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Program Information

Improving Dose Prescriptions for Safety, Reporting, and Clinical Guideline Consistency

I Das

J Moran
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M Langer

I Das1*, J Moran2*, M Langer3*, (1) NYU Langone Medical Center, New York, NY, (2) University Michigan Medical Center, Ann Arbor, MI, (3) Indiana University, Indianapolis, IN


10:15 AM : ICRU-83: Guidelines and Compliance in IMRT - I Das, Presenting Author
10:35 AM : Standardizing Prescriptions to Improve Patient Safety - J Moran, Presenting Author
10:55 AM : Keeping Guidelines on Track: The Effect on Clinical Practice of Neglecting Guidelines for Dose Prescription and Reporting - M Langer, Presenting Author

WE-D-201-0 (Wednesday, August 2, 2017) 10:15 AM - 11:15 AM Room: 201

Radiation dose is an important parameter in treatment outcome analysis. ICRU-83 (1) provided guidelines on prescription, recording and reporting dose in Intensity Modulated Radiation Therapy (IMRT). This international guideline provides valuable information for uniformity in IMRT practice such that outcomes can be compared. However, a survey of major radiation oncology centers found that ICRU-83 guidelines for recording and prescribing treatment are not generally followed and even terminologies are not universally adopted as shown by Das et al (2). This session will call attention to the value of the guidelines from the viewpoints of a physicist and radiation oncologist, emphasizing rationales for adherence. The discussion will identify common areas of patient safety, compliance failure, discuss probable causes and offer guidance on potential remedies within and across institutions. Areas of compliance failure to be highlighted will include: reporting or achieving recommended values for dose homogeneity, dose at the prescription point and the incorrect applications of D95 and D50 within and across institutions as well as by tumor sites. The causes of noncompliance will be elaborated in the context of treatment planning system design limitations, engineering of tolerance guidelines, shortfalls in optimization algorithms, lack of knowledge and training among planners regarding reporting and achieving dose values to meet ICRU standards. Causes of failure arising from the ICRU-83 standards themselves in term of ambiguities, infeasibilities, inefficiencies or inconsistencies with emerging changes in oncologic practice will be discussed as well.

1.ICRU Report 83. Prescribing, Recording, and Reporting Intensity-Modulated Photon-Beam Therapy (IMRT), International Commission on Radiation Units and Measurements; Bethesda, MD,2010.
2. Das IJ, Andersen A, Chen ZJ, Dimofte A, Glatstein E, et al. State of dose prescription and compliance to international standard (ICRU-83) in intensity modulated radiation therapy among academic institutions. Pract Radiat Oncol 2017;7:e145-e155.

Learning Objectives:
1. Culture of safety in context of dose prescription
2. Summarize ICRU-83 guidelines for IMRT, especially D98, D50 and D2
3. Provides patterns of compliance among institutions, propose remedies that can be implemented within institutions, cooperative groups, and standard setting bodies
4. Analyze root cause for current degree of noncompliance in terms of optimization, algorithm, cost function and provide solution


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