Evaluation of the clinical feasibility of cone-beam computed tomography guided online adaption for simulation-free palliative radiotherapy
Background and purpose: Simulation-free radiotherapy, where diagnostic imaging is used for treatment planning, improves accessibility of radiotherapy for eligible palliative patients. Combining this pathway with online adaptive radiotherapy (oART) may improve accuracy of treatment, expanding the num...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-10-01
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| Series: | Physics and Imaging in Radiation Oncology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405631623000817 |
| _version_ | 1797397543787692032 |
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| author | Alannah Kejda Alexandra Quinn Shelley Wong Toby Lowe Isabelle Fent Maegan Gargett Stephanie Roderick Kylie Grimberg Sarah Bergamin Thomas Eade Jeremy Booth |
| author_facet | Alannah Kejda Alexandra Quinn Shelley Wong Toby Lowe Isabelle Fent Maegan Gargett Stephanie Roderick Kylie Grimberg Sarah Bergamin Thomas Eade Jeremy Booth |
| author_sort | Alannah Kejda |
| collection | DOAJ |
| description | Background and purpose: Simulation-free radiotherapy, where diagnostic imaging is used for treatment planning, improves accessibility of radiotherapy for eligible palliative patients. Combining this pathway with online adaptive radiotherapy (oART) may improve accuracy of treatment, expanding the number of eligible patients. This study evaluated the adaptive process duration, plan dose volume histogram (DVH) metrics and geometric accuracy of a commercial cone-beam computed tomography (CBCT)-guided oART system for simulation-free, palliative radiotherapy. Materials and methods: Ten previously treated palliative cases were used to compare system-generated contours against clinician contours in a test environment with Dice Similarity Coefficient (DSC). Twenty simulation-free palliative patients were treated clinically using CBCT-guided oART. Analysis of oART clinical treatment data included; evaluation of the geometric accuracy of system-generated synthetic CT relative to session CBCT anatomy using a Likert scale, comparison of adaptive plan dose distributions to unadapted, using DVH metrics and recording the duration of key steps in the oART workflow. Results: Auto-generated contours achieved a DSC of higher than 0.85, excluding the stomach which was attributed to CBCT image quality issues. Synthetic CT was locally aligned to CBCT anatomy for approximately 80% of fractions, with the remaining suboptimal yet clinically acceptable. Adaptive plans achieved a median CTV V95% of 99.5%, compared to 95.6% for unadapted. The median overall oART process duration was found to be 13.2 mins, with contour editing being the most time-intensive adaptive step. Conclusions: The CBCT-guided oART system utilising a simulation-free planning approach was found to be sufficiently accurate for clinical implementation, this may further streamline and improve care for palliative patients. |
| first_indexed | 2024-03-09T01:11:34Z |
| format | Article |
| id | doaj.art-57a4641757f14fb18e1ca5500c42ea3f |
| institution | Directory Open Access Journal |
| issn | 2405-6316 |
| language | English |
| last_indexed | 2024-03-09T01:11:34Z |
| publishDate | 2023-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Physics and Imaging in Radiation Oncology |
| spelling | doaj.art-57a4641757f14fb18e1ca5500c42ea3f2023-12-11T04:16:27ZengElsevierPhysics and Imaging in Radiation Oncology2405-63162023-10-0128100490Evaluation of the clinical feasibility of cone-beam computed tomography guided online adaption for simulation-free palliative radiotherapyAlannah Kejda0Alexandra Quinn1Shelley Wong2Toby Lowe3Isabelle Fent4Maegan Gargett5Stephanie Roderick6Kylie Grimberg7Sarah Bergamin8Thomas Eade9Jeremy Booth10Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia; Corresponding author at: Department of Radiation Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia.Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, AustraliaNorthern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, AustraliaNorthern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, AustraliaNorthern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, AustraliaNorthern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, AustraliaNorthern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, AustraliaNorthern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, AustraliaNorthern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, AustraliaNorthern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, AustraliaNorthern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, AustraliaBackground and purpose: Simulation-free radiotherapy, where diagnostic imaging is used for treatment planning, improves accessibility of radiotherapy for eligible palliative patients. Combining this pathway with online adaptive radiotherapy (oART) may improve accuracy of treatment, expanding the number of eligible patients. This study evaluated the adaptive process duration, plan dose volume histogram (DVH) metrics and geometric accuracy of a commercial cone-beam computed tomography (CBCT)-guided oART system for simulation-free, palliative radiotherapy. Materials and methods: Ten previously treated palliative cases were used to compare system-generated contours against clinician contours in a test environment with Dice Similarity Coefficient (DSC). Twenty simulation-free palliative patients were treated clinically using CBCT-guided oART. Analysis of oART clinical treatment data included; evaluation of the geometric accuracy of system-generated synthetic CT relative to session CBCT anatomy using a Likert scale, comparison of adaptive plan dose distributions to unadapted, using DVH metrics and recording the duration of key steps in the oART workflow. Results: Auto-generated contours achieved a DSC of higher than 0.85, excluding the stomach which was attributed to CBCT image quality issues. Synthetic CT was locally aligned to CBCT anatomy for approximately 80% of fractions, with the remaining suboptimal yet clinically acceptable. Adaptive plans achieved a median CTV V95% of 99.5%, compared to 95.6% for unadapted. The median overall oART process duration was found to be 13.2 mins, with contour editing being the most time-intensive adaptive step. Conclusions: The CBCT-guided oART system utilising a simulation-free planning approach was found to be sufficiently accurate for clinical implementation, this may further streamline and improve care for palliative patients.http://www.sciencedirect.com/science/article/pii/S2405631623000817Simulation-free radiotherapyOnline adaptionRadiotherapyPalliative |
| spellingShingle | Alannah Kejda Alexandra Quinn Shelley Wong Toby Lowe Isabelle Fent Maegan Gargett Stephanie Roderick Kylie Grimberg Sarah Bergamin Thomas Eade Jeremy Booth Evaluation of the clinical feasibility of cone-beam computed tomography guided online adaption for simulation-free palliative radiotherapy Physics and Imaging in Radiation Oncology Simulation-free radiotherapy Online adaption Radiotherapy Palliative |
| title | Evaluation of the clinical feasibility of cone-beam computed tomography guided online adaption for simulation-free palliative radiotherapy |
| title_full | Evaluation of the clinical feasibility of cone-beam computed tomography guided online adaption for simulation-free palliative radiotherapy |
| title_fullStr | Evaluation of the clinical feasibility of cone-beam computed tomography guided online adaption for simulation-free palliative radiotherapy |
| title_full_unstemmed | Evaluation of the clinical feasibility of cone-beam computed tomography guided online adaption for simulation-free palliative radiotherapy |
| title_short | Evaluation of the clinical feasibility of cone-beam computed tomography guided online adaption for simulation-free palliative radiotherapy |
| title_sort | evaluation of the clinical feasibility of cone beam computed tomography guided online adaption for simulation free palliative radiotherapy |
| topic | Simulation-free radiotherapy Online adaption Radiotherapy Palliative |
| url | http://www.sciencedirect.com/science/article/pii/S2405631623000817 |
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