An automatic dose verification system for adaptive radiotherapy for helical tomotherapy

Mo, X. H.; Chen, Mingli; Parnell, D.; Olivera, G.; Galmarini, D.; Lu, Weiguo

doi:10.1088/1742-6596/489/1/012075

Cited by 2 publications

(3 citation statements)

References 6 publications

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“…These software systems have been designed with the aim to streamline the ART workflow and reduce the need for human intervention, by executing automated dose calculations on new CBCT‐based imaging. New contours are derived either through the propagation of planning volumes using DIR, 93 , 94 , 95 , 96 automated delineation, 97 or by a combination of both. 98 In the next phase, dose‐volume histograms (DVH) are calculated on the new contours.…”

Section: Pitfalls For Clinical Implementationmentioning

confidence: 99%

Adaptive radiotherapy for head and neck cancer: Pitfalls and possibilities from the radiation oncologist's point of view

Nuyts,

Bollen,

Eisbruch

et al. 2024

Cancer Medicine

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BackgroundPatients with head and neck cancer (HNC) may experience substantial anatomical changes during the course of radiotherapy treatment. The implementation of adaptive radiotherapy (ART) proves effective in managing the consequent impact on the planned dose distribution.MethodsThis narrative literature review comprehensively discusses the diverse strategies of ART in HNC and the documented dosimetric and clinical advantages associated with these approaches, while also addressing the current challenges for integration of ART into clinical practice.Results and ConclusionAlthough based on mainly non‐randomized and retrospective trials, there is accumulating evidence that ART has the potential to reduce toxicity and improve quality of life and tumor control in HNC patients treated with RT. However, several questions remain regarding accurate patient selection, the ideal frequency and timing of replanning, and the appropriate way for image registration and dose calculation. Well‐designed randomized prospective trials, with a predetermined protocol for both image registration and dose summation, are urgently needed to further investigate the dosimetric and clinical benefits of ART.

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Section: Pitfalls For Clinical Implementationmentioning

confidence: 99%

Adaptive radiotherapy for head and neck cancer: Pitfalls and possibilities from the radiation oncologist's point of view

Nuyts,

Bollen,

Eisbruch

et al. 2024

Cancer Medicine

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“…The automatic platform for adaptive therapy developed by 21 st Century Oncology (Madison,WI) [16] was used to monitor the delivered dose using daily setup Megavoltage CT images (MVCT) acquired from the Tomotherapy units installed in the Cliniques Universitaires Saint-Luc, Brussels, Belgium. Figure 1 illustrates the process to automatically flag the candidate patients for ART.…”

Section: Automatic Decision Support Software For Artmentioning

confidence: 99%

“…In the last few years, several companies have launched commercial software that automatically perform the dose calculation in the new image and generate new contours. The new contours are obtained either by propagating the planning volumes using deformable image registration, [13][14][15][16][17] by using automatic (e.g. atlas-based or machine learning) segmentation models on the new image, 18 or by a combination of both.…”

Section: Introductionmentioning

confidence: 99%

Dosimetrically triggered adaptive radiotherapy for head and neck cancer: Considerations for the implementation of clinical protocols

Montero¹,

Ooteghem

Dumont

et al. 2023

J Applied Clin Med Phys

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PurposeDefining dosimetric rules to automatically detect patients requiring adaptive radiotherapy (ART) is not straightforward, and most centres perform ad‐hoc ART with no specific protocol. This study aims to propose and analyse different steps to design a protocol for dosimetrically triggered ART of head and neck (H&N) cancer. As a proof‐of‐concept, the designed protocol was applied to patients treated in TomoTherapy units, using their available software for daily MVCT image and dose accumulation.MethodsAn initial protocol was designed by a multidisciplinary team, with a set of flagging criteria based only on dose‐volume metrics, including two action levels: (1) surveillance (orange flag), and (2) immediate verification (red flag). This protocol was adapted to the clinical needs following an iterative process. First, the protocol was applied to 38 H&N patients with daily imaging. Automatic software generated the daily contours, recomputed the daily dose and flagged the dosimetric differences with respect to the planning dose. Second, these results were compared, by a sensitivity/specificity test, to the answers of a physician. Third, the physician, supported by the multidisciplinary team, performed a self‐analysis of the provided answers and translated them into mathematical rules in order to upgrade the protocol.The upgraded protocol was applied to different definitions of the target volume (i.e. deformed CTV + 0, 2 and 4 mm), in order to quantify how the number of flags decreases when reducing the CTV‐to‐PTV margin.ResultsThe sensitivity of the initial protocol was very low, specifically for the orange flags. The best values were 0.84 for red and 0.15 for orange flags. After the review and upgrade process, the sensitivity of the upgraded protocol increased to 0.96 for red and 0.84 for orange flags.The number of patients flagged per week with the final (upgraded) protocol decreased in median by 26% and 18% for red and orange flags, respectively, when reducing the CTV‐to‐PTV margin from 4 to 2 mm. This resulted in only one patient flagged at the last fraction for both red and orange flags.ConclusionOur results demonstrate the value of iterative protocol design with retrospective data, and shows the feasibility of automatically‐triggered ART using simple dosimetric rules to mimic the physician's decisions. Using a proper target volume definition is important and influences the flagging rate, particularly when decreasing the CTV‐to‐PTV margin.

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An automatic dose verification system for adaptive radiotherapy for helical tomotherapy

Cited by 2 publications

References 6 publications

Adaptive radiotherapy for head and neck cancer: Pitfalls and possibilities from the radiation oncologist's point of view

Adaptive radiotherapy for head and neck cancer: Pitfalls and possibilities from the radiation oncologist's point of view

Dosimetrically triggered adaptive radiotherapy for head and neck cancer: Considerations for the implementation of clinical protocols

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