Answer Choices –	Responses –
– Yes	21.21% 7
– No	78.79% 26
TOTAL	33
Comments(3)

Q2 w

If you use both, which cases are planned with AAA?

Answered: 24
Skipped: 10

Most cases

7/12/2017 03:16 PM

All cases use AAA for final calc.

5/4/2015 02:14 PM

AAA is still our default for planning.

5/2/2015 01:07 PM

All but lung

5/1/2015 11:46 PM

All.

5/1/2015 08:58 PM

All

5/1/2015 04:39 PM

All of them

5/1/2015 04:15 AM

Most are generally planned with AAA, but when lung targets are small, we verify first with Acuros, and then consider planning with Acuros.

5/1/2015 01:32 AM

None

4/30/2015 03:48 PM

only those rejected by Acuros due to high HU

4/30/2015 03:06 PM

Q3 w

If you use both, which cases are planned with Acuros?

Answered: 24
Skipped: 10

Any that are extremely heterogeneous - lung and high density bone in it.

7/12/2017 03:16 PM

Dosimetrists are free to use Acuros for VMAT optimation.

5/4/2015 02:14 PM

None

5/2/2015 03:39 PM

We use Acuros in cases where AAA is known to have significant uncertainties. Specifically we have used Acuros for lung SBRT planning and in cases involving metal implants.

5/2/2015 01:07 PM

Lung

5/1/2015 11:46 PM

None

5/1/2015 04:39 PM

The ones with prosthesys

5/1/2015 04:15 AM

All our lung SABR plans are performed with Acuros. Plans with large heterogeneous materials/ implants are also planned, or alteast verified, with Acuros, if beams have to enter through the material.

5/1/2015 01:32 AM

All

4/30/2015 03:48 PM

Q4 w

If you have Acuros but do not use it clinically, please explain why.

Answered: 11
Skipped: 23

Dosimetrists are free to use Acuros for VMAT optimation. We get better VMAT QA results with AAA being the final calc rather than Acuros.

5/4/2015 02:14 PM

Need to respect clinical outcome from many years. Acuros is more accurate but past clinical experience is more important. To change MU according to Acuros may be dangerous.

5/2/2015 03:39 PM

Physicians don't like the results.

5/1/2015 08:58 PM

Inconvenient and waiting for next release

5/1/2015 04:39 PM

Concern with HU-electron density calibration - the regular Catphan os not appropriate to use for this calibration and we don't have anything better

5/1/2015 04:15 AM

We mostly use it as a verification tool and as a planing tool for complex rapid arc cases (its faster than AAA for RA). But in most other sites, we have not seen clinically significant differences to warrant its use for ALL treatment sites, since AAA does a adequate job, even when compared with Monte Carlo.

5/1/2015 01:32 AM

high Z materials present it can't be used

4/30/2015 03:06 PM

NA

4/30/2015 01:30 PM

N/A

4/30/2015 12:34 PM

Q5 w

Please add any comments related to the transition to using Acuros.

Answered: 11
Skipped: 23

There is a natural lag between the availability of an algorithm and its use becoming widespread at the clinical level. This has been seen before when the ability for heterogeneity corrections were first introduced into planning systems. In moving from AAA to AXB some dose distributions will look different - more accurate for the planned treatment, but different from the clinical experience of the radiation oncologists, planners and physicists. This brings up questions of what is now an acceptable distribution, should planning practices change, etc. People need an experience base to move forward.

5/2/2015 01:07 PM

It seems that dose to médium is the way to go

5/1/2015 04:15 AM

Migrating from none to heterogeneous calculations requires a LOT of clinical education and planning. Migrating from pencil beam to AAA/CC requires a little bit less amount of work. Migrating from AAA/CC to Acuros requires the least amount of time (assuming you've commissioned it!). You have to explain the difference between D_w to D_t, and have clinicians understand/appreciate that their lung V95% were never really high to begin with... especially the minimum dose to lung PTVs. But other than that, the differences are not as big as you might think. The question remains, however, is it worth the extra calculation time?

5/1/2015 01:32 AM

more data required during commissioning

4/30/2015 03:06 PM

for vmat and imrt the plans are usually have a global max that is 1-2% higher than what we historically had with AAA

4/30/2015 02:03 PM

Through testing I have done, AAA over estimates dose in the buildup region of lung tumors by 6-10%, Acuros shows better accuracy. In relatively homogenous areas, breast, prostate, etc. both AAA and Acuros have shown to be accurate in dose estimation through testing I have done.

4/30/2015 12:45 PM

Transition was easy. Once we did tests to confirm it was more accurate on various phantom studies, we made the switch. Also, it is faster for calculating RapidArc plans.

4/30/2015 12:02 PM

Acuros will give vastly different looking distributions in areas of high CT number variation. Lung plans will look completely different when a plan originally calc'd with AAA is calc'd with acuros . If making the transition time must be spent with physicians to insure they understand they will be giving higher doses than they are used to.

4/30/2015 11:03 AM

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