Do We Still Need Patient-Specific Quality Assurance? Modern Approaches for Safe and Effective Delivery of Same-Day Stereotactic Radiosurgery and Online Adaptive Radiotherapy
Description
This educational session will examine necessity and evolving role of patient-specific quality assurance (PSQA) methods for inversely-optimized plans that improve clinical efficiency and ensure patient safety when an immediate turn around is required for treatments like same-day stereotactic radiosurgery and online-adaptive radiotherapy (oART). Traditional PSQA methods often use phantom-based measurements, a resource and time-intensive activity. Modern oART delivery (Ethos and/or MR-LINAC) demands for more efficient PSQA methods while not compromising plan quality and patient safety. Phantom-less PSQA methods provide possible solutions: streamlined use of EPID-based portal dosimetry for same-day treatments, multileaf-collimator log-file analysis using treatment machine logs acquired during delivery to reconstruct the delivered dose, independent software (Monte Carlo/AI-based) to verify dose calculation, and predictive models to pre-emptively assess a plan’s quality without needing machine time. Examples and combinations of these techniques currently in daily clinical use will be presented and critiqued, highlighting their potential to streamline verification while maintaining treatment quality and patient safety via FMEA methods. With shortage of clinical medical physicists, it is increasingly unrealistic to believe conventional phantom-based PSQA is conducive to an efficient clinic. Adopting these novel daily QA and PSQA techniques can increase confidence of radiation therapy clinics to verify the quality of complex treatments in a shorter amount of time. This will facilitate a wider adoption of advanced modalities like same-day/Linac-based brain radiosurgery and oART towards historically underserved patient cohorts. Participants will gain insights into the latest solutions for PSQA, end-to-end test, clinical implementations, and develop their own stance on necessity of PSQA.