent to seven institutions, one of them twice. Discussions are continuing with the ITC on how best to collect digital data on these phantom irradations, and make that information available for use by the RPC.

• Pelvic (prostate) phantom: The pelvic phantom is expected to be used as part of the credentailing process for RTOG P-0126.

• Thorax phantom – student: Chris Cherry

Cherry has completed the phantom and is finishing the evaluation.

• Breast phantom – Ramesh Tailor and José A. BenComo

The phantom has been commissioned for ion chamber and TLD and film, both without lung. Efforts to incorporate lung material are underway.

OTHER:

• 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, but we have yet to receive any 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.

• 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.

• 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. Both are in reasonably early discussions at this time.

• 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.

• NCCTG: 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 has created a page on its website () titled “Joint AAPM/RPC Registry of Low-energy Brachytherapy Seeds Meeting the AAPM Dosimetric Prerequisites”. This website lists the iodine and palladium sources that meet the AAPM prerequisites, as determined by the LEIBDS. Additional sources will not be added to this list without first holding discussions with the LEIBDS.

IMPLEMENTATION OF TG-51

The RPC continues to conduct or participate in seminars and workshops throughout the U.S.A. regarding the implementation of the TG-51 protocol. Drs. Hanson, Tailor, and Followill made presentations at the Annual AAPM Meeting in Salt Lake City. We receive phone calls on a daily basis from institutions seeking advice. On-line assistance is available on our web page at . The website contains instructional videos, PowerPoint presentations, dry lab exercises with answers, abstracts and publications from the RPC.

Drs. Tailor and Hanson also presented a poster at the Annual AAPM Meeting describing TG-51/TG-21 dose ratios. The poster emphasizes the fact that obtaining calibration factors from different ADCLs, as well as the method of parallel plate chamber calibration, can change published results by as much as 1% and 2.5%, respectively.

We have asked institutions to notify us, on specially prepared forms, of their efforts to implement the TG-51 protocol. To date, 106 of 1,289 megavoltage therapy sites we monitor have submitted their forms. However, our TLD data indicate that 210 of 1,149 (18%) of these institutions appear to have implemented TG-51.

The RPC has developed a list of frequent errors and areas of confusion that we have detected through our review of these forms and through conversations with institutions. We anticipate submitting this list for publication, or posting it on our website.

PARTICIPANT FEE

Institutions invoiced FY02 1281

No XRT/Canceled/Inactive 104

Invoiced by RDS 13

Institutions paid 10

INTERNATIONAL ACTIVITIES

José A. Bencomo was invited to teach a short course on the “Physics of Imaging” at IAEA Regional Program in Medical Physics at the Venezuelan Institute of Scientific Research (IVIC), Caracas, Venezuela, August 27 - September 7, 2001.

Francisco Aguirre delivered lectures and supervised practical sessions for the QA Course at the Regional Training Course on Implementation of the Protocol for the Physical Aspects of Quality Assurance in Radiotherapy, Cordoba, Argentina on the behalf of IAEA, October 1 – 12, 2001.

Geoffrey Ibbott attended the International Electrotechnical Commission Meeting and served on the Subcommittee 62C Meeting, Florence, Italy, October 12-18, 2001.

José A. BenComo invited to lecture on “Digital Imaging: Applications to Mammography” and was also a panel member on the Technical Cooperative for the Improvement of Medical Physicists in Latin American and the Caribbean at the 2nd Ibertolatino American Congress of Physicists in Medicine Meeting in Caracas, Venezuela, October 19, 2001.

VISITS TO INSTITUTIONS

1. J. Francisco Aguirre performed radiological physics measurements and reviewed patient dosimetry at University Hospital/UMDNJ, Newark, NJ and Champlain Valley Physicians Hospital, Fitzpatrick Cancer Center, Plattsburgh, NY, August 6-10, 2001.

2. J. Francisco Aguirre performed radiological physics measurements and reviewed patient dosimetry at Tulane University Hospital and Clinic, New Orleans, LA and Oklahoma Medical Center, Oklahoma City, OK August 19-24, 2001.

3. Andrea Nelson performed radiological physics measurements and reviewed patient dosimetry at Tulane University Hospital and Clinic, New Orleans, LA and Oklahoma University Medical Center, Oklahoma, City, OK, August 19-24, 2001.

4. Sang Cho performed radiological physics measurements and reviewed patient dosimetry at Monmouth Medical Center, Long Branch, NY, August 20-23, 2001.

5. David Followill performed radiological physics measurements and reviewed patient dosimetry at University of Vermont, Fletcher Allen Health Care Center, Burlington, VT, August 24-29, 2001.

6. Geoffrey Ibbott performed radiological physics measurements and reviewed patient dosimetry at University of Vermont, Fletcher Allen Cancer Center, Burlington, VT, August 27-30, 2001.

7. Ramesh Tailor performed radiological physics measurements and reviewed patient dosimetry at Halifax Cancer Center, Halifax, Nova Scotia, Canada, September 8-14, 2001.

8. Andrea Nelson performed radiological physics measurements and reviewed patient dosimetry at St. Luke’s Cancer Center, Bethlehem, PA, October 9-12, 2001.

9. David Followill performed radiological physics measurements and reviewed patient dosimetry at St. Luke’s Cancer Center, Bethlehem, PA , October 9-12, 2001.

MEETINGS ATTENDED

1. Joye Roll attended the Gynecological Oncology Group Meeting, Cincinnati, OH, July 19-21, 2001.

2. Jessica Lowenstein Leif attended the Gynecological Oncology Group Meeting, Cincinnati, OH, July 19-21, 2001.

3. Geoffrey Ibbott attended the Gynecological Oncology Group Meeting, Cincinnati, OH, July 19-21, 2001.

4. Francisco Aguirre attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake City, UT, July 22-26, 2001.

5. Peter Balter attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake City, UT, July 22-26, 2001.

6. José A. BenComo attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake City, UT, July 22-26, 2001.

7. Sang Cho attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake City, UT, July 21-22, 2001.

8. David Followill attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake City, UT, July 22-26, 2001.

9. William Hanson attended the Annual Meeting of the American Association of Physicists in Medicine and also the American College of Radiology Symposium, Salt Lake City, UT, July 20-26, 2001.

10. Nadia Hernandez attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake City, UT, July 21-26, 2001.

11. Geoffrey Ibbott attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake City, UT, July 22-26, 2001.

12. Amanda Krintz attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake City, UT, July 21-26, 2001.

13. Mary Lou Lesseraux attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake City, UT, July 21-25, 2001.

14. Jessica Lowenstein Lief attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake City, UT, July 22-26, 2001.

15. Andrea Nelson attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake City, UT, July 21-25, 2001.

16. Dee Ann Radford attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake City, UT, July 12-26, 2001.

17. Joye Roll attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake City, UT, July 22-26, 2001.

18. Ramesh Tailor attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake City, UT, July 20-26, 2001.

19. Nathan Wells attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake City, UT, July 22-26, 2001.

20. José A. Bencomo attended the Advanced Tech Consortium Meeting in Houston, TX, August, 23-24, 2001.

21. Sang Cho attended the Advanced Tech Consortium Meeting in Houston, TX, August, 23-24, 2001.

22. David Followill attended the Advanced Tech Consortium Meeting in Houston, TX, August, 23-24, 2001.

23. William Hanson attended the Advanced Tech Consortium Meeting in Houston, TX, August, 23-24, 2001.

24. Geoffrey Ibbott attended the Advanced Tech Consortium Meeting in Houston, TX, August, 23-24, 2001.

25. Ramesh Tailor attended the Advanced Tech Consortium Meeting in Houston, TX, August, 23-24, 2001.

26. Sang Cho attended the Workshop on Monte Carlo N-Particle Extension (MCNPX), Chicago, IL, August 27-31, 2001.

27. Geoffrey Ibbott attended the American College of Radiology (ACR) Meeting, San Francisco, CA, September 8-12, 2001.

28. José A. Bencomo attended the Third National Forum on Biomedical Imaging, Arlington, VA, September 13-14, 2001.

29. Geoffrey Ibbott attended the American College of Radiology Imaging Network Meeting and the Mid-Altantic Chapter Meeting of the American Association of Physicists in Medicine. Arlington, VA, September 28-30, 2001.

30. José A. BenComo attended the American College of Radiology Imaging Network Meeting and the Mid-Altantic Chapter Meeting of the American Association of Physicists in Medicine. Arlington, VA, September 28-30, 2001.

31. Mary Lou Lesseraux attended the Annual Meeting of the Society of Research Administrators, Vancouver, British Columbia, Canada, October 12-17, 2001.

32. Geoffrey Ibbott attended the Southwestern Chapter of AAPM Meeting, New Orleans, LA, October 19-20, 2001.

33. José A. Bencomo attended the Annual Meeting of the North Central Cancer Treatment Group Meeting, Rochester, MN, October 24-25, 2001.

34. Irene Harris attended the Annual Meeting of the North Central Cancer Treatment Group Meeting, Rochester, MN, October 24-25, 2001.

35. Geoffrey Ibbott attended the Annual Meeting of the North Central Cancer Treatment Group Meeting, Rochester, MN, October 24-25, 2001.

36. Irene Harris attended the Southwest Oncology Group Meeting in Chicago, IL, October 25-27, 2001.

37. Geoffrey Ibott attended the Southwest Oncology Group Meeting in Chicago, IL, October 25-27, 2001.

38. J. Francisco Aguirre attended the Southwest Oncology Group Meeting in Chicago, IL, October 25-27, 2001.

39. Geoffrey Ibbott attended the Annual Meeting of the Council on Ionizing Radiation Measurements and Standards (CIRMS), Gaithersburg, MD, October 29-31, 2001.

STATUS SUMMARY

Dosimetry review visits were made to 9 institutions, at which 79 beams† were reviewed, 3403 TLD reports were evaluated, and 308 patients' charts were evaluated. There are five 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 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)

July 1, 2001 – October 30, 2001

______________________________________________________________________________

PERSONNEL (salaries, fringe benefits): $707,979.43

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

|J. Francisco Aguirre - Newark and New York |$ 1,681.55 |

|J. Francisco Aguirre - New Orleans and Oklahoma |1,256.79 |

|Andrea Nelson – New Orleans and Oklahoma |1,124.15 |

|Sang Cho - Long Branch |1,652.85 |

|David Followill – Burlington |2,244.94 |

|Geoffrey Ibbott – Burlington |2,364.02 |

|Ramesh Tailor – Nova Scotia |1,788.41 |

|Andrea Nelson – Bethlehem |1,186.00 |

|David Followill– Bethlehem |1,186.00 |

|TOTAL: |$14,484.71 |

Meetings:

|Joye Roll – Cincinnati and Salt Lake City |$ 2,267.70 |

|Jessica Lowenstein Leif – Cincinnati and Salt Lake City |2,080.42 |

|Geoffrey Ibott – Cincinnati and Salt Lake City |2,136.72 |

|J. Francisco Aguirre – Salt Lake City |1,041.15 |

|Peter Balter – Salt Lake City |1,802.00 |

|José A. BenComo – Salt Lake City |756.76 |

|Sang Cho – Salt Lake City |748.44 |

|David Followill – Salt Lake City |1,703.15 |

|William Hanson– Salt Lake City |1,654.03 |

|Nadia Hernandez– Salt Lake City |1,831.42 |

|Amanda Krintz– Salt Lake City |835.96 |

|Mary Lou Lesseraux– Salt Lake City |1,302.31 |

|Andrea Nelson – Salt Lake City |1,249.67 |

|Dee Ann Radford – Salt Lake City |1,183.73 |

|Ramesh Tailor – Salt Lake City |1,869.44 |

|Nathan Wells – Salt Lake City |1,446.18 |

|Geoffrey Ibbott – Houston |0.00 |

|David Followill – Houston |0.00 |

|José BenComo– Houston |0.00 |

|Sang Cho – Houston |0.00 |

|Ramesh Tailor – Houston |0.00 |

|William Hanson – Houston |0.00 |

|Sang Cho – Chicago |2,568.39 |

|Geoffrey Ibbott – San Francisco |1,441.89 |

|Geoffrey Ibbott – Arlington |0.00 |

|José A. BenComo – Arlington |1,154.09 |

|J. Francisco Aguirre, Cardoba |0.00 |

|Geoffrey Ibbott – Florence |0.00 |

|Mary Lou Lesseraux – Vancouver |2,291.00 |

|Geoffrey Ibbott – New Orleans |283.18 |

|José A. BenComo |860.03 |

|Irene Harris – Chicago and Rochester |2,040.25 |

|Geoffrey Ibbott – Chicago and Rochester |1,478.47 |

|J. Francisco Aguirre |1,142.00 |

|Geoffrey Ibbott – Gaithersburg |1,399.00 |

|TOTAL: |$ 38,567.38 |

|CONSULTANTS | |

|Fiscal 2001 this funds contains $10,000 | |

|EQUIPMENT: | |

|Computers, printers, etc. |$ 9,189.99 |

|SUPPLIES: |$ 42,850.55 |

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

|TLD supplies, software, etc. | |

| | |

|OTHER EXPENSE: |$ 19,789.50 |

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

|equipment repair, etc. – Database Conversion | |

| | |

|SPACE RENTAL: |$ 65,388.56 |

| | |

|Total Expenditures July 1, 2001 – October 30, 2001 |$ 875,374.30 |

|Indirect costs @ 26% | 227,597.32 |

|TOTAL |$1,102,971.62 |

RPC Report to RTC July 2001

|Clinical Study Groups |Office Reviewing |Special Projects |

| |Patient Records | |

| | | |

|American College of Surgeons Oncology Group |RPC | |

|ACOSOG | |US guided Prostate |

| | |RPC Institution List |

|Cancer and Acute Leukemia Group B |QARC | |

|Cancer and Acute Leukemia Group B | | |

|Children’s Oncology Group COG | | |

|(POG, CCG, WILMS, RHABDO) |QARC | |

|Eastern Cooperative Oncology Group |QARC | |

|ECOG | | |

|Gynecologic Oncology Group |RPC | |

|GOG | |HDR Pre-approval |

|National Surgical Adjuvant Breast |RPC | |

|and Bowel Project | |B-06 Study revisited |

|NSABP | |Breast phantom |

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

|NCCTG | |TRUS guided Prostate |

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

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

| |Brachytherapy by RPC |Prostate Implant Pre-approval |

| | |Stereotactic Phantom |

| | |Lung Phantom |

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

|SWOG |RPC (retrospective of Selected Studies) |TBI evaluation |

| | |Lung & Breast Study Review |

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

|CTSU | | |

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