As the complexity of planning techniques has increased, the ability to conform dose to targets and spare critical structures has improved. However, this complexity has increased uncertainty in ensuring safe treatments, questioning the current state of pre-treatment QA, and calling for necessary improvements.
Common second check methods do not equip you to catch errors in your base measurement data and the resulting TPS beam models, which are common causes for dose discrepancies.
Point checks and conventional 3D methods lack the sensitivity needed to deal with complex plans involving small fields, density interfaces, or high modulation.
While measurement QA is able to check for delivery issues, its sensitivity to TPS calculation errors, which are very common, is found to be extremely low1.
Once the treatment regimen begins, most decisions to replan continue to be made based on obvious changes to patient anatomy. Care teams simply lack the time to fully utilize CBCT imaging for thorough dosimetric tracking for a host of reasons.
Quality of CBCTs often limits their usability beyond simply catching gross positioning errors or anatomy changes.
A thorough assessment of daily CBCTs involving contouring, dose calculation, and analysis of resulting data can become a huge time sink for clinics dealing with large patient volumes and limited time.
Lack of appropriate tools for decision support can result in lower confidence in replan decisions, leading to replan decisions being made too early or too late. This can have a direct impact on patient care.
A Monte Carlo simulation-based validation of your base data and TPS beam models can help prevent systematic discrepancies in dose calculation while reducing dependence on manual QA. Utilize institution-specific beam models derived from validated base data for superior plan second check accuracy.
The gold standard for accuracy, especially for complex and highly modulated plans. Cases typically calculate in less than 5 minutes. Supports all common Varian Medical Systems®, Elekta®, Siemens®, TomoTherapy®, and Accuray CyberKnife® treatment machines.
MIM SureCalc MonteCarlo provides industry-leading deformation algorithms to support automatic adaptation of contours to daily imaging, as well as summing of daily delivered doses over time to incorporate the cumulative effect of fractions delivered.
Automated processing of incoming daily/weekly fraction images and automated reporting of critical dose and volume trends across fractions make ART a clinical reality.
Customizable to every clinic’s unique needs, MIM SureCalc MonteCarlo aims to enhance confidence in decision making. Critical plan, dose, MU, and volume information can be easily summarized into structured reports or interactive MIM sessions for comprehensive assessments.
MIM SureCalc MonteCarlo allows for enhancements that drastically improve usability of CBCTs for adaptive use. Reduce artifacts, improve HU consistency, and expand field of view - all in an automated fashion. Monte Carlo dose calculation on enhanced CBCT allows for a superior representation of dose on current patient anatomy.
Advanced Radiation Therapist Kate Stewart describes Royal Brisbane and Women’s Hospital's typical adaptive radiotherapy workflow, and how her team has utilized dosimetric assessment in MIM SureCalc MonteCarlo to make relevant replan decisions.
1. Talcott, W.J. & Lincoln, H. & Kelly, J.R. & Tressel, L. & Wilson, L.D. & Decker, R.H. & Evans, Suzanne. (2019). A Blinded, Prospective Study of Problematic Plan Detection During Physician Chart Rounds. International Journal of Radiation Oncology*Biology*Physics. 105. S23-S24. 10.1016/j.ijrobp.2019.06.425.