@OliveTree,
- If you have great dosimetry/physics staff then I guess you can adopt "scarbrtj's approach" ---> "...just sign the PDF, and then go fishing."
But I think the patients deserve our meticulousness, which is crucial in this field. Anyway, I have discovered the rare errors by CMD/PhD physicists years ago. People are human and to be human is to err.
I have adopted a new approach ---> I hope the following helps you and others:
- Everyday my staff print a day sheet for me with all the patients names on it. You can print it from Mosaiq or Varian Aria system.
Carry this sheet with you at all time during the day.
- Let's say:
1. Mr. John Doe has brain mets from lung ca. You reviewed:
a. Opposed laterals (90 + 270 degrees)
b. RAO (87 degrees) and LAO (273 degrees) to avoid the lenses.
Let's say you like plan "b" better, write it down on your day sheet "87/273" or something like that.
A few days later the PDF is uploaded into Mosaiq or Varian Eclipse, all you have to do is verify it against what you wrote down
and that is it.
2. Mrs. Jane Doe has colon ca met to left hip. You reviewed:
a. AP/PA 23 MV
b. AP/PA 6 MV
Let's say you like plan "a" with 23 MV photons better, write it down on your day sheet "23".
These are code words that only you/your residents understand.
3. IMRT, VMAT is much harder to track, please read on. You reviewed:
a. 8-field static IMRT, let's say spinal cord PRV mean dose is 4345 cGy.
b. VMAT, let's say spinal cord PRV mean dose is 4305 cGy.
Let's say you like plan "b" better.
Just write down on your sheet "sp cord 4305".
When you check the PDF a few days later, if you see spinal cord PRV mean dose = 4345 cGy, and if you check it against your day sheet, you will know something is wrong, i.e., the wrong plan was uploaded.
Most staff know to delete the other "non-approved" plans ASAP and keep only the plan you approved, but humans are humans, we err a bit.
So the way to protect the patients/yourself is to use this little trick I call "dosing signature", which is the "fingerprint" of the approved plan.
Next time you evaluate different plans, you will see spinal cord, heart, lung doses are slightly different a bit from plan to plan.
Let's say you evaluate a lung ca patient dosimetry with 3 plans (a, b, c). Let's say you like plan "c".
Immediately write down the "dosing signature", let's say plan "c" has a mean heart hose of 4506.7895 cGy.
Write it down as "4506.7895 cGy", which must match with the uploaded PDF.
It is virtually impossible for plans "a" and "b" to have the same exact figures of "4506.7895 cGy".
Anyway, this is my trick and it has helped me tremendously...