“Scan-(pre)Plan-Treat” Workflow for Bone Metastases Using the Ethos Therapy System: A Single-Center, In Silico Experience

PURPOSE: To report on the accuracy of automated delineation, treatment plan quality, and duration of an in-silico “scan-(pre)plan-treat” (SPT) workflow for vertebral bone metastases using a 1 × 8 Gy regimen. METHOD AND MATERIALS: The cloud-based emulator system of the Ethos therapy system was used to adapt an organ-at-risk-sparing preplan created on the diagnostic CT to the anatomy-of-the-day using the cone beam CT made before treatment. RESULTS: SPT using the Ethos emulator system resulted in relatively good coverage of the PTV and acceptable dose to the OAR. Delivery time and plan homogeneity was the best for 7-field IMRT plan template. CONCLUSIONS: A SPT workflow formula results in a highly conformal treatment delivery while maintaining an acceptable timeframe for the patient on the treatment couch.