Commissioning using class solutionsJason Morton: GenesisCare: Adelaide Radiotherapy Centre

A brief history in commissioning at ARC• Initially heavily 2D / 3D planning based• Fields not optimized to test specific function• Standard fields not updated, but added to =

wasted resources• Lots of replication (mostly just

square/rectangular fields)• Poor efficiency of measurement (mostly just

IC point doses)• Loss of specific testing

Why the need for change? - Quality• Lots of tests does not mean good quality testing• Items missed during commissioning• A lack of consistency• Previous results and experience not put into consideration (factors don’t

change between linacs)• Individual plans for testing different every time but not necessarily better • Standards updated and documents released to clearly help define tests• A need to include new techniques without affecting efficiency

Why the need for change? - Personnel• Extra workload on RT’s during linac replacement• Extra workload on physics staff during CAT and commissioning• Extra hours on other linacs to compensate

SOP strategy• Include specific tests• Stay with established protocols• Work with other groups within GCC (mostly WA with Elekta and Pinnacle)• Be ambitious• Be realistic (i.e. Measure how long it took before and work out how fast it can be

done in future)• Don’t replicate (if you have data already, use it as a benchmark)• Commission for the future (i.e. include treatment techniques not currently being

done in the department)

StructureSOP Governance

Generic set of rules

Specific class solution for TPS and new Linac/Techniques

Specific class solution for TPS and Linac/Techniques

Specific class solution for matched TPS and Linac/Techniques

SOP Governance• Simple and defined from principles (i.e. not need changing over time)• Initial 1.5 pages for acceptance and commissioning

Class solution (Quality)• Specific to department setup• Includes full list of specific tests that must be carried out• Commissioning class solution below

Specific tests and benchmarks• Area survey and abs dose calibration• TPS specific data (Pinnacle, Radcalc, Independent SS)• TRS-430 (Match tests,Don’t repeat what is done in TPS like profile overlays)• TecDoc-1583• TG-119• Validation of orientations, rotations and wedge direction• Check MLC parameters (T&G, LOCT)• Check primary collimator (1/4 blocked)• GCC Audit (external physics audit)• L3 Audits for imaging and specific techniques

Timelines and Plans

Page 10

• Gantt chart created (Complex and big)• Simple spreadsheets for summary (Below)• Only change what you have control over (are responsible for)• Chart 1 Unmatched with data collection/validation reduced 3 weeks• Chart 2 matched machine with data collection/validation at 2 weeks

Matched Linacs• Put the effort into matching• Perform limited set of machine data collection• Use existing beam model• Proceed to validation

Timeline summaryCriteria 2005 2008 2009 2011 2013 2015 2016

Time ATP/CAT 2 2 2 2 2 2 2

Time Commissioning 14* 10 10 10 8 5 2

2D Planning Photons Y Y Y Y Y Y Y

2D Planning Electrons Y Y Y Y Y Y Y

3D Planning Photons Y Y Y Y Y Y Y

3D Planning Electrons Y Y Y Y Y Y Y

2D Imaging Y Y Y Y Y Y Y

IMRT Y Y Y Y Y

IGRT Y Y Y Y Y Y

kV Imaging Y Y Y

VMAT Y Y

SABR Y Y

SRS Y Y

FFF Y Y

kV Imaging Y Y

SOP Introduced

Finished 2 weeks early

Matched Machine SOP

Access

Efficiency

Time saving• TPS plans and models created before starting when available• Test/benchmark plans ready for delivery• Test and QA equipment calibrated on an existing matched linac before

commissioning starts• Matched linac• Reduced measurement sets for matched linacs

Collaboration – The key to success• Initial Pinnacle Elekta models taken from WA• Modifications and improvements shared with other GCC physics groups• Initial beam matching taken from WA• New Elekta CAT SOP in collaboration with NSW• New Elekta commissioning SOP datasets from NSW to be tried in 2017 as SA SOP

The future• Dream to roll out a GCC wide SOP for Elekta / Pinnacle• Use NSW benchmark cases as initial benchmark• Have GCC wide linac model for Elekta w/Agility head• Look at focussing on ways to improve both quality and efficiency• Have GCC wide tables of known factors and their error %• Baseline matched machine data for comparison• Potential to streamline machine matched commissioning further = validation with

reduced data collection (still currently collecting all data)

Thank-you