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TBI Technique Improvements for Anesthetized Pediatric Patients Based on Near-Miss Incident Reporting

International j.urnal of Medical Physics, Clinical Engineering and Radiation Oncology 2016年第4期5卷 270-280页

作者： Ning Cao Eric C. Ford matthew j. nyflot Ralph P. Ermoian Nicole W. Pelly Lori Young Kristi Hendrickson Department of Radiation Oncology University of Washington Seattle WA USA Department of Anesthesiology & Pain Medicine University of Washington Seattle WA USA

Purpose: To share our clinical experience of an optimized and comprehensive pediatric TBI technique. Methods and Materials: Through the use of incident learning, safety-critical areas were identified in our procedure for total body irradiation (TBI) for pediatric patients under anesthesia for bone-marrow transplant. The previous procedure lacked flexibility to accommodate various requests from the anesthesia team due to the wide range of patient sizes. To address this issue and to improve the process overall, we updated our procedure for TBI simulation, dosimetry planning, patient setup during treatment, and in vivo dosimetry. A simulation form was redesigned with additional detailed instructions and documentation requirements. The dose calculation procedure was reformulated to remove dependence on setup variations. Tissue compensation determination and therefore dose uniformity were improved by introducing rigorous calculation methods. Calculations were performed on 28 previously-treated patients to compare the dose uniformity using the new versus previous methods. Results: The new procedures improve interdepartmental communication, simplify the workflow, decrease the risk of treating patients in a setup that differs from that used during the simulation, and reduce dose heterogeneity. The new compensator design significantly improved patient dose uniformity: 0.8% ± 0.4% (new method) vs. 4.2% ± 2.3% (previous method) (p Conclusion: A near-miss incident reporting system was used to improve the safety and quality of pediatric TBI procedures under anesthesia.

关键词： Pediatric Total Body Irradiation Simulation Dosimetry Treatment Setup Continuous Safety Improvement (CSI)

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Accuracy Comparison of 4D Computed Tomography (4DCT) and 4D Cone Beam Computed Tomography (4DCBCT)

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International j.urnal of Medical Physics, Clinical Engineering and Radiation Oncology 2017年第3期6卷 323-335页

作者： Tzu-Cheng Lee Stephen R. Bowen Sara St. j.mes George A. Sandison Paul E. Kinahan matthew j. nyflot Department of Bioengineering University of Washington Seattle WA USA Department of Radiation Oncology University of Washington Seattle WA USA Department of Radiology University of Washington Seattle WA USA

The ability of respiratory-correlated fan beam CT (4DCT) and respiratory-correlated cone beam CT (4DCBCT) to accurately estimate tumor volume is critical to accurate dosimetry and treatment verification for lung stereotactic body radiation therapy (SBRT) and other motion-managed therapies. However, it is known that 4DCT and 4DCBCT differ in aspects of image acquisition and reconstruction that may lead to discrepancies between the two modalities. To evaluate quantitative differences between 4DCT and 4DCBCT imaging under respiratory motion, we performed a phantom study in the ground truth setting. A programmable respiratory motion phantom was used to simulate the 1D S-I position of a known-size lesion. Ten sinusoidal and twenty patient-specific breathing waveforms were applied to drive lesion motion during the 4DCT and 4DCBCT acquisitions. The difference in lesion volume acquired between the two imaging modalities was as high as 34.4% and 18.4% for sinusoidal and patient-specific breathing motions, respectively. When compared to the true volume, 4DCT measurement often underestimated the lesion size whereas 4DCBCT overestimated the lesion volume in most of the cases. 4DCBCT gave more accurate recovery of the volume than 4DCT for most settings tested in this study. These findings may be helpful for improving the definition of internal target and planning target volume margins, and extracting quantitative information from on-board treatment verification imaging.

关键词： 4DCT 4DCBCT Verification Imaging Respiratory Motion Phantom

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