Mobius 3D Research Articles

Commissioning of Mobius3D/FX for patient-specific quality assurance: The CUIMC-NewYork Presbyterian Hospital experience.

To present the process undertaken by our institute in commissioning Mobius3D (M3D) for patient-specific quality assurance. 168 plans were randomly selected to compare dose distribution measured with ArcCheck and dose calculated from M3D, both compared against the treatment planning system (TPS). The gamma criteria for measurement and M3D are 3%/2mm with 10% and 50% dose thresholds, respectively. The effect of tissue inhomogeneity was investigated on 11 plans by recalculating the dose in M3D on a homogeneous phantom. Tolerance and action limits were established following the AAPM Task Group 218 recommendations. The M3D showed high variability in gamma passing rate compared to the measurement. Twenty-three out of 168 plans had false negative dose comparisons. These plans fall under high tissue inhomogeneity like lung and metal implants, small field targets, and breast plans planned with high energy. One false negative case (0.6%) was observed. A single tolerance limit of 91% and 92% gamma passing rate for the M3D and measurement-based PSQA were established, respectively. Against the expectation, recalculating plans on the homogeneous phantom in M3D did not necessarily increase the gamma passing rate. These plans have a duty cycle >4.2, and the small field sizes combined with differences in slice thickness contributed to observed dose differences in the homogeneous phantom comparisons. Following the commissioning, M3Dis adopted in our institute. Currently, the gamma criteria used for measurement and M3Dare 3%/2mm, 40% dose threshold, with gamma passing rates of 92% and 95%, respectively. A higher passing rate for M3D is adopted until more data is available. The combined effect of plan modulation, the field sizes, the tissue inhomogeneity, the dose algorithm, and the volume averaging effect from differences in slice thickness can contribute to the differences in dose in M3Dand TPS.

Can Polymetastatic Disease Be ARRESTed Using SABR? A Dosimetric Feasibility Study to Inform Development of a Phase 1 Trial

PurposePhase 2 randomized trials suggest that stereotactic ablative radiation therapy improves progression-free and overall survival in patients with oligometastatic cancer, with phase 3 trials currently testing stereotactic ablative radiation therapy in up to 10 metastases. Whether stereotactic radiation therapy could provide similar benefits in polymetastatic disease (>10 metastases) is unknown. We sought to evaluate the dosimetric feasibility of using stereotactic radiation therapy in polymetastatic disease in preparation for a phase 1 trial. Methods and MaterialsFive craniospinal computed tomography simulations were used to simulate 24 metastatic targets (n = 2 patients), 30 targets (n = 2 patients), and 50 targets (n = 1 patient) that were not present on the initial scan. Creation of radiation therapy plans was attempted for doses up to 30 Gy in 5 fractions, with de-escalation to 24 Gy/4, 18 Gy/3, 12 Gy/2, or 6 Gy/1 if not feasible based on standardized dose constraints. Plans were created using Raystation for delivery on linear accelerators using volumetric modulated arc therapy and validated using Mobius 3D. ResultsA stereotactic radiation therapy treatment plan was generated for each simulated patient. Dose constraints were met to a dose of 30 Gy in 5 fractions for the patients with 24 and 30 lesions. For the patient with 50 targets, dose de-escalation to 12 Gy in 2 fractions was required to meet lung constraints. Estimated beam-on time varied between 18 and 29 minutes per fraction of 6 Gy. Median D95 planning target volume dosimetry ranged from 96.6% to 97.7% of the prescription dose. The conformity index (R100) range was 0.89 to 0.95, and R50 range was 6.84 to 8.72. ConclusionsStereotactic radiation therapy treatment plans meeting standardized dose constraints could be created in the setting of 24 to 50 metastatic lesions using volumetric modulated arc therapy. This safety of this approach is being evaluated in a phase 1 trial (NCT04530513).

Use of Receiver Operating Curve Analysis and Machine Learning With an Independent Dose Calculation System Reduces the Number of Physical Dose Measurements Required for Patient-Specific Quality Assurance

Our purpose was to assess the use of machine learning methods and Mobius 3D (M3D) dose calculation software to reduce the number of physical ion chamber (IC) dose measurements required for patient-specific quality assurance during corona virus disease2019. In this study, 1464 inversely planned treatments using Pinnacle or Raystation treatment planning software (TPS) were delivered using Elekta Versa HD and Varian Truebeam and Truebeam STx linear accelerators between June 2018 and November 2019. For each plan, an independent dose calculation was performed using M3D, and an absolute dose measurement was taken using a Pinpoint IC inside the Mobius phantom. The point dose differences between the TPS and M3D calculation and between TPS and IC measurements were calculated. Agreement between the TPS and IC was used to define the ground truth plan failure. To reduce the on-site personnel during the pandemic, 2 methods of receiver operating characteristic analysis (n = 1464) and machine learning (n = 603) were used to identify patient plans that would require physical dose measurements. In the receiver operating characteristic analysis, a predelivery M3D difference threshold of 3% identified plans that failed an IC measurement at a 4% threshold with 100% sensitivity and 76.3% specificity. This indicates that fewer than 25% of plans required a physical dose measurement. A threshold of 1% on a machine learning model was able to identify plans that failed an IC measurement at a 3% threshold with 100% sensitivity and 54.3% specificity, leading to fewer than 50% of plans that required a physical dose measurement. It is possible to identify plans that are more likely to fail IC patient-specific quality assurance measurements before delivery. This possibly allows for a reduction of physical measurements taken, freeing up significant clinical resources and reducing the required amount of on-site personnel while maintaining patient safety.

Validation of secondary dose calculation system with manufacturer-provided reference beam data using heterogeneous phantoms.

The Mobius3D (M3D) system (Mobius Medical Systems) is a second-check dosimetry system. We investigated the dose calculation accuracy of this system using heterogeneous phantoms with reference beam data provided by the manufacturer using simple and patient plans. We compared the dose distributions between M3D and the treatment planning system, as well as the measurements in solid water phantoms, heterogeneous phantoms, and patient plans for Varian and Elekta accelerators. The M3D results agreed well with the measurements in the solid water phantoms for the simple plans. However, the accuracy of M3D appeared to depend on the type of accelerator, as indicated by the slight differences in the dose measurements. Furthermore, the M3D dose measurements differed by 5-10% in the lung and bone regions. Regarding the patient plans, we confirmed that M3D is reasonably accurate as a second-check system, despite the slight accelerator type-dependent dose difference.

EP-2158: Feasibility of Mobius 3D as an independent MU checker for the adaptive work flow on the MR-Linac

EP-2158: Feasibility of Mobius 3D as an independent MU checker for the adaptive work flow on the MR-Linac

Refinement of MLC modeling improves commercial QA dosimetry system for SRS and SBRT patient-specific QA.

Mobius 3D (M3D) provides a volumetric dose verification of the treatment planning system's calculated dose using an independent beam model and a collapsed cone convolution superposition algorithm. However, there is a lack of investigation into M3D's accuracy and effectiveness for stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT) quality assurance (QA). Here, we collaborated with the vendor to develop a revised M3D beam model for SRS/SBRT cases treated with a 6X flattening filter-free (FFF) beam and high-definition multiple leaf collimator (HDMLC) on an Edge linear accelerator. Eighty SRS/SBRT cases, planned with AAA dose algorithm and validated with Gafchromic film, were compared to M3D dose calculations using 3D gamma analysis with 2%/2 mm gamma criteria and a 10% threshold. A revised beam model was developed by refining the HD-MLC model in M3D to improve small field dose calculation accuracy and beam profile agreement. All cases were reanalyzed using the revised beam model. The impact of heterogeneity corrections for lung cases was investigated by applying lung density overrides to five cases. For the standard and revised beam models, respectively, the mean gamma passing rates were 94.6% [standard deviation (SD): 6.1%] and 98.0% [SD: 1.7%] (for the overall patient), 88.2% [SD: 17.3%] and 93.8% [SD: 6.8%] (for the brain PTV), 71.4% [SD: 18.4%] and 81.5% [SD: 14.3%] (for the lung PTV), 83.3% [SD: 16.7%] and 67.9% [SD: 23.0%] (for the spine PTV), and 78.6% [SD: 14.0%] and 86.8% [SD: 12.5%] (for the PTV of all other sites). The lung PTV mean gamma passing rates improved from 74.1% [SD: 7.5%] to 89.3% [SD: 7.2%] with the lung density overridden. The revised beam model achieved an output factor within 3% of plastic scintillator measurements for 2 × 2 cm2 MLC field size, but larger discrepancies are still seen for smaller field sizes which necessitate further improvement of the beam model. Special attention needs to be paid to small field dosimetry, MLC modeling, and inhomogeneity corrections in the beam model for SRS/SBRT QA. The improvements noted in this study, and further collaborations between clinical physicists and the vendor to refine the M3D beam model could enable M3D to become a premier SRS/SBRT QA tool.

A multi-institutional survey evaluating patient related QA – phase II

Abstract In phase I of the survey a planning intercomparison of patient-related QA was performed at 12 institutions. The participating clinics created phantom based IMRT and VMAT plans which were measured utilizing the ArcCheck diode array. Mobius3D (M3D) was used in phase II. It acts as a secondary dose verification tool for patient-specific QA based on average linac beam data collected by Mobius Medical Systems. All Quasimodo linac plans will be analyzed for the continuation of the intercomparison. We aim to determine if Mobius3D is suited for use with diverse treatment techniques, if beam model customization is needed. Initially we computed first Mobius3D results by transferring all plans from phase I to our Mobius3D server. Because of some larger PTV mean dose differences we checked if output factor customization would be beneficial. We performed measurements and output factor correction to account for discrepancies in reference conditions. Compared to Mobius3D's preconfigured average beam data values, these corrected output factors differed by ±1.5% for field sizes between 7x7cm2 and 30x30cm2 and to −3.9% for 3x3cm2. Our method of correcting the output factors turns out good congruence to M3D's reference values for these medium field sizes.

Preliminary application and discussion of independent 3D dose calculation in intensity-modulated radiotherapy for cervical cancer

Objective To assess the feasibility for the automated treatment planning verification system Mobius3D (M3D) to perform an independent 3D dose calculation in intensity-modulated radiotherapy (IMRT) for cervical cancer. Methods Twenty patients with cervical cancer were randomly selected. With treatment planning systems (Pinnacle, Version 9.2; Eclipse, Version 13.5), all IMRT plans were divided into 7 fields to meet the dosimetric goals. The optimized plans were exported to the M3D server. The percentage differences in the volume of region of interest (ROI) and the dose calculation of target volume and organ at risk (OAR) were evaluated for the two treatment planning systems, and theγ passing rate was used to assess the accuracy of M3D calculation. Results The difference in the volume of ROI for Pinnacle 9.2 to M3D was less than that for Eclipse 13.5 to M3D, with maximum differences of 0.22%±0.69% and 3.5%±1.89% for Pinnacle 9.2 and Eclipse 13.5, respectively. The differences in the dose calculation of target volume and OAR for the two treatment planning systems to M3D were within ±1%. After recalculating by M3D, the dose difference between Pinnacle 9.2 and M3D was smaller than that between Eclipse 13.5 and M3D, but the mean differences were all within ±3%. The γ passing rates for target volume and OAR were more than 95% on average. Conclusions The method of utilizing the automated treatment planning verification system to validate the accuracy of plans is convenient. It can be used as a secondary check tool to improve accuracy in IMRT dose calculation. Key words: Intensity-modulated radiotherapy; Dose calculation; Quality assurance

SU‐F‐T‐440: The Feasibility Research of Checking Cervical Cancer IMRT Pre‐ Treatment Dose Verification by Automated Treatment Planning Verification System

Purpose:To assess the preliminary feasibility of automated treatment planning verification system in cervical cancer IMRT pre‐treatment dose verification.Methods:The study selected randomly clinical IMRT treatment planning data for twenty patients with cervical cancer, all IMRT plans were divided into 7 fields to meet the dosimetric goals using a commercial treatment planning system(PianncleVersion 9.2and the EclipseVersion 13.5). The plans were exported to the Mobius 3D (M3D)server percentage differences of volume of a region of interest (ROI) and dose calculation of target region and organ at risk were evaluated, in order to validate the accuracy automated treatment planning verification system.Results:The difference of volume for Pinnacle to M3D was less than results for Eclipse to M3D in ROI, the biggest difference was 0.22± 0.69%, 3.5±1.89% for Pinnacle and Eclipse respectively. M3D showed slightly better agreement in dose of target and organ at risk compared with TPS. But after recalculating plans by M3D, dose difference for Pinnacle was less than Eclipse on average, results were within 3%.Conclusion:The method of utilizing the automated treatment planning system to validate the accuracy of plans is convenientbut the scope of differences still need more clinical patient cases to determine. At present, it should be used as a secondary check tool to improve safety in the clinical treatment planning.

SU‐F‐T‐285: Evaluation of a Patient DVH‐Based IMRT QA System

Purpose:To evaluate the clinical performance of a patient DVH‐based QA system for prostate VMAT QA.Methods:Mobius3D(M3D) is a QA software with an independent beam model and dose engine. The MobiusFX(MFX) add‐on predicts patient dose using treatment machine log files. We commissioned the Mobius beam model in two steps. First, the stock beam model was customized using machine commissioning data, then verified against the TPS with 12 simple phantom plans and 7 clinical 3D plans. Secondly, the Dosimetric Leaf Gap(DLG) in the Mobius model was fine‐tuned for VMAT treatment based on ion chamber measurements for 6 clinical VMAT plans. Upon successful commissioning, we retrospectively performed IMRT QA for 12 VMAT plans with the Mobius system as well as the ArcCHECK‐3DVH system. Selected patient DVH values (PTV D95, D50; Bladder D2cc, Dmean; Rectum D2cc) were compared between TPS, M3D, MFX, and 3DVH.Results:During the first commissioning step, TPS and M3D calculated target Dmean for 3D plans agree within 0.7%±0.7%, with 3D gamma passing rates of 98%±2%. In the second commissioning step, the Mobius DLG was adjusted by 1.2mm from the stock value, reducing the average difference between MFX calculation and ion chamber measurement from 3.2% to 0.1%. In retrospective prostate VMAT QA, 5 of 60 MFX calculated DVH values have a deviation greater than 5% compared to TPS. One large deviation at high dose level was identified as a potential QA failure. This echoes the 3DVH QA result, which identified 2 instances of large DVH deviation on the same structure. For all DVH's evaluated, M3D and MFX show high level of agreement (0.1%±0.2%), indicating that the observed deviation is likely from beam modelling differences rather than delivery errors.Conclusion:Mobius system provides a viable solution for DVH based VMAT QA, with the capability of separating TPS and delivery errors.

Evaluation of a novel secondary check tool for intensity‐modulated radiotherapy treatment planning

The purpose of this study was to assess the accuracy and efficacy of an automated treatment plan verification, or “secondary check”, tool (Mobius3D), which uses a reference dataset to perform an independent three‐dimensional dose verification of the treatment planning system (TPS) dose calculation and assesses plan quality by comparing dose‐volume histograms to reference benchmarks. The accuracy of the Mobius3D (M3D) system was evaluated by comparing dose calculations from IMRT and VMAT plans with measurements in phantom geometries and with TPS calculated dose distributions in prostate, lung, and head and neck patients (ten each). For the patient cases, instances of DVH limits exceeding reference values were also recorded. M3D showed agreement with measured point and planar doses that was comparable to the TPS in phantom geometries. No statistically significant differences (p<0.05) were noted. M3D dose distributions from VMAT plans in patient cases were in good agreement with the TPS, with an average of 99.5% of dose points showing γ5%,3mm<1. The M3D system also identified several plans that had exceeded dose‐volume limits specified by RTOG protocols for those sites. The M3D system showed dosimetric accuracy comparable with the TPS, and identified several plans that exceeded dosimetric benchmarks. The M3D system possesses the potential to enhance the current treatment plan verification paradigm and improve safety in the clinical treatment planning and review process.PACS number: 87.55.D‐, 87.55.km, 87.55.Qr,

SU-E-T-575: Independent Verification of VMAT Treatment Plans Using a DICOM-RT Framework

Purpose: To compare volumetric modulated arc therapy (VMAT) treatment plans calculated with Eclipse 10 (RapidArc, Varian Medical Systems) and Pinnacle 9.2 (SmartArc, Philips Healthcare) to those computed with an independent verification system utilizing a DICOM‐RT framework Mobius3D (M3D 1.1, Mobius Medical Systems, LP). Methods: Mobius3D (M3D) utilizes standardized machine data, supplemented by custom scaled measured depth dose curves, output factors and off‐axis ratios, to create institution specific beam models as an independent dose validation check. A randomly selected set of clinical radiotherapy plans generated by two treatment planning systems (TPS) consisting of 26 RapidArc prostate plans and 29 SmartArc head and neck plans were exported to M3D. The requisite DICOM‐RT files sent to M3D included CT images, contoured structure sets, RT plan and RT dose. This data was used to recalculate 3D dose distributions using a collapsed cone algorithm in M3D. Dose distributions were compared to those calculated by the TPS 3D dose using a 3D gamma analysis with 3% global dose difference and 3 mm isodose point distance criteria. Additionally, TPS's and M3D's target coverage and regions of interests sparing were compared by calculating the mean dose percent difference for each structure. DVH from each system were also compared. Results: On average, M3D plans showed excellent 3D gamma passing rates agreement of (99.1%±1.1%) and (95.7%±2.2%) relative to RapidArc and SmartArc plans, respectively. Similarly, the M3D recalculated and RapidArc and SmartArc calculated mean target dose percent differences demonstrated small differences of (−0.3%±1.2%) and (− 1.2%±0.9%), respectively. Conclusion: Mobius3D enables a paradigm shift in clinical quality assurance practice by moving beyond single point dose and MU verification to a full 3D treatment plan QA check. The VMAT results obtained utilizing fast and fully automated M3D software showed that M3D is suitable for an independent check of RapidArc and SmartArc plans.