Clinical workflow of cone beam computer tomography-based daily online adaptive radiotherapy with offline magnetic resonance guidance

• Verfasst von: Kim, Ji-Young [VerfasserIn]
• Verfasst von: Tawk, Bouchra [VerfasserIn]
• Verfasst von: Knoll, Maximilian [VerfasserIn]
• Verfasst von: Hoegen-Saßmannshausen, Philipp [VerfasserIn]
• Verfasst von: Liermann, Jakob [VerfasserIn]
• Verfasst von: Huber, Peter E. [VerfasserIn]
• Verfasst von: Lifferth, Mona [VerfasserIn]
• Verfasst von: Lang, Clemens [VerfasserIn]
• Verfasst von: Häring, Peter [VerfasserIn]
• Verfasst von: Gnirs, Regula [VerfasserIn]
• Verfasst von: Jäkel, Oliver [VerfasserIn]
• Verfasst von: Schlemmer, Heinz-Peter [VerfasserIn]
• Verfasst von: Debus, Jürgen [VerfasserIn]
• Verfasst von: Hörner-Rieber, Juliane [VerfasserIn]
• Verfasst von: Weykamp, Fabian [VerfasserIn]
• Titel: Clinical workflow of cone beam computer tomography-based daily online adaptive radiotherapy with offline magnetic resonance guidance
• Titelzusatz: the Modular Adaptive Radiotherapy System (MARS)
• Verf.angabe: Ji-Young Kim, Bouchra Tawk, Maximilian Knoll, Philipp Hoegen-Saßmannshausen, Jakob Liermann, Peter E. Huber, Mona Lifferth, Clemens Lang, Peter Häring, Regula Gnirs, Oliver Jäkel, Heinz-Peter Schlemmer, Jürgen Debus, Juliane Hörner-Rieber and Fabian Weykamp
• E-Jahr: 2024
• Jahr: 19 March 2024
• Umfang: 14 S.
• Illustrationen: Illustrationen
• Fussnoten: Gesehen am 16.08.2024
• Titel Quelle: Enthalten in: Cancers
• Ort Quelle: Basel : MDPI, 2009
• Jahr Quelle: 2024
• Band/Heft Quelle: 16(2024), 6, Artikel-ID 1210, Seite 1-14
• ISSN Quelle: 2072-6694
• DOI: doi:10.3390/cancers16061210
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Ethos
• Sach-SW: MR-guided radiotherapy
• Sach-SW: online adaptive radiotherapy
• K10plus-PPN: 1898869162

Abstract

Purpose: The Ethos (Varian Medical Systems) radiotherapy device combines semi-automated anatomy detection and plan generation for cone beam computer tomography (CBCT)-based daily online adaptive radiotherapy (oART). However, CBCT offers less soft tissue contrast than magnetic resonance imaging (MRI). This work aims to present the clinical workflow of CBCT-based oART with shuttle-based offline MR guidance. Methods: From February to November 2023, 31 patients underwent radiotherapy on the Ethos (Varian, Palo Alto, CA, USA) system with machine learning (ML)-supported daily oART. Moreover, patients received weekly MRI in treatment position, which was utilized for daily plan adaptation, via a shuttle-based system. Initial and adapted treatment plans were generated using the Ethos treatment planning system. Patient clinical data, fractional session times (MRI + shuttle transport + positioning, adaptation, QA, RT delivery) and plan selection were assessed for all fractions in all patients. Results: In total, 737 oART fractions were applied and 118 MRIs for offline MR guidance were acquired. Primary sites of tumors were prostate (n = 16), lung (n = 7), cervix (n = 5), bladder (n = 1) and endometrium (n = 2). The treatment was completed in all patients. The median MRI acquisition time including shuttle transport and positioning to initiation of the Ethos adaptive session was 53.6 min (IQR 46.5-63.4). The median total treatment time without MRI was 30.7 min (IQR 24.7-39.2). Separately, median adaptation, plan QA and RT times were 24.3 min (IQR 18.6-32.2), 0.4 min (IQR 0.3-1,0) and 5.3 min (IQR 4.5-6.7), respectively. The adapted plan was chosen over the scheduled plan in 97.7% of cases. Conclusion: This study describes the first workflow to date of a CBCT-based oART combined with a shuttle-based offline approach for MR guidance. The oART duration times reported resemble the range shown by previous publications for first clinical experiences with the Ethos system.