Partnerships are essential to disaster recovery. U.S. Government and American Indian Nations live on mutual soil and must partner when disasters occur. However, they have a long history of broken promises and lost trust. The government-to-government policy initiated by President Clinton in 1994 was first used in disaster management on a small Sioux reservation in the northern plains of the U.S. The government-to-government policy is demonstrably effective when disaster planning and practices are culturally congruent with Tribal nations' values and lived realities. This paper explicates cultural congruence of the government-to-government policy with the history of the Sioux Tribe and highlights recent improvements in disaster recovery efforts resulting from use of the 1994 policy.

Purpose: Use Sun Nuclear Quality Reports™ with PlanIQ™ to evaluate different treatment delivery techniques for various treatment sites. Methods: Fifteen random patients with different treatment sites were evaluated. These include the Head/Neck, prostate, pelvis, lung, esophagus, axilla, bladder and abdomen. Initially, these sites were planned on the Pinnacle 3 V9.6 treatment planning system and utilized nine 6MV step‐n‐shoot IMRT fields. The RT plan, dose and structure sets were sent to Quality Reports™ where a DVH was recreated and the plans were compared to a unique Plan Algorithm for each treatment site. Each algorithm has its own plan quality metrics and objectives, which include the PTV coverage, PTV maximum dose, the prescription dose outside the target, doses to the critical structures, and the global maximum dose and its location. Each plan was scored base on meeting each objective. Plans may have been reoptimized and reevaluated with Quality Reports™ based on the initial score. PlanIQ™ was used to evaluate if any objective not met was achievable or difficult to obtain. A second plan using VMAT delivery was created for each patient and scored with Quality Reports™. Results: There were a wide range of scores for the different treatment sites with some scoring better for IMRT plans and some better for the VMAT deliveries. The variation in the scores could be attributed to the treatment site, location, and shape of the target. Most deliveries were chosen for the VMAT due to the short treatment times and quick patient throughput with acceptable plan scores. Conclusion: The tools are provided for both physician and dosimetrist to objectively evaluate the use of VMAT delivery versus the step‐n‐shoot IMRT delivery for various sites. PlanIQ validates if objectives can be met. For the physicist, a concise pass/fail report is created for plan evaluation.

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