REPORT TO THE AAPM RADIATION THERAPY COMMITTEE
Report No. 110
July 1, 2001 – October 31, 2001
PERSONNEL
Geoffrey S. Ibbott, Ph.D. has been on staff since early January as Chief of the Section of
Outreach Physics. On August 1, 2001, Geoff became Director of the RPC and P.I. of the grant.
William F. Hanson, Ph.D. retired on August 31, 2001, and returned to the institution on a parttime basis effective October 1, 2001.
Dr. Hanson’s principal activities include remaining as Director of the ADCL, maintaining the
animal irradiation facilities, and continuing his teaching responsibilities. His office is located in
the hospital, convenient to the ADCL facilities. He is continuing his involvement with the RPC
in a consultant capacity.
The RPC is presently recruiting an M.S. Medical Physicist to begin work shortly after the first of
the year. A candidate has been identified but negotiations are not yet complete. Once this
physicist is on staff, we will be fully staffed.
GRANT ACTIVITIES
The RPC major grant began its second year of the current five year cycle on January 1, 2001. A
non-competing renewal was submitted for institution review on October 10, 2001, well in
advance of the NCI deadline.
The Advanced Technology Subcontract with the Image Guided Therapy Quality Assurance
Center (ITC) in St. Louis began the last year of its three-year term on April 1, 2001. Upon
Dr. Hanson’s retirement, Dr. Ibbott has been named P.I. for this sub-contract. A meeting of the
consortium was held at the RPC offices on August 23-24, 2001. It was attended by
representatives of the four quality assurance offices and a lively and valuable discussion was
held. The focus of this meeting was on communication with the study groups and influence over
protocol design. The groups represented 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 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 and to discuss
further activities in light of the increasing complexity of radiation therapy due to new
technologies.
The RPC continues to interact frequently with the Clinical Trials Support Unit (CTSU) on
conference calls and by e-mail. Together with the CTSU, QARC, and the RTOG QA Office, it
RPC Report to the AAPM Radiation Therapy Committee
Report No. 110
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was decided that the RPC was the best entity to develop and maintain a current list of
radiotherapy facilities participating in cooperative group studies, and to make that list available.
The list of institutions is presently available on the RPC website, with some limited search
capabilities. To ensure security and confidentiality, we have developed a unique numbering
system for the participating institutions, that is independent of any other numbering system
including the RPC numbers, the CTEP numbers, and any existing codes such as zip code. It is
anticipated that CTSU and the study groups will be able to use this unique radiotherapy facility
number (RTF number) to help uniquely identify participating institutions. Such unique
indentification is not possible at present.
The COMS grant has been converted to a subcontract with the COMS PI (University of
Pennsylvania). Upon Dr. Hanson’s retirement, Dr. Followill was named PI on this subcontract.
The subcontract is supporting a graduate student who is recalculating the dose to critical
structures for patients treated with 125I implants.
A contract has been developed with Amgen Corporation to provide support for a study of total
body irradiation that they are conducting. Dr. Followill is PI of this contract. It is expected that
220 patients will be treated at 16 institutions under this protocol. AMGEN has asked us to
conduct TLD dosimetry for these patients, and to review the charts.
STUDY GROUP ACTIVITIES
Credentialing processes:
 RTOG protocol P-0019, radioactive implants for prostate therapy. The RPC participates in
the credentaling of institutions to participate in this protocol. Since February, credentialing
activity is as follows:
 New forms can be downloaded from our web site. In addition, a list of the sources
meeting the AAPM prerequisites and therefore acceptable for use with this protocol is
published on our web site. The list is maintained through collaboration with the
Brachytherapy Subcommittee.
 Institutions not previously approved must go through the same pre-approval process
as was used for protocol 98-05.
 Institutions previously approved do not need to reapply unless they plan to use a new
source model, a new physician is performing the implants, or a new physicist will be
involved.
 Since July, pre-approval activity is as follows:
6 Institutions have applied for pre-approval for P-0019
5 have been approved (each requested a different seed model)
7 have been requested to submit additional/revised information
Since it inception, approximately 50 institutions have been credentialed.
 Dr. Alan Pollack has left M.D. Anderson. Dr. Deborah Kuban will review the
pre-approval submissions in the future. Drs. Pollack and Kuban reviewed several
cases together recently to introduce Dr. Kuban to the process.
 ACOSOG is conducting a similar protocol involving radioactive implants for prostate
therapy. ACOSOG has asked QARC to develop a credentialing process similar to the
RPC process for RTOG. Through conference calls with QARC and the ITC, we have
developed a consistent set of forms and procedures to be used for both RTOG and
ACOSOG. There are only slight differences in the requirements for the two study
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Page 3 of 11
groups, and it is hoped that this process may serve as a model for further
collaborations on credentialing procedures.
 RTOG protocol 99-11 may soon be modified to allow institutions to use IMRT. It
has been agreed that the RPC Head & Neck phantom will be used to credential
institutions to participate in this protocol.
RTOG protocol H-0022, IMRT for head and neck cancer. This credentialing process is
underway, and consists of the following two components:
 The institution is required to transmit radiotherapy data electronically to the ITC in
St. Louis.
 The institution is required to successfully plan and treat the IMRT Head and Neck
phantom from the RPC. The RPC IMRT phantom has been sent to seven institutions,
one of them twice. Discussions are continuing with the ITC on how best to collect
digital data on these phantom irradations, and make that information available for use
by the RPC.
Pelvic (prostate) phantom: The pelvic phantom is expected to be used as part of the
credentailing process for RTOG P-0126.
Thorax phantom – student: Chris Cherry
Cherry has completed the phantom and is finishing the evaluation.
Breast phantom – Ramesh Tailor and José A. BenComo
The phantom has been commissioned for ion chamber and TLD and film, both without lung.
Efforts to incorporate lung material are underway.
OTHER:
 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, but we have yet to
receive any 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.
 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.
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 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. Both are in reasonably early discussions at this time.
 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.
 NCCTG: 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 has created a page on its website (http://rpc.mdanderson.org) titled “Joint AAPM/RPC
Registry of Low-energy Brachytherapy Seeds Meeting the AAPM Dosimetric Prerequisites”.
This website lists the iodine and palladium sources that meet the AAPM prerequisites, as
determined by the LEIBDS. Additional sources will not be added to this list without first
holding discussions with the LEIBDS.
IMPLEMENTATION OF TG-51
The RPC continues to conduct or participate in seminars and workshops throughout the U.S.A.
regarding the implementation of the TG-51 protocol. Drs. Hanson, Tailor, and Followill made
presentations at the Annual AAPM Meeting in Salt Lake City. We receive phone calls on a daily
basis from institutions seeking advice. On-line assistance is available on our web page at
http://rpc.mdanderson.org. The website contains instructional videos, PowerPoint presentations,
dry lab exercises with answers, abstracts and publications from the RPC.
Drs. Tailor and Hanson also presented a poster at the Annual AAPM Meeting describing
TG-51/TG-21 dose ratios. The poster emphasizes the fact that obtaining calibration factors from
different ADCLs, as well as the method of parallel plate chamber calibration, can change
published results by as much as 1% and 2.5%, respectively.
We have asked institutions to notify us, on specially prepared forms, of their efforts to
implement the TG-51 protocol. To date, 106 of 1,289 megavoltage therapy sites we monitor
have submitted their forms. However, our TLD data indicate that 210 of 1,149 (18%) of these
institutions appear to have implemented TG-51.
The RPC has developed a list of frequent errors and areas of confusion that we have detected
through our review of these forms and through conversations with institutions. We anticipate
submitting this list for publication, or posting it on our website.
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PARTICIPANT FEE
Institutions invoiced FY02
No XRT/Canceled/Inactive
Invoiced by RDS
Institutions paid
1281
104
13
10
INTERNATIONAL ACTIVITIES
José A. Bencomo was invited to teach a short course on the “Physics of Imaging” at IAEA
Regional Program in Medical Physics at the Venezuelan Institute of Scientific Research (IVIC),
Caracas, Venezuela, August 27 - September 7, 2001.
Francisco Aguirre delivered lectures and supervised practical sessions for the QA Course at the
Regional Training Course on Implementation of the Protocol for the Physical Aspects of Quality
Assurance in Radiotherapy, Cordoba, Argentina on the behalf of IAEA, October 1 – 12, 2001.
Geoffrey Ibbott attended the International Electrotechnical Commission Meeting and served on
the Subcommittee 62C Meeting, Florence, Italy, October 12-18, 2001.
José A. BenComo invited to lecture on “Digital Imaging: Applications to Mammography” and
was also a panel member on the Technical Cooperative for the Improvement of Medical
Physicists in Latin American and the Caribbean at the 2nd Ibertolatino American Congress of
Physicists in Medicine Meeting in Caracas, Venezuela, October 19, 2001.
VISITS TO INSTITUTIONS
1. J. Francisco Aguirre performed radiological physics measurements and reviewed patient dosimetry at
University Hospital/UMDNJ, Newark, NJ and Champlain Valley Physicians Hospital, Fitzpatrick Cancer
Center, Plattsburgh, NY, August 6-10, 2001.
2.
J. Francisco Aguirre performed radiological physics measurements and reviewed patient dosimetry at Tulane
University Hospital and Clinic, New Orleans, LA and Oklahoma Medical Center, Oklahoma City, OK
August 19-24, 2001.
3.
Andrea Nelson performed radiological physics measurements and reviewed patient dosimetry at Tulane
University Hospital and Clinic, New Orleans, LA and Oklahoma University Medical Center, Oklahoma, City,
OK, August 19-24, 2001.
4.
Sang Cho performed radiological physics measurements and reviewed patient dosimetry at Monmouth Medical
Center, Long Branch, NY, August 20-23, 2001.
5.
David Followill performed radiological physics measurements and reviewed patient dosimetry at University of
Vermont, Fletcher Allen Health Care Center, Burlington, VT, August 24-29, 2001.
6.
Geoffrey Ibbott performed radiological physics measurements and reviewed patient dosimetry at University of
Vermont, Fletcher Allen Cancer Center, Burlington, VT, August 27-30, 2001.
7.
Ramesh Tailor performed radiological physics measurements and reviewed patient dosimetry at Halifax Cancer
Center, Halifax, Nova Scotia, Canada, September 8-14, 2001.
8.
Andrea Nelson performed radiological physics measurements and reviewed patient dosimetry at St. Luke’s
Cancer Center, Bethlehem, PA, October 9-12, 2001.
9.
David Followill performed radiological physics measurements and reviewed patient dosimetry at St. Luke’s
Cancer Center, Bethlehem, PA , October 9-12, 2001.
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MEETINGS ATTENDED
1.
Joye Roll attended the Gynecological Oncology Group Meeting, Cincinnati, OH, July 19-21, 2001.
2.
Jessica Lowenstein Leif attended the Gynecological Oncology Group Meeting, Cincinnati, OH, July 19-21,
2001.
3.
Geoffrey Ibbott attended the Gynecological Oncology Group Meeting, Cincinnati, OH, July 19-21, 2001.
4.
Francisco Aguirre attended the Annual Meeting of the American Association of Physicists in Medicine, Salt
Lake City, UT, July 22-26, 2001.
5.
Peter Balter attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake
City, UT, July 22-26, 2001.
6.
José A. BenComo attended the Annual Meeting of the American Association of Physicists in Medicine, Salt
Lake City, UT, July 22-26, 2001.
7.
Sang Cho attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake City,
UT, July 21-22, 2001.
8.
David Followill attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake
City, UT, July 22-26, 2001.
9.
William Hanson attended the Annual Meeting of the American Association of Physicists in Medicine and also
the American College of Radiology Symposium, Salt Lake City, UT, July 20-26, 2001.
10. Nadia Hernandez attended the Annual Meeting of the American Association of Physicists in Medicine, Salt
Lake City, UT, July 21-26, 2001.
11. Geoffrey Ibbott attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake
City, UT, July 22-26, 2001.
12. Amanda Krintz attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake
City, UT, July 21-26, 2001.
13. Mary Lou Lesseraux attended the Annual Meeting of the American Association of Physicists in Medicine, Salt
Lake City, UT, July 21-25, 2001.
14. Jessica Lowenstein Lief attended the Annual Meeting of the American Association of Physicists in Medicine,
Salt Lake City, UT, July 22-26, 2001.
15. Andrea Nelson attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake
City, UT, July 21-25, 2001.
16. Dee Ann Radford attended the Annual Meeting of the American Association of Physicists in Medicine, Salt
Lake City, UT, July 12-26, 2001.
17. Joye Roll attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake City,
UT, July 22-26, 2001.
18. Ramesh Tailor attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake
City, UT, July 20-26, 2001.
19. Nathan Wells attended the Annual Meeting of the American Association of Physicists in Medicine, Salt Lake
City, UT, July 22-26, 2001.
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20. José A. Bencomo attended the Advanced Tech Consortium Meeting in Houston, TX, August, 23-24, 2001.
21. Sang Cho attended the Advanced Tech Consortium Meeting in Houston, TX, August, 23-24, 2001.
22. David Followill attended the Advanced Tech Consortium Meeting in Houston, TX, August, 23-24, 2001.
23. William Hanson attended the Advanced Tech Consortium Meeting in Houston, TX, August, 23-24, 2001.
24. Geoffrey Ibbott attended the Advanced Tech Consortium Meeting in Houston, TX, August, 23-24, 2001.
25. Ramesh Tailor attended the Advanced Tech Consortium Meeting in Houston, TX, August, 23-24, 2001.
26. Sang Cho attended the Workshop on Monte Carlo N-Particle Extension (MCNPX), Chicago, IL, August 27-31,
2001.
27. Geoffrey Ibbott attended the American College of Radiology (ACR) Meeting, San Francisco, CA, September 812, 2001.
28. José A. Bencomo attended the Third National Forum on Biomedical Imaging, Arlington, VA, September 13-14,
2001.
29. Geoffrey Ibbott attended the American College of Radiology Imaging Network Meeting and the Mid-Altantic
Chapter Meeting of the American Association of Physicists in Medicine. Arlington, VA, September 28-30,
2001.
30. José A. BenComo attended the American College of Radiology Imaging Network Meeting and the Mid-Altantic
Chapter Meeting of the American Association of Physicists in Medicine. Arlington, VA, September 28-30,
2001.
31. Mary Lou Lesseraux attended the Annual Meeting of the Society of Research Administrators, Vancouver,
British Columbia, Canada, October 12-17, 2001.
32. Geoffrey Ibbott attended the Southwestern Chapter of AAPM Meeting, New Orleans, LA, October 19-20, 2001.
33. José A. Bencomo attended the Annual Meeting of the North Central Cancer Treatment Group Meeting,
Rochester, MN, October 24-25, 2001.
34. Irene Harris attended the Annual Meeting of the North Central Cancer Treatment Group Meeting, Rochester,
MN, October 24-25, 2001.
35. Geoffrey Ibbott attended the Annual Meeting of the North Central Cancer Treatment Group Meeting,
Rochester, MN, October 24-25, 2001.
36. Irene Harris attended the Southwest Oncology Group Meeting in Chicago, IL, October 25-27, 2001.
37. Geoffrey Ibott attended the Southwest Oncology Group Meeting in Chicago, IL, October 25-27, 2001.
38. J. Francisco Aguirre attended the Southwest Oncology Group Meeting in Chicago, IL, October 25-27, 2001.
39. Geoffrey Ibbott attended the Annual Meeting of the Council on Ionizing Radiation Measurements and
Standards (CIRMS), Gaithersburg, MD, October 29-31, 2001.
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STATUS SUMMARY
Dosimetry review visits were made to 9 institutions, at which 79 beams† were reviewed, 3403 TLD reports
were evaluated, and 308 patients' charts were evaluated. There are five institutions that are 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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Page 9 of 11
EXPENDITURES OF THE RADIOLOGICAL PHYSICS CENTER
(RPC Grant, the COMS Subcontract, and the High Technology Subcontract)
July 1, 2001 – October 30, 2001
______________________________________________________________________________
PERSONNEL (salaries, fringe benefits):
$707,979.43
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
J. Francisco Aguirre - Newark and New York
J. Francisco Aguirre - New Orleans and Oklahoma
Andrea Nelson – New Orleans and Oklahoma
Sang Cho - Long Branch
David Followill – Burlington
Geoffrey Ibbott – Burlington
Ramesh Tailor – Nova Scotia
Andrea Nelson – Bethlehem
David Followill– Bethlehem
TOTAL:
$ 1,681.55
1,256.79
1,124.15
1,652.85
2,244.94
2,364.02
1,788.41
1,186.00
1,186.00
$14,484.71
Meetings:
Joye Roll – Cincinnati and Salt Lake City
Jessica Lowenstein Leif – Cincinnati and Salt Lake City
Geoffrey Ibott – Cincinnati and Salt Lake City
J. Francisco Aguirre – Salt Lake City
Peter Balter – Salt Lake City
José A. BenComo – Salt Lake City
Sang Cho – Salt Lake City
David Followill – Salt Lake City
William Hanson– Salt Lake City
Nadia Hernandez– Salt Lake City
Amanda Krintz– Salt Lake City
Mary Lou Lesseraux– Salt Lake City
Andrea Nelson – Salt Lake City
Dee Ann Radford – Salt Lake City
Ramesh Tailor – Salt Lake City
Nathan Wells – Salt Lake City
Geoffrey Ibbott – Houston
David Followill – Houston
José BenComo– Houston
Sang Cho – Houston
Ramesh Tailor – Houston
William Hanson – Houston
Sang Cho – Chicago
Geoffrey Ibbott – San Francisco
Geoffrey Ibbott – Arlington
José A. BenComo – Arlington
J. Francisco Aguirre, Cardoba
Geoffrey Ibbott – Florence
Mary Lou Lesseraux – Vancouver
Geoffrey Ibbott – New Orleans
José A. BenComo
Irene Harris – Chicago and Rochester
Geoffrey Ibbott – Chicago and Rochester
J. Francisco Aguirre
Geoffrey Ibbott – Gaithersburg
TOTAL:
$ 2,267.70
2,080.42
2,136.72
1,041.15
1,802.00
756.76
748.44
1,703.15
1,654.03
1,831.42
835.96
1,302.31
1,249.67
1,183.73
1,869.44
1,446.18
0.00
0.00
0.00
0.00
0.00
0.00
2,568.39
1,441.89
0.00
1,154.09
0.00
0.00
2,291.00
283.18
860.03
2,040.25
1,478.47
1,142.00
1,399.00
$ 38,567.38
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CONSULTANTS
Fiscal 2001 this funds contains $10,000
EQUIPMENT:
Computers, printers, etc.
$ 9,189.99
SUPPLIES:
Office supplies, laboratory and record keeping, TLD,
TLD supplies, software, etc.
$ 42,850.55
OTHER EXPENSE:
Postage, telephone, reprints, copying, computer fees,
equipment repair, etc. – Database Conversion
$ 19,789.50
SPACE RENTAL:
$ 65,388.56
Total Expenditures July 1, 2001 – October 30, 2001
Indirect costs @ 26%
TOTAL
$ 875,374.30
227,597.32
$1,102,971.62
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RPC Report to RTC July 2001
Clinical Study Groups
Office Reviewing
Patient Records
Special Projects
American College of Surgeons Oncology Group
ACOSOG
RPC
Cancer and Acute Leukemia Group B
Cancer and Acute Leukemia Group B
QARC
Children’s Oncology Group COG
(POG, CCG, WILMS, RHABDO)
QARC
Eastern Cooperative Oncology Group
ECOG
QARC
Gynecologic Oncology Group
GOG
RPC
HDR Pre-approval
National Surgical Adjuvant Breast
and Bowel Project
NSABP
RPC
B-06 Study revisited
Breast phantom
North Central Cancer Treatment Group
NCCTG
RPC
Radiation Therapy Oncology Group
RTOG
RTOG
3D CRT by IGTQA Center
Brachytherapy by RPC
Southwest Oncology Group
SWOG
SWOG QAC (early review)
RPC
(retrospective
of
Selected Studies)
Clinical Trial Support Unit
CTSU
QARC, RPC, RTOG
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US guided Prostate
RPC Institution List
Early Review of Lung Study
TRUS guided Prostate
IMRT Phantom /pre-approval
Prostate Phantom
Prostate Implant Pre-approval
Stereotactic Phantom
Lung Phantom
US guided Prostate
TBI evaluation
Lung & Breast Study Review
RPC Institution List