TABLE III.
Mitigation strategies for ART processes with critical failures.
| Failure | QC strategy | Prototypes and commercial tools | |
|---|---|---|---|
| (1) | Isocenter documentation | Automated isocenter capture, checklists, monitoring trends in daily patient shifts | |
| (2) | Miscommunication of planning directives and failure to properly account for dose accumulation | Well-defined protocols, stable clinical workflow, staff training, integrated record management, electronic physician order, and whiteboard systems | Santanam (Ref. 8), Mallalieu (Ref. 9) |
| (3) | Poor dataset fusion | Automated fusion tools, specialty training for onsite staff | |
| (4) | Incorrect target/structure delineation and construction | Automated contour integrity verification software | ImSimQAcontour, StructSure (not specifically designed for ART) |
| (5) | Poor plan optimization and or incorrect dose computation | Automated software verifying: | RadCalc (LifeLine Software), IMSure (Standard Imaging), muCheck (Oncology Data Systems Imaging), Sun (Ref. 16), Xing (Ref. 24), Yang (Ref. 12) |
| • dose computation | |||
| • leaf sequencing | |||
| • plan integrity | |||
| (6) | Poor plan review | Automated comparisons between planning goals and achieved goals, decision support software | Zhu (Ref. 13), Moore (Ref. 14) |
| (7) | Incorrect interpretation of plan data for treatment delivery | Independent verification software comparing data indicated by the planning to data read by the delivery system | QAPV (IHE-RO) (Ref. 15) |
| (8) | Failures in treatment parameter setup on treatment machine | Simulated delivery, pretreatment (running gantry rotations and MLC patterns without dose output) | Sun (Ref. 16), QUASAR™ Automated Delivery QA Software (Modus Medical) |
| Retrospective MLC QA, post-treatment | |||
| (9) | Failures occurring during treatment delivery | Transmission detectors | In vivo EPID dosimetry, DAVID harp chamber, MatriXXEvolution, investigational transmission detectors [Islam (Ref. 19), Goulet (Ref. 20), Wong (Ref. 21)] |
| Real-time MLC/gantry monitoring | Jiang (Ref. 22) |