Multicentre knowledge sharing and planning/dose audit on flattening filter free beams for SBRT lung

Hansen, Christian Rønn; Sykes, J.; Barber, Jeffrey; West, Katrina; Bromley, Regina; Szymura, Kathryn; Fisher, S.; Sim, J.; Bailey, Michael R.; Chrystal, D.; Deshpande, Shrikant; Franji, I.; Nielsen, Troels Halfeld; Brink, Carsten; Thwaites, David

doi:10.1088/1742-6596/573/1/012018

Cited by 9 publications

(9 citation statements)

References 9 publications

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“…In addition, the MRL offers the possibility to evaluate the response observed on MRI of the individual patient could change the future of RT [22]. This of course requires evidence built on randomized trials and cooperation between centres with MRLs [1,23,24]. Due to the limited capacity on the MRL there is also a need for an assessment of which patients will benefit the most from MR image guided treatments [25].…”

Section: Discussionmentioning

confidence: 99%

First clinical experiences with a high field 1.5 T MR linac

et al. 2019

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Purpose: A 1.5 T MR Linac (MRL) has recently become available. MRL treatment workflows (WF) include online plan adaptation based on daily MR images (MRI). This study reports initial clinical experiences after five months of use in terms of patient compliance, cases, WF timings, and dosimetric accuracy. Method and materials: Two different WF were used dependent on the clinical situation of the day; Adapt To Position WF (ATP) where the reference plan position is adjusted rigidly to match the position of the targets and the OARs, and Adapt To Shape WF (ATS), where a new plan is created to match the anatomy of the day, using deformable image registration. Both WFs included three 3D MRI scans for plan adaptation, verification before beam on, and validation during IMRT delivery. Patient compliance and WF timings were recorded. Accuracy in dose delivery was assessed using a cylindrical diode phantom. Results: 19 patients have completed their treatment receiving a total of 176 fractions. Cases vary from prostate treatments (60 Gy/20F) to SBRT treatments of lymph nodes (45 Gy/3F) and castration by ovarian irradiation (15 Gy/3F). The median session time (patient in to patient out) for 127 ATPs was 26[21-78] min, four fractions lasted more than 45 minutes due to additional plan adaptation. For the 49 ATSs a median time of 12[1-24] min was used for contouring resulting in a total median session time of 42[29-91] min. Three SBRT fractions lasted more than an hour. The time on the MRL couch was well tolerated by the patients. The median gamma pass rate (2mm,2% global max) for the adapted plans was 99.2[93.4-100]%, showing good agreement between planned and delivered dose. Conclusion: MRL treatments, including daily MRIs, plan adaptation and accurate dose delivery is possible within a clinically acceptable timeframe and is well tolerated by the patients.

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Section: Discussionmentioning

confidence: 99%

First clinical experiences with a high field 1.5 T MR linac

et al. 2019

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“…Moreover, the constant technological advances in medical equipment over the last decade have caused a rapid change in clinical practice. Clinical audits are essential in the learning and implementation of new technology into clinical use, 2 as results are shared, decreasing occurrence of mistakes and translating into better standards of care nationally. 3 The public inquiry into the high mortality rate following paediatric cardiac surgery at the Bristol Royal Infirmary in 1984–1995 is a well-documented failure in the UK healthcare delivery service; to prevent such catastrophes from occurring again, the Department of Health highlighted the importance of regular clinical audits at the core of a local performance monitoring system.…”

Section: Introductionmentioning

confidence: 99%

Clinical Audit Platform for Students (CAPS): a pilot study

Kumar

Hashmi

Morad

et al. 2020

Postgraduate Medical Journal

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BackgroundA clinical audit measures specific clinical outcomes or processes against a predefined standard. However, many clinicians are unable to carry out audits given their time constraints. Alternatively, medical students may often wish to complete audits early in their career to strengthen their portfolios. As such, the student clinical audit platform was designed to connect willing supervisors and these medical students.MethodsProject supervisors were members of a regional trainee-led network. Interested students were familiarised with the various aspects of an audit and allocated to supervisors with similar interests. There was regular communication to track progress and anonymised feedback forms were distributed to all students and supervisors after a year.ResultsA total of 17 responses were received from the 19 students who were involved in a project. Based on a 5-point Likert scale, students displayed a mean improvement in their understanding of a clinical audit (1.18±1.07, p<0.001), the confidence to approach a supervisor (1.29±1.21, p<0.001) and the ability to conduct an audit by themselves in the future (1.77±1.15, p<0.001). Of the seven affiliated supervisors, five provided feedback with 80% indicating they had projects which remained inactive and all happy with the quality of work produced by their students.ConclusionDespite limitations to this programme, the platform produced projects which were disseminated both locally and nationally, demonstrating positive collaboration between medical students and clinicians. We present our findings and evaluations to encourage similar audit platforms to be adopted at other locations.

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“…Dose coverage across PTV1 and CTV1 were superior for the host configuration treatment plans, however differences were generally not statistically significant. AP Configurations A and C produced superior femoral head coverage, although AP Configuration A produced inferior bladder V 50Gy and V 60Gy (Table A. (Table A. 5). AP Configuration B plans produced superior dose coverage for PTV1imrt (D 95% = 97.5%) and PTV1 (D 99.9% = 69.9 Gy) compared to the host treatment plans (D 95% = 97.1%, D 99.9% = 67.9 Gy), although produced hotter PTVimrt (D 0% = 106.09%, 105.51% respectively).…”

Section: Protocol Bmentioning

confidence: 99%

“…Conventional treatment planning for Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) require many manual processes, with treatment planners iteratively adjusting optimisation goals within a treatment planning system to develop clinically acceptable treatment plans. This process is not only time-consuming, but treatment plan quality is inherently dependent on the individual skill of the planner [1] , [2] , [3] , [4] , [5] . The importance of high-quality treatment planning on clinical outcomes has been demonstrated during clinical trials [6] , [7] , [8] .…”

Section: Introductionmentioning

confidence: 99%

Adapting automated treatment planning configurations across international centres for prostate radiotherapy

Roach

Wortel

Ochoa

et al. 2019

Physics and Imaging in Radiation Oncology

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Background and purpose: Automated configurations are increasingly utilised for radiotherapy treatment planning. This study investigates whether automated treatment planning configurations are adaptable across clinics with different treatment planning protocols for prostate radiotherapy. Material and methods: The study comprised three participating centres, each with pre-existing locally developed prostate AutoPlanning configurations using the Pinnacle 3 ® treatment planning system. Using a three-patient training dataset circulated from each centre, centres modified local prostate configurations to generate protocol compliant treatment plans for the other two centres. Each centre applied modified configurations on validation datasets distributed from each centre (10 patients from 3 centres). Plan quality was assessed through DVH analysis and protocol compliance. Results: All treatment plans were clinically acceptable, based off relevant treatment protocol. Automated planning configurations from Centre's A and B recorded 2 and 18 constraint and high priority deviations respectively. Centre C configurations recorded no high priority deviations. Centre A configurations produced treatment plans with superior dose conformity across all patient PTVs (mean = 1.14) compared with Centre's B and C (mean = 1.24 and 1.22). Dose homogeneity was consistent between all centre's configurations (mean = 0.083, 0.077, and 0.083 respectively). Conclusions: This study demonstrates that automated treatment planning configurations can be shared and implemented across multiple centres with simple adaptations to local protocols.

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Multicentre knowledge sharing and planning/dose audit on flattening filter free beams for SBRT lung

Cited by 9 publications

References 9 publications

First clinical experiences with a high field 1.5 T MR linac

First clinical experiences with a high field 1.5 T MR linac

Clinical Audit Platform for Students (CAPS): a pilot study

Adapting automated treatment planning configurations across international centres for prostate radiotherapy

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