Log File Analysis Reduces Clinical Operational Burden for PSQA

“With ClearCalc and RadMonteCarlo, the verification process became much more consistent and traceable.” 

This June, we look at how Radformation accelerates quality assurance (QA) in the clinic. We sat down with Raúl Alfonso Suárez Jaimes, Head of Medical Physics, to learn how Oncoservice in Bolivia has dramatically increased its clinical efficiency. This helped them handle a growing number of patients and increasingly complex plans without losing confidence in their treatment delivery.

About Oncoservice

Oncoservice has two sites in Bolivia, one in Santa Cruz and one in La Paz. The team includes five radiation oncologists, supported by three medical physicists and three dosimetrists for plan review and quality assurance. Even with the help of 10 technicians, Oncoservice treats nearly 1000 patients per year, and up to 120 per day, which means they have a lot of plans to create, review, and verify.

Raúl says that the decision to implement Radformation's solutions was driven by the need to manage their rapidly expanding multi-site model and the subsequent increase in patients. They use AutoContour, ClearCheck, and ClearCalc with RadMonteCarlo to streamline contouring, plan review, and dose verification. They also use RadMachine for machine QA. The clinic is equipped with two Elekta^Ⓡ linear accelerators (linacs) and uses Monaco^Ⓡ as its treatment planning system (TPS).

Solving the PSQA Bottleneck with ClearCalc and RadMonteCarlo

Oncoservice's priority was implementing AutoContour for organs at risk (OAR) contouring. Moving from manual to automated contouring reduced delineation times from about 2 hours to just 25 minutes. However, as a result, patient-specific quality assurance (PSQA) became a bottleneck in the workflow.

Initially, Raúl’s team performed PSQA using physical phantom measurements for every case. This approach often required using the linacs outside of normal patient hours, increasing the team’s workload. Despite these operational challenges, the staff showed great commitment to performing these checks to avoid delays in starting patient treatments.

To solve this, Oncoservice implemented ClearCheck and ClearCalc with RadMonteCarlo. Thanks to these solutions, they can now validate a plan the same day it is approved. The new workflow consists of:

1. Plan approval in ClearCheck

2. Immediate dose plan verification in RadMonteCarlo

3. Plan evaluation using dose-volume histograms (DVH) and gamma index

4. Post-processing validation using Log Files in ClearCalc and RadMonteCarlo.

Since they already used Monte Carlo in their Monaco TPS for advanced techniques like VMAT, Raúl wanted to ensure the algorithm was consistent between Monaco and RadMonteCarlo. The results gave him complete clinical confidence: “We performed comparative physical measurements against RadMonteCarlo using standard gamma criteria for VMAT (3%/3 mm with a 10% threshold). The results were very similar, also above 98%, which gave us the confidence to implement this workflow clinically.”

Log File Analysis Makes the Difference in PSQA

Verifying plans before treatment is one thing, but PSQA allows the clinic to observe what is actually happening during each session delivered to the patient. ClearCalc’s Log File Analysis (LFA) with RadMonteCarlo significantly optimized this workflow, reducing the time needed for these checks. This not only helped them keep up with the workload but also freed up more time for other essential daily tasks of a medical physicist.

Raúl and his colleagues value the importance of PSQA in boosting confidence in the treatments delivered. He states: “Log Files are what truly make a difference in PSQA. We went from physical verification—where we basically just checked if a plan passed—to an approach where we can evaluate fraction by fraction how the treatment is actually being delivered to the patient. In clinical practice, that provides a much higher level of confidence and safety. That is exactly the next step we want to develop at Oncoservice using tools like ChartCheck Adaptive, aiming for an evaluation that is even more representative of the real treatment given to the patient.”

Currently, the team continues to use phantoms for certain advanced cases like SRS or SBRT, while Log File Analysis (LFA) has become the main tool for daily PSQA. For Raúl, the next step is to move toward adaptive tools that integrate daily dose and anatomical information, allowing an even more complete evaluation of the treatment delivered to the patient.

Quality Assurance Improves Traceability and Alignment

Raúl notes that adding Radformation tools allowed his clinic to develop more unified and standardized QA protocols. Not only did ClearCalc and RadMonteCarlo strengthen PSQA, but AutoContour significantly reduced manual contouring time, and ClearCheck reinforced clinical plan review and auditing. Additionally, RadMachine expanded QA capabilities across radiotherapy, diagnostic radiology, and nuclear medicine. Together, these tools have improved the traceability and standardization of processes for both treatment plans and equipment, which is especially important for regulatory bodies.

Raúl encourages clinics that fear these technologies will add complexity to their workflows to see them instead as a way to relieve manual tasks and optimize daily work. Regarding Radformation's tools, he comments: “Sometimes people think you need a huge infrastructure or a large staff to implement them, but they actually end up being very practical solutions for problems that many centers face every day. In the end, it’s not about having more tools, but about working with more control and more confidence in every treatment you deliver.”

About Raúl

When he is not at the clinic, Raúl likes to relax at home with his two cats, Tom and Kiara. He enjoys making and sharing a good cup of coffee while catching up with his parents, who live outside of Bolivia. Raúl loves trying new things for the experience, like visiting new places and trying his hand at painting. One of his favorite vacation destinations is the Caribbean Sea, where he can enjoy the beaches of Venezuela and some traditional arepas with grated cheese and butter.