REPORT TO THE AAPM RADIATION THERAPY COMMITTEE
Report No. 111
November 1, 2001 – March 31, 2002
PERSONNEL
Robert Pinney began work on January 22, 2002 as a TLD technician. He replaces an employee
who left at the end of last year.
Paola Alvarez, M.S. has been recruited to take the vacant Medical Physicist position. She is
expected to arrive in Houston in July. She will be leaving positions at the Universidad Nacional
de General San Martín and at the Comision Nacional de Energia Atomica in Buenos Aires,
Argentina. The latter position involves work at the Secondary Standard Dosimetry Laboratory in
Buenos Aires. Ms. Alvarez completed a six month practical training experience at the RPC
several years ago.
GRANT ACTIVITIES
The RPC major grant began its third year of the current five year cycle on January 1, 2002.
The Advanced Technology Subcontract with the Image Guided Therapy QA Center (ITC) in St.
Louis will end on March 31, 2002. The ITC has submitted an application for continuation of this
contract for an additional five-year period. The RPC will again be a subcontractor on this
contract.
The Advanced Technology QA Consortium (ATC) has met twice since our previous report, on
November 19, 2001 and on March 8, 2002. The groups participating in the conference calls
included the RPC, the ITC, the Quality Assurance Review Center (QARC), the Resource Center
for Emerging Technologies (RCET) and the Physics Committee of the Radiation Therapy
Oncology Group (RTOG). These groups all exist to support NCI funded clinical trials in
radiation therapy because the efficacy of the treatments is directly dependent upon the use of
correct physics methods and data. The purpose of these meetings has been to enhance the
interaction among the various QA offices, to collaborate on issues having similar requirements
among the study groups, and to plan further activities in light of the increasing complexity of
radiation therapy due to new technologies.
The RPC continues to interact frequently with the Cancer Trials Support Unit (CTSU) on
conference calls and by email. In response to suggestions and requests from CTSU, the RPC has
made available on its web site a list of all monitored institutions. The list is searchable, and can
also be downloaded in alphabetical or zip code order. In addition, some information regarding
the treatment equipment available at each institution is available. Another significant feature is
the assignment of a unique radiotherapy facility number (RTF#) to help uniquely identify
RPC Report to the AAPM Radiation Therapy Committee
Report No. 111
Page 2 of 11
participating institutions. This unique identifier will help all groups distinguish among
institutions with similar or confusing names.
The COMS grant has been converted to a subcontract with the COMS PI (University of
Pennsylvania). Dr. Followill has been named PI on this subcontract. The subcontract supports a
student who recalculated the dose to critical structures for patients treated with eye plaques. This
work is completed, and the RPC is pursuing funding for additional projects.
A contract has been developed with Amgen Corporation to provide support for a study of total
body irradiation. Dr. Followill is PI of this contract. It is expected that 220 patients will be
treated at 16 institutions under this protocol. The RPC will conduct TLD dosimetry for these
patients and will review the charts.
STUDY GROUP ACTIVITIES
Radiation Therapy Oncology Group
Credentialing processes:
 We continue to credential institutions to participate in the RTOG Protocol P-0019,
radioactive implants for prostate. The protocol has closed but institutions continue to pursue
credentialing in anticipation of a phase III study to come in the near future. The RPC
credentialing process also is used for ACOSOG protocol Z0070 and NCCTG protocol
N0052.
 We continue to credential institutions to participate in the RTOG Protocol H-0022, IMRT for
head and neck cancer. Institutions are required to transmit radiotherapy data electronically to
the ITC in St. Louis. They are also required to successfully image, plan and treat the RPC’s
IMRT Head and Neck Phantom. The IMRT phantom has been sent to 11 institutions. The
TLD results available to date are given in the table below.
Institution
1
2
3
4
5
6
7
8
9
average
std dev
Primary PTV sup
0.96
0.92
1.03
0.95
1.08
1.00
1.00
0.97
1.03
0.99
4.9%
Primary PTV inf
1.03
0.95
-0.99
1.06
1.02
0.98
0.97
1.03
1.00
3.7%
Secondary PTV
1.09
0.92
1.00
0.97
1.10
0.98
1.00
0.96
1.05
1.01
6.0%
*The mean and standard deviation values exclude institution #7.
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Critical Structure
0.98
0.81
1.15
-1.34
1.09
2.24
0.87
1.08
1.05*
17.1%*
RPC Report to the AAPM Radiation Therapy Committee
Report No. 111
Page 3 of 11
The phantom also contains radiochromic film that is used to determine the dose profile in
three orthogonal directions. A representative comparison of film data with the institution’s
treatment plan is shown in the figure below.
8.00
POSTERIOR
ANTERIOR
Cord
6.00
Dose (Gy)
Primary
PTV
Institution's Plan
4.00
Primary PTV
Cord
2.00
RPC film
0.00
-3.5
-2.5
-1.5
-0.5
0.5
1.5
2.5
3.5
Distance (cm)
 We have held discussions with the study chairs of two additional RTOG protocols to
consider conducting credentialing activities for their protocols.
- Dr. I-Chow Joe Hsu at UCSF has written a protocol for HDR brachytherapy boost for
prostate.
- Dr. Robert R. Kuske, Jr. is planning a Phase III study of breast therapy, allowing a
variety of treatments including external beam and brachytherapy.
 RTOG protocol 9406, Conformal therapy for prostate treatment. The RPC has reviewed the
records of MDACC patients entered onto the study and are able to evaluate the doses
delivered. We anticipate writing a proposal to RTOG for an ancillary study to evaluate the
correctness of the data through the ITC for these patients.
Southwest Oncology Group
 SWOG Intergroup Protocol S9927: Breast treatment allowing everything from simple
parallel opposed, through electron treatments, to conformal therapy. SWOG has agreed to
have us review these patients. Several patients have been entered onto the study, and we
have received 3 charts. We anticipate up to 1500 patients, so will consider a method of
sampling.
 SWOG TBI Survey: We have received data on TBI procedures for 25 SWOG institutions.
The data are under review and will be presented at the spring SWOG meeting, summarizing
the way that TBI is done and attempting to answer the question from SWOG concerning the
diversity of treatments used. This may lead to SWOG guidelines for future protocols.
 SWOG: The RPC reviewed proposed protocol S0122, a phase two trial of patients with
limited stage small cell lung cancer. The RPC has proposed that it participate in the
evaluation of patients submitted to this protocol, particularly because the protocol calls for a
comparison of heterogeneity corrected and uncorrected treatment plans. The RPC submitted
a number of other comments on this protocol.
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Gynecologic Oncology Group
 GOG has two new proposals that we are dealing with. (1)They wish to include Syed
applications as acceptable replacements for conventional tandem and ovoid treatment for
GYN patients. (2) They also wish to implement image based 3-D treatment planning for
GYN implants. We are participating in a subcommittee that will investigate image-based
protocols.
North Central Cancer Treatment Group
 The RPC commented on proposed protocol N0028, phase I/II study of escalating
radiotherapy for non-small cell lung cancer. The RPC made a number of suggestions
regarding the use of 3D terminology and calculation procedures, and offered to participate in
the review of cases submitted to this protocol.
INTERACTION WITH THE SUBCOMMITTEE ON LOW-ENERGY INTERSTITIAL
BRACHYTHERAPY
The RPC was identified as principal contact for questions about low-energy brachytherapy
sources in the AAPM’s advice to physicists on 125I or 103Pd brachytherapy sources. Soon after
publications of the advice, the RPC received many calls and e-mails. More recently, the rate of
contacts on this issue has decreased to one or two each week.
The RPC maintains a page on its web site http://rpc.mdanderson.org titled “Joint AAPM/RPC
Registry of Low-energy Brachytherapy Seeds Meeting the AAPM Dosimetric Prerequisites”.
The registry presently lists 10 seeds of which all but two were placed on the registry when it was
created in March 2001. The original 8 seeds are being required by the subcommittee to be reregistered so that the subcommittee can exert the same review on these seeds as was given to
seeds added subsequently.
IMPLEMENTATION OF TG-51
The RPC continues to monitor the transition of institutions to the TG-51 protocol. We have
asked institutions to notify us, on specially prepared forms, of their efforts to implement the
TG-51 protocol. To date, 163 of 1,296 megavoltage therapy sites we monitor have submitted
their forms. However, our TLD data indicate that 293 of these institutions appear to have
implemented TG-51.
The RPC has prepared and submitted a publication listing the frequent errors and areas of
confusion that we have detected through our review of these forms and through conversations
with institutions. The publication is presently in review.
We continue to conduct or participate in seminars and workshops throughout the USA regarding
the implementation of the TG-51 protocol. We receive phone calls frequently from institutions
seeking advice. On-line assistance is available on our web page at http://rpc.mdanderson.org.
The web site contains instructional videos, PowerPoint presentations, a dry lab exercises with
answers, abstracts and publications from the RPC.
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Page 5 of 11
PARTICIPANT FEE:
Institutions invoiced FY02
No XRT/Canceled/Inactive
Invoiced by RDS
Institutions paid
1295
112
13
938
PRESENTATIONS
Geoffrey Ibbott:
“Radiological Physics Center Credentialing Programs”
Radiation Therapy Oncology Group, IMRT Symposium
Amanda Krintz:
“Reanalysis of the COMS Medium Tumor Trial Dosimetry”
Collaborative Ocular Melanoma Study Annual Technical Meeting
INTERNATIONAL ACTIVITIES
Geoffrey Ibbott attended and served as an invited speaker on “IMRT Quality Assurance by the
Radiological Physics Center,” for the Asia Oceania Congress of Medical Physics Meeting,
Bangkok, Thailand, November 11-17, 2001.
Geoffrey Ibbott attended the International Workshop on Gel Dosimetry, Brisbane, Australia,
November 18-22, 2001.
William Hanson met with the International Atomic Energy Agency (IAEA) in order to establish
procedures for on-site review visits for quality assurance in radiotherapy treatment planning,
Vienna, Austria, December 4-11, 2001.
Francisco Aguirre delivered lectures at the 27th Central American and Caribbean Physics Course
(CURCCAF), Panama City, Panama, December 9-14, 2001.
William Hanson met with representatives of the European Society for Therapeutic Radiology
and Oncology (ESTRO-EQUAL) to discuss monitoring of European institutions participating in
protocols based in the United States and Paris, France, December 12-15, 2001.
Geoffrey Ibbott met with representatives of the European Society for Therapeutic Radiology and
Oncology (ESTRO-EQUAL) to discuss monitoring of European institutions participating in
protocols based in the United States and Paris, France, December 12-15, 2001.
Geoffrey Ibott attended as an observer and rapporteur for the Advisory Group Meeting of the
IAEA, SSC-10, concerning the Evaluation and the Recommendations on the Dosimetry Program
(10th Meeting of the Scientific Committee SCC-10), Vienna, Austria, February 23 – March 2,
2002.
VISITS TO INSTITUTIONS
1. David Followill performed radiological physics measurements and reviewed patient dosimetry at the University
of Minnesota and Fairview Southdale Medical Center, Minneapolis, MN, November 12-16, 2001.
2.
Andrea Nelson performed radiological physics measurements and reviewed patient dosimetry at the University
of Minnesota and Fairview Southdale Medical Center, Minneapolis, MN, November 12-16, 2001.
3.
Ramesh Tailor performed radiological physics measurements and reviewed patient dosimetry at Duke
University Medical Center, Durham, NC, December 8-14, 2001.
4.
Jessica Lowenstein performed radiological physics measurements and reviewed patient dosimetry at East
Carolina University, Greenville, NC, January 6-11, 2002.
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5.
David Followill performed radiological physics measurements and reviewed patient dosimetry at Naval Medical
Center, Portsmouth, VA, January 7-9, 2002.
6.
Andrea Nelson performed radiological physics measurements and reviewed patient dosimetry at Harrington
Cancer Center, Amarillo, TX, January 7-10, 2002.
7.
J. Francisco Aguirre performed radiological physics measurements and reviewed patient dosimetry at
Massachusetts General Hospital, Boston, MA, January 21-25, 2002.
8.
Geoffrey Ibbott performed radiological physics measurements and reviewed patient dosimetry at Massachusetts
General Hospital, Boston, MA, January 21-25, 2002.
9.
Jessica Lowenstein performed radiological physics measurements and reviewed patient dosimetry at Overton
Brooks Cancer Center, Shreveport, LA, February 6-7, 2002.
10. David Followill performed radiological physics measurements and reviewed patient dosimetry at Emory Clinic
and Grady Memorial Hospital, Atlanta, GA, February 11-14, 2002.
11. J. Francisco Aguirre performed radiological physics measurements and reviewed patient dosimetry at Rutland
Regional Medical Center, Rutland, VT and Atlantic City Medical Center, Pomona, NJ, February 22 – March 2,
2002.
12. Jessica Lowenstein performed radiological physics measurements and reviewed patient dosimetry at Glen Falls
Hospital, Glen Falls, NY and Samaritan Hospital, Troy, NY, February 24 – March 1, 2002.
13. Andrea Nelson performed radiological physics measurements and reviewed patient dosimetry at VA Hospital
Memphis, Memphis, TN and Haley VA Hospital, Tampa, FL, February 25 – March 1, 2002
14. David Followill performed radiological physics measurements and reviewed patient dosimetry at Stanford
University, Palo Alto, CA and Santa Clara Valley Center, San Jose, CA, March 11-14, 2002.
15. Jessica Lowenstein performed radiological physics measurements and reviewed patient dosimetry at Stanford
University, Palo Alto, CA and Santa Clara Valley Center, San Jose, CA, March 11-14, 2002.
16. Andrea Nelson performed radiological physics measurements and reviewed patient dosimetry at University of
Mississippi, Jackson, MS, March 16-20, 2002.
17. Sang Cho performed radiological physics measurements and reviewed patient dosimetry at University of
Southern California Medical Center, Los Angeles, CA, March 17-21, 2002.
MEETINGS ATTENDED
1.
Sang Cho attended the American Society for Therapeutic Radiology and Oncology (ASTRO) Meeting. San
Francisco, CA, November 3-8, 2001.
1.
Geoffrey Ibbott attended the American Society for Therapeutic Radiology and Oncology (ASTRO) Meeting
and participated in meetings of the AAPM QA Subcommittee, the LEIBS Subcommittee, the Radiation Therapy
Committee and the ACR Practice Accreditation Committee. San Francisco, CA, November 3-8, 2001.
2.
David Followill attended the American Society for Therapeutic Radiology and Oncology (ASTRO) Meeting
and participated in a meeting of the ASTRO Physics Committee and the AAPM QA Subcommittee. San
Francisco, CA, November 4-8, 2001.
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Report No. 111
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3.
José BenComo attended the National Institute of Biomedical Imaging Bioengineering (NIBIB), Bethesda, MD,
November 9, 2001
4.
Sang Cho attended the Eastern Cooperative Oncology Group Meeting and represented the RPC at the Radiation
Oncology Committee. Miami, FL, November 11, 2001.
5.
J. Francisco Aguirre attended the Cancer and Acute Leukemia Group B Meeting, Jacksonville, FL, November
16-18, 2001
6.
Geoffrey Ibbott attended the Radiological Society of North America Meeting (RSNA) where he chaired a poster
session and participated in meetings of the AAPM ADCL Subcommittee, the Newsletter Editorial Committee,
and the RSNA Program Committee. Chicago, IL, November 24-26, 2002.
7.
Amanda Krintz attended the Collaborative Ocular Melanoma Study Data Analysis Group Meeting, Baltimore,
MD, December 5-7, 2001.
8.
José BenComo attended the DICOM Working Group #18 Meeting, Philadelphia, PA, December 11, 2001
9.
Geoffrey Ibbott attended the American Board of Radiology Radiation Oncology Written Exam Committee
Meeting. Tucson, AZ, January 13-14, 2002.
10. Geoffrey Ibbott attended the Gynecologic Oncology Group Meeting and represented the RPC at the Radiation
Oncology Committee meeting, the Cervix Committee meeting, and the Chart Review. New Orleans, LA,
January 17-19, 2002.
11. Joye Roll attended the Gynecologic Oncology Group Meeting, New Orleans and represented the RPC at the
Radiation Oncology Committee meeting, the Cervix Committee meeting, and the Chart Review. LA, January
17-19, 2002.
12. Jessica Lowenstein attended the Gynecologic Oncology Group Meeting and represented the RPC at the
Radiation Oncology Committee meeting, the Cervix Committee meeting, and the Chart Review. New Orleans,
LA, January 17-19, 2002.
13. José BenComo attended the Third National Forum on Biomedical Imaging in Oncology, Arlington, VA,
January 30 – February 1, 2002.
14. David Followill attended the Radiation Therapy Oncology Group Semi-annual Meeting, Tampa, FL,
January 31, 2002 – February 3, 2002.
15. Geoffrey Ibbott attended the Radiation Therapy Oncology Group Semi-annual Meeting and served as a member
of the Quality Control and Medical Physics Committees. He also gave a talk at an IMRT symposium on
“Radiological Physics Center Credentialing Programs.” Tampa, FL, January 31, 2002 – February 3, 2002.
16. Irene Harris attended the Radiation Therapy Oncology Group Semi-annual Meeting, Tampa, FL, January 31,
2002 – February 3, 2002.
17. José BenComo attended the Semi-annual Meeting of ACRIN, and also served as a member of the Quality
Assurance Committee, New Orleans, LA, February 28 – March 3, 2002.
18. José BenComo attended the Three Dimensional (3D) Quality Assurance Center Meeting, St. Louis, MO,
March 15-16, 2002.
19. David Followill attended the Collaborative Ocular Melanoma Study Annual Technical Meeting and served as a
member of the Executive Committee and represented the RPC at the Plaqued Eyes Committee and Cataract
Working Group. Baltimore, MD, March 17-19, 2002.
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20. Geoffrey Ibbott attended the Collaborative Ocular Melanoma Study Annual Technical Meeting and represented
the RPC at the Plaqued Eyes Committee and Cataract Working Group. Baltimore, MD, March 17-19, 2002.
21. Amanda Krintz attended the Collaborative Ocular Melanoma Study Annual Technical Meeting and presented a
talk on “Reanalysis of the COMS Medium Tumor Trial Dosimetry” Baltimore, MD, March 17-19, 2002.
STATUS SUMMARY
Dosimetry review visits were made to 20 institutions, at which 112 beams† were reviewed, 1,965 TLD
reports were evaluated, and 448 patients' charts were evaluated. There is one institution that is a special high priority
for a dosimetry review visit (based on TLD, chart check, etc).
A summary of cooperative groups and institutions’ participation in them are included in the attached table.
†The review of one photon energy is considered a "beam"; however, review of a cadre of electrons on one machine
is considered only one "beam". Measurement of TBI and other special procedures are also considered one "beam".
Respectfully submitted,
Geoffrey S. Ibbott, Ph.D.
Chief, Section of Outreach Physics
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RPC Report to the AAPM Radiation Therapy Committee
Report No. 111
Page 9 of 11
EXPENDITURES OF THE RADIOLOGICAL PHYSICS CENTER
(RPC Grant, the COMS Subcontract, and the High Technology Subcontract)
November 1, 2001 – March 31, 2002
______________________________________________________________________________
PERSONNEL (salaries, fringe benefits):
$ 893,568.09
9 Physicists, 1 Supervisor of Quality Assurance Dosimetry Services, 4 Dosimetrists, 1 Information
Manager, 1 Database Administrator, 1 Programmer Analyst I, 1 Radiological Physics Supervisor, 4
Radiological Physics Technicians, 1 Department Administrator, 1 Administrative Assistant, 1
Administrative Clerk, 1 Departmental Buyer, 2 Secretaries, and 2 Graduate Research Assistants.
TRAVEL
Visits
David Followill – Minneapolis, MN
Andrea Nelson – Minneapolis, MN
Ramesh Tailor – Durham, NC
Jessica Lowenstein – Greenville, NC
David Followill – Portsmouth, VA
Andrea Nelson – Amarillo, TX
J. Francisco Aguirre – Boston, MA
Geoffrey Ibbott – Boston, MA
Jessica Lowenstein – Shreveport, LA
David Followill – Altanta, GA
J. Francisco Aguirre – Rutland, VT and Pomona, NJ
Jessica Lowenstein – Glen Falls, NY and Troy, NY
Andrea Nelson – Memphis, TN and Tampa, FL
David Followill – Palo Alto and San Jose, CA
Jessica Lowenstein - Palo Alto and San Jose, CA
Andrea Nelson – Jackson, MS
Sang Cho – Los Angeles, CA
TOTAL:
$1622.93
1178.92
1493.03
807.37
924.75
693.79
1378.68
1285.53
712.04
1133.42
1641.00
1025.06
1833.51
1451.50
1451.50
966.00
1327.00
$20,926.03
Meetings:
Sang Cho – San Francisco, CA
Geoffrey Ibbott – San Francisco, CA
David Followill – San Francisco, CA
José BenComo – Bethesda, MD
Sang Cho – Miami, FL
Geoffrey Ibbott – Bangkok, Thailand and Brisbane, Australia
J. Francisco Aguirre – Jacksonville, FL
Geoffrey Ibbott – Chicago, IL
William Hanson – Vienna, Austria and Paris, France
Amanda Krintz – Baltimore, MD
J. Francisco Aguirre – Panama City, Panama
José BenComo – Philadelphia, PA
Geoffrey Ibbott – Paris, France
Geoffrey Ibbott – Tucscon, AZ
Geoffrey Ibbott – New Orleans, LA
Joye Roll – New Orleans, LA
Jessica Lowenstein – New Orleans, LA
José BenComo – Arlington, VA
David Followill – Tampa, FL
Geoffrey Ibbott – Tampa, FL
Irene Harris – Tampa, FL
José Bencomo – New Orleans, LA
José BenComo – St. Louis, MO
David Followill – Baltimore, MD
Geoffrey Ibbott – Baltimore, MD
TOTAL:
$2,015.48
1,818.08
1,576.10
649.12
814.37
2,920.89
787.50
1,134.00
0.00
717.76
0.00
779.75
0.00
0.00
857.00
625.66
655.23
769.08
942.02
888.02
844.95
1,037.00
720.50
1,438.00
1,438.00
$ 23,428.51
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RPC Report to the AAPM Radiation Therapy Committee
Report No. 111
Page 10 of 11
CONSULTANTS
Fiscal 2002 this funds contains $9,700
Saiful Huq - ASTRO
EQUIPMENT:
Computers, printers, etc.
$
775.52
$ 32,485.95
SUPPLIES:
Office supplies, laboratory and record keeping, TLD,
TLD supplies, software, etc.
$ 26,471.56
OTHER EXPENSE:
Postage, telephone, reprints, copying, computer fees,
equipment repair, etc. – Database Conversion
$
SPACE RENTAL:
$ 83,035.05
Total Expenditures November 1, 2001 – March 31, 2002
Indirect costs @ 25%
TOTAL
$1,085,289.61
271,322.40
$1,356,612.01
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4,598.90
RPC Report to the AAPM Radiation Therapy Committee
Report No. 111
Page 11 of 11
RPC Report to RTC March 2002
Clinical Study Groups
American College of Surgeons Oncology Group
ACOSOG
Cancer and Acute Leukemia Group B
Office Reviewing
Patient Records
QARC
US guided Prostate
RPC Institution List
QARC
Children’s Oncology Group COG
(POG, CCG, WILMS, RHABDO)
QARC
Eastern Cooperative Oncology Group
ECOG
QARC
Gynecologic Oncology Group
GOG
RPC
National Surgical Adjuvant Breast
and Bowel Project
NSABP
RPC
North Central Cancer Treatment Group
NCCTG
Special Projects
RPC
3D Benchmark Case
IMRT Benchmark Case
HDR Pre-approval
Electron Transfer of
Patient Records
Image Based Treatment Planning
Breast phantom
Early Review of Lung Study
TRUS guided Prostate
Pre-approval
Radiation Therapy Oncology Group
RTOG
RTOG
3D CRT by ITC Center
Brachytherapy by RPC
IMRT Phantom /pre-approval
Prostate Phantom
Prostate Implant
Pre-approval LDR/HDR
Stereotactic Phantom
Lung Phantom
Cervix HDR Pre-approval
Patient Calculation Program
Southwest Oncology Group
SWOG
SWOG QAC (early review)
RPC (retrospective review
of Selected Studies)
US guided Prostate
Lung & Breast Study Review
Clinical Trial Support Unit
CTSU
QARC, RPC, RTOG
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RPC Institution List
RTF Numbers