In-house Planning Research Articles

The management income statement as an untapped reporting opportunity in small and medium-sized enterprises

Purpose: The main aim of the article is to present the concept of managerial account reporting for a production company from the SME sector, using case studies. The auxiliary aims were to present the systems of managerial account reporting for different sectors in the literature and to explain its absence in Polish companies. Methodology/approach: The article is based on the implementations of cost accounting in companies in different sectors. The case study method is applied in the study.Findings: The article presents case studies that describe in-house managerial account reports in companies from different sectors and the reasons for not using such solutions in Polish companies.Research limitations/implications: The consequences of the typical ʽaccountancyʼ approach in financial reporting in SMEs is the lack of and the limited usefulness of accounting as such in managing a company.Practical implications: A properly constructed in-house plan of accounts makes it possible to pre-pare a managerial account report for decision-making.Originality/value: The article constitutes a summary and a reflection on the construction and use of managerial accounting tools in company management and SME accounting.

In-house virtual surgical planning and guided mandibular reconstruction is less precise, but more economical and time-efficient than commercial procedures.

To compare an in-house and a commercially available surgical planning solution for mandibular reconstruction in terms of postoperative reconstruction accuracy and economic benefit. Twenty-nine consecutive patients with advanced oral squamous cell carcinoma (OSCC) requiring segmental mandibular reconstruction were enrolled. Fifteen patients underwent in-house surgical planning and 14 patients underwent a commercially available planning solution. A morphometric comparison of preoperative and postoperative computed tomography (CT) data sets and a cost-benefit comparison were performed. Volumes of planned and reconstructed bone segments differed significantly for both in-house planning (p = 0.0431) and commercial planning (p < 0.0001). Significant differences in osteotomy angles were demonstrated for in-house planning (p = 0.0391). Commercial planning was superior to in-house planning for total mandibular deviation (p = 0.0217), intersegmental space volumes (p = 0.0035), and lengths (p = 0.0007). No significant difference was found between the two planning solutions in terms of intersegmental ossification and the incidence of wound healing disorders. In-house planning took less time than commercial planning (p < 0.0001). Component manufacturing costs (p < 0.0001) and total cumulative costs (p < 0.0001) were significantly lower for in-house planning. In-house surgical planning is less accurate but has a cost advantage and could be performed in less time.

Realizing in-house algorithm-driven free fibula flap set up within 24 hours: a pilot study evaluating accuracy with open-source tools.

This study aims to critically evaluate the effectiveness and accuracy of a time safing and cost-efficient open-source algorithm for in-house planning of mandibular reconstructions using the free osteocutaneous fibula graft. The evaluation focuses on quantifying anatomical accuracy and assessing the impact on ischemia time. A pilot study was conducted, including patients who underwent in-house planned computer-aided design and manufacturing (CAD/CAM) of free fibula flaps between 2021 and 2023. Out of all patient cases, we included all with postoperative 3D imaging in the study. The study utilized open-source software tools for the planning step, and three-dimensional (3D) printing techniques. The Hausdorff distance and Dice coefficient metrics were used to evaluate the accuracy of the planning procedure. The study assessed eight patients (five males and three females, mean age 61.75 ± 3.69 years) with different diagnoses such as osteoradionecrosis and oral squamous cell carcinoma. The average ischemia time was 68.38 ± 27.95 min. For the evaluation of preoperative planning vs. the postoperative outcome, the mean Hausdorff Distance was 1.22 ± 0.40. The Dice Coefficients yielded a mean of 0.77 ± 0.07, suggesting a satisfactory concordance between the planned and postoperative states. Dice Coefficient and Hausdorff Distance revealed significant correlations with ischemia time (Spearman's rho = -0.810, p = 0.015 and Spearman's rho = 0.762, p = 0.028, respectively). Linear regression models adjusting for disease type further substantiated these findings. The in-house planning algorithm not only achieved high anatomical accuracy, as reflected by the Dice Coefficients and Hausdorff Distance metrics, but this accuracy also exhibited a significant correlation with reduced ischemia time. This underlines the critical role of meticulous planning in surgical outcomes. Additionally, the algorithm's open-source nature renders it cost-efficient, easy to learn, and broadly applicable, offering promising avenues for enhancing both healthcare affordability and accessibility.

Analysis of delivery and recalculation of dose using DICOM treatment records

ObjectiveA procedure has been proposed for patient-specific QA that, instead of comparing a measurement to the planned dose, compares the dose calculated by an independent system to the dose calculated by the planning system. It is still prudent, however, to check the accuracy of the beam delivery. For this purpose, the DICOM records from the first treatment fraction can be compared to the planned treatment using an in-house developed planning system. MethodsTotally 1,398 patient portals were subjected to the new QA procedure. The dose distribution for each portal was first recalculated on a water phantom by two treatment planning systems and the dose distributions were compared. When agreement was observed, the patient was allowed to start treatment without a measurement. The record from the first day was imported into an in-house planning system which was used to evaluate the delivery for errors and calculate the delivered dose distribution and compare it to the planned dose distribution. ResultsA total of 266 portals passed a strict comparison between the clinical and QA dose calculations and directly used for treatment without measurements. For those portals, the comparison of the delivery records to the plan showed that 99% of spot positions deviated less than 0.2 ​mm and 99.7% of spot metersets deviated by less than 0.3%. On the other hand, 64 portals showed spot size deviations greater than the tolerance of ± 15% with some as large as ±25%. For 32 portals in which the record was used to calculate the delivered dose distribution, the Gamma passing rates between the planned and delivered distributions were always above 95% using a 2% dose difference and 2 ​mm distance-to-agreement criteria. ConclusionsThe new QA process has been implemented slowly with strict constraints. The amount of beam time required has been reduced while maintaining safety.

Review of cost and surgical time implications using virtual patient specific planning and patient specific implants in midface reconstruction

Aim: Summarize the available data on midfacial virtual patient specific planning and patient specific implants, highlighting the financial costs and savings, and additionally emphasize the potential cost implications of transitioning to “in-house” virtual 3D modeling and printing. Methods: Review of current literature. Results: Current literature suggests cost benefits of virtual patient specific planning and patient specific implants in the form of improved ischemia time, better boney apposition between flaps, and reduced patient complications. This reduction of complications includes a reduction in blood loss and time spent in the intensive care unit from flap failure. Improved boney apposition results in a higher likelihood of boney union and a further reduction in failure and complications. Subjective benefits of virtual patient specific planning and patient specific implants are shown in the form of improved reconstructive surgeon mental energy. In-house production of 3D models and presurgical planning provides additional cost benefits for providers as they can produce viable models at a fraction of the price of that which is produced by industrial companies. Providers can also construct and use models in an expedient manner compared to industrial models, allowing for the opportunity to be utilized in more acute settings. The foundation of developing an in-house workflow is adequate funding, resources, and clinical volume. Facilities also must focus on appropriate quality and safety measures, as well as appropriate workflow development for adequate production of models. Conclusion: Virtual patient specific planning and patient specific implants show benefits in midfacial reconstructive outcomes, resulting in realized financial and temporal gains for both patient and provider. These gains may be enhanced by moving to in-house planning and printing.

Improvement of Internal Management on the Basis of the Harmonized System of Indicators Financial Statements

In the article the industrial enterprise management system is presented in the form of a multi-level, hierarchical subsystem of internal firm planning. In this case, the main purpose of the market activities of the enterprise is to maximize the net discounted income. Also, an attempt is made to harmonize the indicators of operational, tactical and long-term planning and not to lose the essence of strategic decisions. In-house planning combines two systems - technical and economic, financial, and operational and production planning. Attempts to create on the basis of the existing system of indicators some integrated assessment of the efficiency of the enterprise are analyzed. Preference is given to the use of a system of balanced scores, which is part of the concept of strategic objectives. Attention is drawn to the fact that it is necessary to use in addition to quantitative and nonfinancial indicators. The solution, problems of formation of the coordinated system of management of the enterprise are seen in the coordinated decision of functional problems and the corresponding indicators with use of measures of economic and mathematical modelling. To form a long-term strategic plan of the enterprise, it is proposed to consider five hierarchical stages of planning. The term of the planning horizon in the future is determined by the terms of implementation of the most long-term investment projects. This allows for a scientifically sound assessment of such projects. However, in such constantly changing conditions, it is necessary to annually adjust long-term plans with the organization of slippery strategic planning and management.

In-House, Open-Source 3D-Software-Based, CAD/CAM-Planned Mandibular Reconstructions in 20 Consecutive Free Fibula Flap Cases: An Explorative Cross-Sectional Study With Three-Dimensional Performance Analysis

BackgroundMandibular reconstruction is conventionally performed freehand, CAD/CAM-assisted, or by using partially adjustable resection aids. CAD/CAM-assisted reconstructions are usually done in cooperation with osteosynthesis manufacturers, which entails additional costs and longer lead time. The purpose of this study is to analyze an in-house, open-source software-based solution for virtual planning.Methods and MaterialsAll consecutive cases between January 2019 and April 2021 that underwent in-house, software-based (Blender) mandibular reconstruction with a free fibula flap (FFF) were included in this cross-sectional study. The pre- and postoperative Digital Imaging and Com munications in Medicine (DICOM) data were converted to standard tessellation language (STL) files. In addition to documenting general information (sex, age, indication for surgery, extent of resection, number of segments, duration of surgery, and ischemia time), conventional measurements and three-dimensional analysis methods (root mean square error [RMSE], mean surface distance [MSD], and Hausdorff distance [HD]) were used.ResultsTwenty consecutive cases were enrolled. Three-dimensional analysis of preoperative and virtually planned neomandibula models was associated with a median RMSE of 1.4 (0.4–7.2), MSD of 0.3 (-0.1–2.9), and HD of 0.7 (0.1–3.1). Three-dimensional comparison of preoperative and postoperative models showed a median RMSE of 2.2 (1.5–11.1), MSD of 0.5 (-0.6–6.1), and HD of 1.5 (1.1–6.5) and the differences were significantly different for RMSE (p < 0.001) and HD (p < 0.001). The difference was not significantly different for MSD (p = 0.554). Three-dimensional analysis of virtual and postoperative models had a median RMSE of 2.3 (1.3–10.7), MSD of -0.1 (-1.0–5.6), and HD of 1.7 (0.1–5.9).ConclusionsOpen-source software-based in-house planning is a feasible, inexpensive, and fast method that enables accurate reconstructions. Additionally, it is excellent for teaching purposes.

Methodology for analyzing the effectiveness of the use of tools for in-house planning of de-fense enterprises in the context of digitalization

Methodology for analyzing the effectiveness of the use of tools for in-house planning of de-fense enterprises in the context of digitalization

Cubik system: maximizing possibilities of in-house computer-guided surgery for complex craniofacial reconstruction

Craniofacial reconstruction represents a major challenge due to the complex anatomical morphology. Although implant production has often been outsourced to external companies, in-house planning and manufacturing has developed in many centres. This note introduces a conceptualized modular mould system to perform any desired craniofacial reconstruction, named ‘Cubik’, inspired by the famous Rubik’s cube. A sophisticated virtual process is described that simulates realistic cranio-orbital resections, and the workflow to create multi-component moulds in order to achieve intraoperatively moulded implants is presented. The description focuses on the appropriate definition of interfaces between the subdivision surfaces of the planned implant, which is the key element to successful design and function of the moulds during surgery and is the peculiarity of the Cubik system. The use of Cubik does not prolong the overall duration of surgery, and it appears to be a very versatile tool, allowing personalized implants with different morphology to be created, which are suitable to cover every potential defect of the skull and the orbital region. This study extends the potential of in-house production, allowing highly accurate implantable craniofacial implants to be fabricated, and in the future this might represent a solution to achieve in-house replacement of other segments of the facial skeleton.

Design of Military Service Framework for Enabling Migration to Military SaaS Cloud Environment

The military of the Republic of South Korea applies infrastructure as a service (IaaS) cloud-computing technology and applications distributed nationwide are transferred to two defense-integrated data centers (DIDCs). However, to improve the quality of the military information service provided by the DIDCs, it is crucial to expand the cloud-computing service from IaaS to the software as a service (SaaS) level. Owing to the in-house planning, development and operation of military applications by the Ministry of National Defense and each military force, these organizations operate several applications that are similar and redundant. Accordingly, SaaS can reduce the costs of IT services and management overhead by eliminating similar and redundant applications and integrating them into common services. In this study, a military service framework (MSF) was designed based on the criteria of business functions and service targets. The MSF was applied to applications currently in operation to create a current military SaaS portfolio, whereas the future military SaaS portfolio was restructured by identifying common services within and between organizations and throughout the military. Consequently, 369 future military SaaS portfolios were created, representing a 36% decrease realized by integrating similar and redundant systems out of 580 applications.

Detecting Factors Effective in Knowledge Sharing Model Among Educational Staff

One of the effective organs in implementing economic, social and cultural development policies in each country is the Ministry of Education, which trains specialized and experienced manpower as the basis for the comprehensive development of countries, production of knowledge and research knowledge, and the provision of specialized services by universities and higher education centers. Accordingly, it facilitates sharing knowledge and identifying factors affecting it in the education organization, especially among employees who are the most important elements in any organization. Because it can create an atmosphere full of trust and interaction, the employees can share their knowledge and experiences with each other; hence, it can be an important strength for the education organization as well as society. In this regard, the present study aimed to identify the factors affecting the knowledge sharing model in individual, organizational, environmental, and extra-environmental dimensions among educational staff. The study revealed that the main individual dimension includes enjoyment of knowledge sharing, organizational commitment, specific organizational knowledge, trust, motivation, value of knowledge, and individual and group interactions. Organizational dimension also encompasses organizational culture, documentation development, in-house planning and organizational rewards. The environmental dimension includes technical knowledge, information technology context, knowledge memory upgrading, and economic and social factors. The trans-environmental dimension consists of political and legal factors and international interactions. This descriptive-analytical research used a library technique.

Analysis of a volumetric-modulated arc therapy (VMAT) single phase prostate template as a class solution.

To assess a class solution template for volumetric-modulated arc therapy (VMAT) for prostate cancer using plan analysis software. VMAT is a development of intensity-modulated radiotherapy (IMRT) with potential advantages for the delivery of radiotherapy (RT) in prostate cancer. Class solutions are increasingly used for facilitating RT planning. Plan analysis software provides an objective tool for evaluating class solutions. The class solution for VMAT was based on the current static field IMRT template. The plans of 77 prostate cancer patients were evaluated using a set of in-house plan quality metrics (scores) (PlanIQ™, Sun Nuclear Corporation). The metrics compared the class solution for VMAT planning with the IMRT template and the delivered clinical plan (CP). Eight metrics were associated with target coverage and ten with organs-at-risk (OAR). Individual metrics were summed and the combined scores were subjected to non-parametric analysis. The low-dose wash for both static IMRT and VMAT plans were evaluated using 40Gy and 25Gy isodose volumes. VMAT plans were of equal or better quality than the IMRT template and CP for target coverage (combined score) and OAR combined score. The 40Gy isodose volume was marginally higher with VMAT than IMRT (4.9%) but lower than CP (-6.6%)(P=0.0074). The 25Gy volume was significantly lower with VMAT than both IMRT (-32.7%) and CP (-34.4%)(P<0.00001). Automated VMAT planning for prostate cancer is feasible and the plans are equal to or better than the current IMRT class solution and the delivered clinical plan.

Clinical Implementation of an In-House Developed Plan Quality Control Tool to Guarantee High Quality Automatically Generated Radiation Therapy Plans for Prostate Cancer Patients

In our institute all prostate radiotherapy plans are automatically generated with a single treatment technique template in an auto-planning module on treatment planning software. Since the planning process is fully automatic it is more difficult for the planner to decide if the plan is optimal or needs improvement. Currently, a scorecard is used to evaluate if a plan meets the clinical dose criteria. However, this scorecard only represents dose criteria for the population, and does not guarantee an optimal plan for each individual patient. We developed an in-house plan quality control (QC) tool to check if the automated prostate treatment plans are optimal or need further improvement. This tool predicts a personalized dose-volume histogram (DVH) for each organ-at-risk (OAR) based on the anatomy of each individual patient. All prostate plans have one single VMAT arc (95 to 265°), by which 70 Gy is given in 28 fractions of 2.5 Gy. Historical data consisting of 129 automated prostate plans which all fulfill the clinical dose criteria are used in this study. The model is trained on 100 plans and validated on a separate test set of 29 plans based on a random split. The model is made by first calculating principal components (PCs) of the DVH and overlapping volume histogram (OVH), which is a measure to capture individual patient anatomical information. Second, the calculated PCs are used to fit a support vector regression model that predicts DVH PCs from OVH PCs. The plan QC tool is implemented in our clinical workflow. The plans are exported from the TPS in DICOM format and sent to a PACS that triggers an application. The application automatically calculates the predicted and planned DVH curves and generates a personalized scorecard in a PDF report. The report is added to the departmental oncology information system (OIS) and reviewed by the planner. Threshold levels of 3Gy for dose and 3% for volume metrics are set to detect if a plan needs to be replanned. Plans are replanned by changing the treatment technique template for each of the OAR dose parameters that can be improved and start the Auto-Planning again. All plans in the test dataset were checked by the plan QC tool. For the 29 plans, 8 plans had OAR dose parameters that deviated more than the 3Gy and 3% thresholds from the predicted values. These 8 plans were further optimized after which the DVH metrics were within the threshold levels with respect to the predicted DVH metrics. The mean improvement is 4,2Gy for mean dose and 4,0% for V30Gy and V60Gy of the rectal and anal wall. An independent plan QC tool is necessary to make sure that automated prostate treatment plans are optimal for each individual patient. This tool generates a personalized scorecard for each plan and can be safely implemented in the clinic to guarantee high quality automated prostate plans, and thus optimize and individualize patient treatment.

Differences in trochlear parameters between native and prosthetic kinematically or mechanically aligned knees.

Kinematic (KA) and mechanical (MA) alignment techniques are two different philosophies of implant positioning that use the same TKA implants. This might generate differences in the resulting prosthetic trochleae parameters between the two techniques of alignment. Our study aim was to test the following hypotheses: (1) mechanically or kinematically aligned femoral implant understuffs the native trochlear articular surface and poorly restores the native groove orientation, and (2) the orientation of the prosthetic trochlear groove and trochlear fill are different between MA and KA. Three-dimensional models of the femur were made from segmentation of preoperative Magnetic Resonance Imaging scans (MRIs) of ten subjects with isolated medial tibiofemoral osteoarthritis. In-house planning and analysis software kinematically and mechanically aligned a modern cruciate retaining femoral component and determined differences in parameters of the trochlear fit between native and prosthetic trochleae, and between KA and MA prosthetic trochleae. The MA prosthetic trochleae did not fill (understuffed) the entire length of the native medial facet and the proximal 70% of the native groove and lateral facet, and oriented the trochleae groove 8° more valgus than native. The KA prosthetic trochleae understuffed the proximal 70% of the native trochleae, and had a groove 6° more valgus than native. The KA trochleae understuffed the medial facet distally and oriented the groove 2° less valgus and 3° more internally rotated than the MA trochleae. MA and KA prosthetic trochleae substantially understuff and create a prosthetic groove more valgus compared to native trochlear anatomy, and they also differed between each other regarding trochleae stuffing and groove alignment. Although randomized trials have not shown differences in patellofemoral complications between KA and MA, a femoral component designed specifically for KA that more closely restores the native trochlear anatomy might improve patient reported satisfaction and function. Level 2 controlled laboratory study.

In-house planning in times of crisis: opportunities for further development

In-house planning in times of crisis: opportunities for further development

TU-FG-201-10: Quality Management of Accelerated Partial Breast Irradiation (APBI) Plans

Purpose: Since 2008, over 700 patients received high dose rate (HDR) APBI treatment at Virginia Hospital Center. The complexity involved in the planning process demonstrated a broad variation between patient geometry across all applicators, in relation to anatomical regions of interest. A quality management program instituting various metrics was implemented in March 2013 with the goal of ensuring an optimal plan is achieved for each patient. Methods: For each plan, an in-house complexity index, geometric conformity index, and plan quality index were defined. These indices were obtained for all patients treated. For patients treated after the implementation, the conformity index and quality index were maximized while other dosimetric limits, such as maximum skin and rib doses, were strictly kept. Subsequently, all evaluation parameters and applicator information were placed in a database for cross-evaluation with similar complexity. Results: Both the conformity and quality indices show good correlation with the complexity index. They decrease as complexity increases for all applicators. Multi lumen type balloon applicators demonstrate a minimal advantage over single lumen applicators in increasingly complex patient geometries, as compared to SAVI applicators which showed considerably greater advantage in these circumstances. After the implementation of the in-house planning protocol, there is a direct improvement of quality for SAVI plans. Conclusion: Due to their interstitial nature, SAVI devices show a better conformity in comparison to balloon-based devices regardless of the number of lumens, especially in complex cases. The quality management program focuses on optimizing indices by utilizing prior planning knowledge based on complexity levels. The database of indices assists in decision making and has subsequently aided in balancing the experience level among planners. This approach has made APBI planning more robust for patient care, with a measurable improvement in the plan quality.

Notes on the single route lateral transhipment problem

Previous research has analyzed deterministic and stochastic models of lateral transhipments between different retailers in a supply chain. In these models the analysis assumes given fixed transhipment costs and determines under which situations (magnitudes of excess supply and demand at various retailers) the transhipment is profitable. However, in reality, these depend on aspects like the distance between retailers or the transportation mode chosen. In many situations, combining the transhipments may save transportation costs. For instance, one or more vehicle routes may be used to redistribute the inventory of the potential pickup and delivery stations. This can be done in any sequence as long as the vehicle capacity is not violated and there is enough load on the vehicle to satisfy demand. The corresponding problem is an extension of the one-commodity pickup and delivery traveling salesman and the pickup and delivery vehicle routing problem. When ignoring the routing aspect and assuming given fixed costs, transhipment is only profitable if the quantities are higher than a certain threshold. In contrast to that, the selection of visited retailers is dependent on the transportation costs of the tour and therefore the selected retailers are interrelated. Hence the problem also has aspects of a (team) orienteering problem. The main contribution is the discussion of the tour planning aspects for lateral transhipments which may be valuable for in-house planning but also for price negotiations with external contractors. A mixed integer linear program for the single route and single commodity version is presented and an improved LNS framework to heuristically solve the problem is introduced. Furthermore, the effect of very small load capacity on the structure of optimal solutions is discussed.

DGGG Guidelines Programme: Status Quo - Quo Vadis!

The Guidelines programme of the German Society of Gynaecology and Obstetrics (DGGG) is an executive part of the DGGG Guidelines Commission. It includes in-house planning and organisation of all guidelines as well as representation outside of the DGGG. This article does not concern the development of the guidelines as much as it concerns the planning, organisation, registration, editing and publication of the guidelines in context of the DGGG Guidelines programme. It targets interested parties, especially authors and coordinators of guidelines.

An Integrated Approach to Hydrographic Surveying of Large Reservoirs—Application to Tarbela Reservoir in Pakistan

Hydrographic surveying in reservoirs is a key activity in order to collect data for a variety of purposes like estimation of storage capacity, rate and pattern of sediment deposition, movement of underwater sediment delta and reservoir routing, etc. These parameters play a pivotal role in any planning, management and operation activity of the reservoirs. Traditional approaches to perform hydrographic surveying in Indus Basin are time consuming, laborious, comparatively inaccurate and costly. As water resources are under immense pressure due to a variety of factors, such inefficient methods are not acceptable for efficient water management. In this study, an integrated approach for hydrographic surveying is introduced and evaluated in terms of its efficiency in comparison with the traditional methods of hydrographic surveying. The approach develops an integrated environment of hydrographic surveying comprising human, hardware and software. The process of surveying starts from in-house planning using specialized geo-spatial softwares. Then, on site a combination of computer hardware, echosounder, differential global positioning system (DGPS), survey vessel and survey crew is made. Post-processing is performed after conducting a survey in order to improve quality of data by filtering errors and producing the end product like reservoir underwater terrain, development of reservoir stage-area and stage-storage relationships, etc. The study was applied to Tarbela Reservoir, Pakistan.

Commissioning of intensity modulated neutron radiotherapy (IMNRT)

Intensity modulated neutron radiotherapy (IMNRT) has been developed using inhouse treatment planning and delivery systems at the Karmanos Cancer Center∕Wayne State University Fast Neutron Therapy facility. The process of commissioning IMNRT for clinical use is presented here. Results of commissioning tests are provided including validation measurements using representative patient plans as well as those from the TG-119 test suite. IMNRT plans were created using the Varian Eclipse optimization algorithm and an inhouse planning system for calculation of neutron dose distributions. Tissue equivalent ionization chambers and an ionization chamber array were used for point dose and planar dose distribution comparisons with calculated values. Validation plans were delivered to water and virtual water phantoms using TG-119 measurement points and evaluation techniques. Photon and neutron doses were evaluated both inside and outside the target volume for a typical IMNRT plan to determine effects of intensity modulation on the photon dose component. Monitor unit linearity and effects of beam current and gantry angle on output were investigated, and an independent validation of neutron dosimetry was obtained. While IMNRT plan quality is superior to conventional fast neutron therapy plans for clinical sites such as prostate and head and neck, it is inferior to photon IMRT for most TG-119 planning goals, particularly for complex cases. This results significantly from current limitations on the number of segments. Measured and calculated doses for 11 representative plans (six prostate∕five head and neck) agreed to within -0.8 ± 1.4% and 5.0 ± 6.0% within and outside the target, respectively. Nearly all (22∕24) ion chamber point measurements in the two phantom arrangements were within the respective confidence intervals for the quantity [(measured-planned)∕prescription dose] derived in TG-119. Mean differences for all measurements were 0.5% (max = 7.0%) and 1.4% (max = 4.1%) in water and virtual water, respectively. The mean gamma pass rate for all cases was 92.8% (min = 88.6%). These pass rates are lower than typically achieved with photon IMRT, warranting development of a planar dosimetry system designed specifically for IMNRT and∕or the improvement of neutron beam modeling in the penumbral region. The fractional photon dose component did not change significantly in a typical IMNRT plan versus a conventional fast neutron therapy plan, and IMNRT delivery is not expected to significantly alter the RBE. All other commissioning results were considered satisfactory for clinical implementation of IMNRT, including the external neutron dose validation, which agreed with the predicted neutron dose to within 1%. IMNRT has been successfully commissioned for clinical use. While current plan quality is inferior to photon IMRT, it is superior to conventional fast neutron therapy. Ion chamber validation results for IMNRT commissioning are also comparable to those typically achieved with photon IMRT. Gamma pass rates for planar dose distributions are lower than typically observed for photon IMRT but may be improved with improved planar dosimetry equipment and beam modeling techniques. In the meantime, patient-specific quality assurance measurements should rely more heavily on point dose measurements with tissue equivalent ionization chambers. No significant technical impediments are anticipated in the clinical implementation of IMNRT as described here.