Cargando…

Clinical commissioning of an adaptive radiotherapy platform: Results and recommendations

Online adaptive radiotherapy platforms present a unique challenge for commissioning as guidance is lacking and specialized adaptive equipment, such as deformable phantoms, are rare. We designed a novel adaptive commissioning process consisting of end‐to‐end tests using standard clinical resources. T...

Descripción completa

Detalles Bibliográficos
Autores principales: Kisling, Kelly, Keiper, Timothy D., Branco, Daniela, Kim, Grace Gwe‐Ya, Moore, Kevin L, Ray, Xenia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9797177/
https://www.ncbi.nlm.nih.gov/pubmed/36316805
http://dx.doi.org/10.1002/acm2.13801
_version_ 1784860640140066816
author Kisling, Kelly
Keiper, Timothy D.
Branco, Daniela
Kim, Grace Gwe‐Ya
Moore, Kevin L
Ray, Xenia
author_facet Kisling, Kelly
Keiper, Timothy D.
Branco, Daniela
Kim, Grace Gwe‐Ya
Moore, Kevin L
Ray, Xenia
author_sort Kisling, Kelly
collection PubMed
description Online adaptive radiotherapy platforms present a unique challenge for commissioning as guidance is lacking and specialized adaptive equipment, such as deformable phantoms, are rare. We designed a novel adaptive commissioning process consisting of end‐to‐end tests using standard clinical resources. These tests were designed to simulate anatomical changes regularly observed at patient treatments. The test results will inform users of the magnitude of uncertainty from on‐treatment changes during the adaptive workflow and the limitations of their systems. We implemented these tests for the cone‐beam computed tomography (CT)‐based Varian Ethos online adaptive platform. Many adaptive platforms perform online dose calculation on a synthetic CT (synCT). To assess the impact of the synCT generation and online dose calculation on dosimetric accuracy, we conducted end‐to‐end tests using commonly available equipment: a CIRS IMRT Thorax phantom, PinPoint ionization chamber, Gafchromic film, and bolus. Four clinical scenarios were evaluated: weight gain and weight loss were simulated by adding and removing bolus, internal target shifts were simulated by editing the CTV during the adaptive workflow to displace it, and changes in gas were simulated by removing and reinserting rods in varying phantom locations. The effect of overriding gas pockets during planning was also assessed. All point dose measurements agreed within 2.7% of the calculated dose, with one exception: a scenario simulating gas present in the planning CT, not overridden during planning, and dissipating at treatment. Relative film measurements passed gamma analysis (3%/3 mm criteria) for all scenarios. Our process validated the Ethos dose calculation for online adapted treatment plans. Based on our results, we made several recommendations for our clinical adaptive workflow. This commissioning process used commonly available equipment and, therefore, can be applied in other clinics for their respective online adaptive platforms.
format Online
Article
Text
id pubmed-9797177
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-97971772022-12-30 Clinical commissioning of an adaptive radiotherapy platform: Results and recommendations Kisling, Kelly Keiper, Timothy D. Branco, Daniela Kim, Grace Gwe‐Ya Moore, Kevin L Ray, Xenia J Appl Clin Med Phys Radiation Oncology Physics Online adaptive radiotherapy platforms present a unique challenge for commissioning as guidance is lacking and specialized adaptive equipment, such as deformable phantoms, are rare. We designed a novel adaptive commissioning process consisting of end‐to‐end tests using standard clinical resources. These tests were designed to simulate anatomical changes regularly observed at patient treatments. The test results will inform users of the magnitude of uncertainty from on‐treatment changes during the adaptive workflow and the limitations of their systems. We implemented these tests for the cone‐beam computed tomography (CT)‐based Varian Ethos online adaptive platform. Many adaptive platforms perform online dose calculation on a synthetic CT (synCT). To assess the impact of the synCT generation and online dose calculation on dosimetric accuracy, we conducted end‐to‐end tests using commonly available equipment: a CIRS IMRT Thorax phantom, PinPoint ionization chamber, Gafchromic film, and bolus. Four clinical scenarios were evaluated: weight gain and weight loss were simulated by adding and removing bolus, internal target shifts were simulated by editing the CTV during the adaptive workflow to displace it, and changes in gas were simulated by removing and reinserting rods in varying phantom locations. The effect of overriding gas pockets during planning was also assessed. All point dose measurements agreed within 2.7% of the calculated dose, with one exception: a scenario simulating gas present in the planning CT, not overridden during planning, and dissipating at treatment. Relative film measurements passed gamma analysis (3%/3 mm criteria) for all scenarios. Our process validated the Ethos dose calculation for online adapted treatment plans. Based on our results, we made several recommendations for our clinical adaptive workflow. This commissioning process used commonly available equipment and, therefore, can be applied in other clinics for their respective online adaptive platforms. John Wiley and Sons Inc. 2022-10-31 /pmc/articles/PMC9797177/ /pubmed/36316805 http://dx.doi.org/10.1002/acm2.13801 Text en © 2022 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Radiation Oncology Physics
Kisling, Kelly
Keiper, Timothy D.
Branco, Daniela
Kim, Grace Gwe‐Ya
Moore, Kevin L
Ray, Xenia
Clinical commissioning of an adaptive radiotherapy platform: Results and recommendations
title Clinical commissioning of an adaptive radiotherapy platform: Results and recommendations
title_full Clinical commissioning of an adaptive radiotherapy platform: Results and recommendations
title_fullStr Clinical commissioning of an adaptive radiotherapy platform: Results and recommendations
title_full_unstemmed Clinical commissioning of an adaptive radiotherapy platform: Results and recommendations
title_short Clinical commissioning of an adaptive radiotherapy platform: Results and recommendations
title_sort clinical commissioning of an adaptive radiotherapy platform: results and recommendations
topic Radiation Oncology Physics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9797177/
https://www.ncbi.nlm.nih.gov/pubmed/36316805
http://dx.doi.org/10.1002/acm2.13801
work_keys_str_mv AT kislingkelly clinicalcommissioningofanadaptiveradiotherapyplatformresultsandrecommendations
AT keipertimothyd clinicalcommissioningofanadaptiveradiotherapyplatformresultsandrecommendations
AT brancodaniela clinicalcommissioningofanadaptiveradiotherapyplatformresultsandrecommendations
AT kimgracegweya clinicalcommissioningofanadaptiveradiotherapyplatformresultsandrecommendations
AT moorekevinl clinicalcommissioningofanadaptiveradiotherapyplatformresultsandrecommendations
AT rayxenia clinicalcommissioningofanadaptiveradiotherapyplatformresultsandrecommendations