RPC Head and Neck Phantom

IROC Houston Liver Phantom Highly Conformal Stereotactic Body Radiation Therapy

Guidelines for Planning and Irradiating the IROC Houston Liver Phantom. Revised May 2006

Credentialing for this protocol requires four steps: (1) one-week period, the institution will image, plan, and submission of the 3D QA Facility Questionnaire for irradiate the phantom and return it to the IROC Stereotactic Body Radiation Therapy with supporting Houston QA Center. Thank you for your cooperation documentation to the Image Guided Therapy Center with this constraint. (ITC, http://itc.wustl.edu), (2) a successful dry run This phantom has been designed and constructed by test, (3) completion of the phantom treatment the IROC Houston. The IROC Houstonphantom experiment and (4) submission of the treatment plan contains two imaging/ dosimetry inserts representing for the first patient treated at the site on this protocol two targets within the liver. The inserts contain a prior to delivering any protocol treatment. The centrally located GTV. There are three orthogonal purpose of steps (2) and (3) is to confirm that the sheets of radiochromic film passing through the dose distribution planned by each institution can be center of the target and two TLD capsules within 0.5 delivered by that institution, and treatment plans can cm of the center of the target. The phantom also be correctly submitted to the ITC. contains normal structures: the stomach, a kidney and The RTOG is requesting that each institution keep the spinal cord, each with TLD in the center. the phantom for no more than 1 week. During this If you have any questions, please contact the appropriate person. IROC Houston Paola Alvarez (713) 745-8989 [email protected] IROC Houston Andrea Molineu (713) 745-8989 [email protected] IROC Houston Geoff Ibbott (713) 745-8989 [email protected] MD Anderson Mike Gillin (713) 563-2507 [email protected] ITC Bill Straube (314) 362-9762 [email protected] ITC Walter Bosch (314) 747-5415 [email protected]

DOSIMETRY INFORMATION TO BE SUBMITTED: The following information is to be submitted to the ITC (see protocol for additional submissions): The following information is to be submitted to the IROC Houston (include in the phantom shipping  The digital treatment planning data in DICOM- box): RT or the RTOG Data Exchange format using either FTP, CD or tape (see the ITC web site for  Original hard-copy isodose distributions in details). the sagittal, axial and coronal planes through the Please cc the IROC Houston center of each of the target volumes. Please ([email protected]) when you ensure that each plane fills an entire page, there inform the ITC of the electronic submission. This are greater than 10 isodose lines and that a scale will allow us to keep better track of who has and has is printed on the page. not submitted the benchmark electronically.  A completed IROC Houston Liver Phantom  Original hard copy isodose distributions in the Institution Information form. sagittal, axial and coronal plane through the target center (identical to those sent to the IROC Houston)  A copy of the completed IROC Houston Liver Phantom-Institution Information form that was sent to the IROC Houston  Send the hard copy data (isodoses and forms) to: Bill Straube, M.S. Image Guided Therapy Center Washington University 4511 Forest Park Ave, Suite 200 St Louis, MO 63108

D:\Docs\2018-04-08\079eea1b2866d6410aa7b2c8797d49d2.doc 1 . Maximum dose of 7.2 Gy allowed within the PTV. Any hotspots greater than 6.6 Gy must be within the PTV. DOSE PRESCRIPTION: . DVHs shall be calculated for the liver (liver minus the GTV), kidney, spinal cord, Only photon beams with nominal energies ranging stomach and target lesions (CTV and PTV). from 6 to 25 MV are allowed. The prescribed dose to the phantom is 6 Gy to the  Critical Normal Structures isodose line circumscribing the PTV, with the following constraints: Normal Volume Dose  PTV: structure . CTV = GTV (Note that this differs from the Spinal Cord Any point  5.1 Gy protocol). PTV = GTV + (0.4 cm to 1.0 cm) Kidney 10%  1.5 Gy depending on the immobilization device Stomach ≤ 5.6 Gy used and/or the individual patient breathing 1 cc motion (see the protocol and ATC website at Normal liver 50% ≤ 3.6 Gy http://atc.wustl.edu/). . The tumors will be labeled GTV1and PTV1 Normal liver 30% ≤ 4.1 Gy for the first tumor and GTV2 and PTV2 for the second tumor. The most lateral tumor Constraints over the normal structures are shall be labeled tumor 1and is in the insert specified in the following table labeled “A”. . Prescribed dose of 6 Gy to the PTV. . Minimum PTV dose of 5.4 Gy. No more than 0.5 cc may receive a dose less than 5.4 Gy.

D:\Docs\2018-04-08\079eea1b2866d6410aa7b2c8797d49d2.doc 2 The phantom should be imaged, planned and irradiated as if it were an actual protocol patient, incorporating all of your customary quality assurance checks.

IRRADIATING THE PHANTOM 9. Assemble the 2D reciprocating platform and  Material included in the 2 boxes: motor drive system per the attached instructions. Liver Phantom Do this on the CT couch so that the phantom and Dosimetric/Imaging inserts the platform can be imaged. Motor driver 10. The motor driver for the platform will have been Motor to platform linkage programmed to simulate the manner in which 2D Reciprocating platform your institution instructs its patients to breathe Rubber hose during the 4D CT. Three acrylic rods containing TLD 11. Position and CT the phantom as you would a Envelope with background film and TLD patient including immobilization techniques. (hidden from view; please don’t try to find it) You may wish to scan with 1 mm slices, Mailing label to return case at IROC Houston’s especially near the target, to better identify expense. the TLD capsules. Traditional IROC Houston TLD block and 12. Turn on the motor drive and acquire your CT irradiation table. (Please irradiate this at the time images for treatment planning. you irradiate the phantom.) 13. Segment the phantom images, contouring the skin, liver, stomach, kidney, spinal cord and Procedures: PTV. Note that the CTV = GTV. PTV = GTV + (0.4 cm to 1.0 cm) depending on the 1. Call the IROC Houston (713-745-8989) with the immobilization device used and/or the individual date that you expect to irradiate the phantom. patient breathing motion. Also contour all 8 TLD Ask for Nadia Hernandez or leave a message. volumes. Please use the following names for Fill the phantom with water: these contours: 2. Thread the rubber hose into the filler hole placed PTV1_TLD_sup for the superior TLD in target A on the base of the phantom. (lateral), 2.1. Fill slowly with water (the rubber hose PTV1_TLD_inf for the inferior TLD in target A, stretches over most faucets). You may PTV2_TLD_sup for the superior TLD in target B need to jiggle the phantom to release air (anterior), trapped inside the cavity. PTV2_TLD_inf for the inferior TLD in target B, 2.2. Remove hose and replace acrylic screw. Stomach_TLD for the TLD at the end of the stomach 3. Allow the phantom to sit with water in it for 20 rod, min. to check for leaks. Mid Stomach_TLD for the TLD in the middle of the stomach rod, 4. Look in the insert spaces and check for water Kidney_TLD for TLD in the kidney, leakage. If you find any water call the IROC Cord_TLD for the TLD in the spinal cord Houston. If not, proceed to the next step.  The dimensions of the TLD volume are 5. Position both of the inserts (A and B). The end approximately 10 mm long by 2 mm diameter labeled “bottom of insert” should be inserted  The outside dimensions of the TLD capsules first in the space labeled with the corresponding are 15 mm long by 4 mm diameter; the TLD letter. Align the 2 black arrows. Make sure that axis is normal to the axial plane. (The capsules each insert is seated properly by making small and the TLD should be visible on CT image) rotations of the insert around its central axis. 14. Plan the treatment as specified in the DOSE 6. Insert the acrylic rod labeled “spinal cord rod” in PRESCRIPTION above. the hole labeled “spinal cord”. The hole and the 15. Remove the inserts and look in the insert space rod are marked in blue. You will see a TLD and check for water leakage. If you find any capsule in the cavity closed with a screw. The water call the IROC Houston. If not, follow the end with the TLD should be inserted first. instructions in step 4 to position the inserts again 7. Insert the acrylic rod labeled “stomach rod” in and proceed to the next step. the hole labeled “stomach”. The hole and the rod 16. Perform your customary QA of the plan prior to are marked in green. You will see a TLD capsule irradiating the phantom. in the cavity closed with a screw at the end of the 17. Irradiate the IROC Houston TLD block rod and in a slot in the middle of the rod. The according to the instructions provided to measure end with the TLD should be inserted first. the reference machine output prior to irradiating 8. Insert the acrylic rod labeled “kidney rod” in the the phantom. hole labeled “kidney”. The hole and the rod are marked in red. You will see a TLD capsule in the cavity closed with a screw. The end with the 18. Assemble the 2D reciprocating platform and TLD should be inserted first. motor drive system per the attached instructions.

D:\Docs\2018-04-08\079eea1b2866d6410aa7b2c8797d49d2.doc 3 Do this on the treatment machine couch so that 23. Remove the acrylic cylinders from holes and the phantom and the platform can be irradiated. place them in the box. 19. Position the phantom as you would a patient 24. Please verify that there is no water in the insert including immobilization techniques prior to space. If you find any water call the IROC delivering the radiation dose. Houston. 20. Turn on the motor drive. 25. Remove the screw on the base of the phantom 21. Irradiate the phantom with the developed plan as and drain the water from the phantom. you would a protocol patient including 26. Put the empty phantom in the box. immobilization techniques. Try to avoid 27. Make sure that the rubber hose is in the box. positioning the axial film at the abutment of 28. Include the dosimetry data discussed above. adjacent MLC leaves or adjacent arcs. Abutting Complete the attached forms. Be sure to include fields or leaves on the film may increase the the scale used on the images coming from your uncertainty of the measurement. TPS. 22. Remove the insert and place it in the box. 29. Return the complete package to the IROC Houston.

D:\Docs\2018-04-08\079eea1b2866d6410aa7b2c8797d49d2.doc 4 IROC Houston Liver Phantom Institution Information

(Original to IROC Houston, copy to ITC)

Please call the IROC Houston to let us know when you are going to irradiate the phantom. We will irradiate TLD standards to meet your schedule. Ask for Nadia Hernandez or leave a message. Phone number: (713) 745-8989.

Institution:______

Address:______

______

Person performing irradiation:______

Person to receive report:______

Radiation Oncologist to receive report: ______

Person to call in case of questions:______

Phone Number:______Fax Number:______

Email address: ______

Treatment Unit:

Manufacturer:______Model:______

In-house specification:______

Photon Beam:

Nominal Energy:______(MV) _ IR (TMR 20/TMR 10): _____ %dd(10)x ______

Collimation Used:

MLC  MIMIC  Other:______No. of leaves: ______

Stereotactic System (if modification to linac):______

Manufacter:______Model:______

Other: ______

D:\Docs\2018-04-08\079eea1b2866d6410aa7b2c8797d49d2.doc 5 Please enclose original copies of your treatment plans. Include the coronal, axial and sagittal planes through the target center. Include scaling factors for each plane. Treatment Planning System: Manufacturer: ______Model:______

Software: ______Version Number:______

Method to Account for Respiratory Induced Target Motion: Please describe your method:

______

D:\Docs\2018-04-08\079eea1b2866d6410aa7b2c8797d49d2.doc 6 Treatment of Phantom: Date of Irradiation:______

Dose specified is to: Muscle Water

Indicate the dose delivered to the TLD as determined by your treatment planning computer

TLD Mean Dose (Gy) Min. Dose (Gy) Max. Dose (Gy)

PTV1_TLD_sup

PTV1_TLD_inf

PTV2_TLD_sup

PTV2_TLD_inf

STOMACH_TLD

Mid-STOMACH_TLD

KIDNEY_TLD

CORD_TLD

Results of the QA:______

______

Did you adjust the MU based on these results?______If so, how much?______Attach copies of the treatment plan including slices in the sagittal, axial and coronal film planes from both targets.

Comments:______

______For Office TLD Batch Film Batch Phantom ID # Code Date Sent Date Rec'd Use Only

D:\Docs\2018-04-08\079eea1b2866d6410aa7b2c8797d49d2.doc 7 This is a cross sectional view of the phantom.

Liver Stomach

Right A Left

Kidney Cord GTV1

D:\Docs\2018-04-08\079eea1b2866d6410aa7b2c8797d49d2.doc 8