Assessment of efficacy in automated plan generation for Varian Ethos intelligent optimization engine

Pokharel, Shyam; Pacheco, Abilio; Tanner, Suzanne M.

doi:10.1002/acm2.13539

Cited by 29 publications

(31 citation statements)

References 36 publications

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“…With oART, clinical teams now have the ability to create custom radiation therapy plans based on the patient's daily anatomy, rather than the patient's anatomy from treatment simulation images, which may have been acquired days or weeks before treatment commencement 3 . While this new treatment delivery approach offers the potential to reduce the dose to healthy tissues, improve target localization, and increase tumor control, the technical, administrative, and implementation challenges associated with oART are significant 3,15–17 …”

Section: Introductionmentioning

confidence: 99%

A roadmap for implementation of kV‐CBCT online adaptive radiation therapy and initial first year experiences

Stanley

Harms

Pogue

et al. 2023

J Applied Clin Med Phys

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Purpose: Online Adaptive Radiation Therapy (oART) follows a different treatment paradigm than conventional radiotherapy, and because of this, the resources, implementation, and workflows needed are unique. The purpose of this report is to outline our institution's experience establishing, organizing, and implementing an oART program using the Ethos therapy system. Methods: We include resources used, operational models utilized, program creation timelines, and our institutional experiences with the implementation and operation of an oART program. Additionally, we provide a detailed summary of our first year's clinical experience where we delivered over 1000 daily adaptive fractions. For all treatments, the different stages of online adaption, primary patient set-up, initial kV-CBCT acquisition, contouring review and edit of influencer structures, target review and edits, plan evaluation and selection, Mobius3D 2nd check and adaptive QA, 2nd kV-CBCT for positional verification, treatment delivery, and patient leaving the room, were analyzed. Results: We retrospectively analyzed data from 97 patients treated from August 2021-August 2022. One thousand six hundred seventy seven individual fractions were treated and analyzed, 632(38%) were non-adaptive and 1045(62%) were adaptive. Seventy four of the 97 patients (76%) were treated with standard fractionation and 23 (24%) received stereotactic treatments. For the adaptive treatments, the generated adaptive plan was selected in 92% of treatments. On average(±std),adaptive sessions took 34.52 ± 11.42 min from start to finish.The entire adaptive process (from start of contour generation to verification CBCT), performed by the physicist (and physician on select days),was 19.84 ± 8.21 min. Conclusion:We present our institution's experience commissioning an oART program using the Ethos therapy system. It took us 12 months from project inception to the treatment of our first patient and 12 months to treat 1000 adaptive fractions. Retrospective analysis of delivered fractions showed that the average overall treatment time was approximately 35 min and the average time for the adaptive component of treatment was approximately 20 min.

show abstract

Section: Introductionmentioning

confidence: 99%

A roadmap for implementation of kV‐CBCT online adaptive radiation therapy and initial first year experiences

Stanley

Harms

Pogue

et al. 2023

J Applied Clin Med Phys

View full text Add to dashboard Cite

show abstract

“…[5,[7][8][9][10][11][12][13][14] With oART, clinical teams now have the ability to create custom radiation therapy plans based on the patient's daily anatomy, rather than the patient's anatomy from treatment simulation images, which may have been days or weeks before treatment commencement [3]. While this new treatment delivery approach offers the potential to reduce the dose to healthy tissues, improve target localization, and increase tumor control, the technical, administrative, and implementation challenges associated with oART are significant [3,[15][16][17].…”

Section: Introductionmentioning

confidence: 99%

A roadmap for implementation of kV-CBCT online adaptive radiation therapy and initial first year experiences

Stanley

Harms

Pogue

et al. 2022

Preprint

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Purpose: Online Adaptive Radiation Therapy(oART) follows a different treatment paradigm than conventional radiotherapy and, because of this, the resources, implementation, and workflows needed are unique. The purpose of this report is to outline our institution's experience establishing, organizing, and implementing an oART program using the Ethos therapy system. Methods: We include resources used; operational models utilized, program creation timelines, and our institutional experiences with implementation and operation of an oART program. Additionally, we provide a detailed summary of our first year's clinical experience where we delivered over 1000 daily adaptive fractions. For all treatments, the different stages of online adaption, primary patient set-up, initial kV-CBCT acquisition, contouring review and edit of influencer structures, target review and edits, plan evaluation and selection, Mobius3D 2nd check and adaptive QA, 2nd kV-CBCT for positional verification, treatment delivery, and patient leaving the room, were analyzed. Results: We retrospectively analyzed data from ninety-seven patients treated from August 2021-August 2022. 1677 individual fractions were treated and analyzed, 632(38%) were non-adaptive and 1045(62%) were adaptive. 74 of the 97 patients (76%) were treated with standard fractionation and 23 (24%) received stereotactic treatments. For the adaptive treatments, the generated adaptive plan was selected in 92% of treatments. On average(±std), adaptive sessions took 34.52±11.42 minutes from start to finish. The entire adaptive process (from start of contour generation to verification CBCT), performed by the physicist (and physician on select days), was 19.84±8.21 minutes. Conclusion: We present our institution's experience establishing, organizing, and implementing an oART program using the Ethos therapy system. It took us 12 months from project inception to treatment of our first patient and 12 months to treat 1000 adaptive fractions. Retrospective analysis of delivered fractions showed that average overall treatment time was approximately 35 minutes and average time for the adaptive component of treatment was approximately 20 minutes.

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“…Recently, a novel ring gantry computed tomography (CT) based radiotherapy machine has been developed with a high-quality cone-beam CT capable of yielding high resolution on-board volumetric images and an artificial intelligence (AI) enhanced treatment planning system (TPS), which is capable of daily adaptive planning (ETHOS, Varian Medical Systems, Palo Alto, CA) [ 17 – 19 ]. The use of cone beam CT-guided adaptive radiotherapy for the clinical ablation of pancreatic cancer has not yet been described.…”

Section: Introductionmentioning

confidence: 99%

The first reported case of a patient with pancreatic cancer treated with cone beam computed tomography-guided stereotactic adaptive radiotherapy (CT-STAR)

et al. 2022

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Background Online adaptive stereotactic radiotherapy allows for improved target and organ at risk (OAR) delineation and inter-fraction motion management via daily adaptive planning. The use of adaptive SBRT for the treatment of pancreatic cancer (performed until now using only MRI or CT on rails-guided adaptive radiotherapy), has yielded promising outcomes. Herein we describe the first reported case of cone beam CT-guided stereotactic adaptive radiotherapy (CT-STAR) for the treatment of pancreatic cancer. Case presentation A 61-year-old female with metastatic pancreatic cancer presented for durable palliation of a symptomatic primary pancreatic mass. She was prescribed 35 Gy/5 fractions utilizing CT-STAR. The patient was simulated utilizing an end-exhale CT with intravenous and oral bowel contrast. Both initial as well as daily adapted plans were created adhering to a strict isotoxicity approach in which coverage was sacrificed to meet critical luminal gastrointestinal OAR hard constraints. Kilovoltage cone beam CTs were acquired on each day of treatment and the radiation oncologist edited OAR contours to reflect the patient’s anatomy-of-the-day. The initial and adapted plan were compared using dose volume histogram objectives, and the superior plan was delivered. Use of the initial treatment plan would have resulted in nine critical OAR hard constraint violations. The adapted plans achieved hard constraints in all five fractions for all four critical luminal gastrointestinal structures. Conclusions We report the successful treatment of a patient with pancreatic cancer treated with CT-STAR. Prior to this treatment, the delivery of ablative adaptive radiotherapy for pancreatic cancer was limited to clinics with MR-guided and CT-on-rails adaptive SBRT technology and workflows. CT-STAR is a promising modality with which to deliver stereotactic adaptive radiotherapy for pancreatic cancer.

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Assessment of efficacy in automated plan generation for Varian Ethos intelligent optimization engine

Cited by 29 publications

References 36 publications

A roadmap for implementation of kV‐CBCT online adaptive radiation therapy and initial first year experiences

A roadmap for implementation of kV‐CBCT online adaptive radiation therapy and initial first year experiences

A roadmap for implementation of kV-CBCT online adaptive radiation therapy and initial first year experiences

The first reported case of a patient with pancreatic cancer treated with cone beam computed tomography-guided stereotactic adaptive radiotherapy (CT-STAR)

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