Real-Time Whole-Brain Radiation Therapy

A Single-Institution Experience

Anh H. Le, Strahinja Stojadinovic, Robert Timmerman, Hak Choy, Romona L. Duncan, Steve B. Jiang, Arnold Pompos

Research output: Contribution to journalArticle

Abstract

Purpose: To demonstrate the feasibility of a real-time whole-brain radiation therapy (WBRT) workflow, taking advantage of contemporary radiation therapy capabilities and seeking to optimize clinical workflow for WBRT. Methods and Materials: We developed a method incorporating the linear accelerator's on-board imaging system for patient simulation, used cone-beam computed tomography (CBCT) data for treatment planning, and delivered the first fraction of prescribed therapy, all during the patient's initial appointment. Simulation was performed in the linear accelerator vault. An acquired CBCT data set was used for scripted treatment planning protocol, providing inversely planned, automated treatment plan generation. The osseous boundaries of the brain were auto-contoured to create a target volume. Two parallel-opposed beams using field-in-field intensity modulate radiation therapy covered this target to the user-defined inferior level (C1 or C2). The method was commissioned using an anthropomorphic head phantom and verified using 100 clinically treated patients. Results: Whole-brain target heterogeneity was within 95%-107% of the prescription dose, and target coverage compared favorably to standard, manually created 3-dimensional plans. For the commissioning CBCT datasets, the secondary monitor unit verification and independent 3-dimensional dose distribution comparison for computed and delivered doses were within 2% agreement relative to the scripted auto-plans. On average, time needed to complete the entire process was 35.1 ± 10.3 minutes from CBCT start to last beam delivered. Conclusions: The real-time WBRT workflow using integrated on-site imaging, planning, quality assurance, and delivery was tested and deemed clinically feasible. The design necessitates a synchronized team consisting of physician, physicist, dosimetrist, and therapists. This work serves as a proof of concept of real-time planning and delivery for other treatment sites.

Original languageEnglish (US)
JournalInternational Journal of Radiation Oncology Biology Physics
DOIs
StateAccepted/In press - Jan 1 2018

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Cone-Beam Computed Tomography
brain
radiation therapy
Radiotherapy
Workflow
planning
cones
Brain
tomography
Particle Accelerators
linear accelerators
dosage
Patient Simulation
delivery
Therapeutics
Clinical Protocols
physicians
assurance
Prescriptions
Appointments and Schedules

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

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title = "Real-Time Whole-Brain Radiation Therapy: A Single-Institution Experience",
abstract = "Purpose: To demonstrate the feasibility of a real-time whole-brain radiation therapy (WBRT) workflow, taking advantage of contemporary radiation therapy capabilities and seeking to optimize clinical workflow for WBRT. Methods and Materials: We developed a method incorporating the linear accelerator's on-board imaging system for patient simulation, used cone-beam computed tomography (CBCT) data for treatment planning, and delivered the first fraction of prescribed therapy, all during the patient's initial appointment. Simulation was performed in the linear accelerator vault. An acquired CBCT data set was used for scripted treatment planning protocol, providing inversely planned, automated treatment plan generation. The osseous boundaries of the brain were auto-contoured to create a target volume. Two parallel-opposed beams using field-in-field intensity modulate radiation therapy covered this target to the user-defined inferior level (C1 or C2). The method was commissioned using an anthropomorphic head phantom and verified using 100 clinically treated patients. Results: Whole-brain target heterogeneity was within 95{\%}-107{\%} of the prescription dose, and target coverage compared favorably to standard, manually created 3-dimensional plans. For the commissioning CBCT datasets, the secondary monitor unit verification and independent 3-dimensional dose distribution comparison for computed and delivered doses were within 2{\%} agreement relative to the scripted auto-plans. On average, time needed to complete the entire process was 35.1 ± 10.3 minutes from CBCT start to last beam delivered. Conclusions: The real-time WBRT workflow using integrated on-site imaging, planning, quality assurance, and delivery was tested and deemed clinically feasible. The design necessitates a synchronized team consisting of physician, physicist, dosimetrist, and therapists. This work serves as a proof of concept of real-time planning and delivery for other treatment sites.",
author = "Le, {Anh H.} and Strahinja Stojadinovic and Robert Timmerman and Hak Choy and Duncan, {Romona L.} and Jiang, {Steve B.} and Arnold Pompos",
year = "2018",
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AU - Le, Anh H.

AU - Stojadinovic, Strahinja

AU - Timmerman, Robert

AU - Choy, Hak

AU - Duncan, Romona L.

AU - Jiang, Steve B.

AU - Pompos, Arnold

PY - 2018/1/1

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N2 - Purpose: To demonstrate the feasibility of a real-time whole-brain radiation therapy (WBRT) workflow, taking advantage of contemporary radiation therapy capabilities and seeking to optimize clinical workflow for WBRT. Methods and Materials: We developed a method incorporating the linear accelerator's on-board imaging system for patient simulation, used cone-beam computed tomography (CBCT) data for treatment planning, and delivered the first fraction of prescribed therapy, all during the patient's initial appointment. Simulation was performed in the linear accelerator vault. An acquired CBCT data set was used for scripted treatment planning protocol, providing inversely planned, automated treatment plan generation. The osseous boundaries of the brain were auto-contoured to create a target volume. Two parallel-opposed beams using field-in-field intensity modulate radiation therapy covered this target to the user-defined inferior level (C1 or C2). The method was commissioned using an anthropomorphic head phantom and verified using 100 clinically treated patients. Results: Whole-brain target heterogeneity was within 95%-107% of the prescription dose, and target coverage compared favorably to standard, manually created 3-dimensional plans. For the commissioning CBCT datasets, the secondary monitor unit verification and independent 3-dimensional dose distribution comparison for computed and delivered doses were within 2% agreement relative to the scripted auto-plans. On average, time needed to complete the entire process was 35.1 ± 10.3 minutes from CBCT start to last beam delivered. Conclusions: The real-time WBRT workflow using integrated on-site imaging, planning, quality assurance, and delivery was tested and deemed clinically feasible. The design necessitates a synchronized team consisting of physician, physicist, dosimetrist, and therapists. This work serves as a proof of concept of real-time planning and delivery for other treatment sites.

AB - Purpose: To demonstrate the feasibility of a real-time whole-brain radiation therapy (WBRT) workflow, taking advantage of contemporary radiation therapy capabilities and seeking to optimize clinical workflow for WBRT. Methods and Materials: We developed a method incorporating the linear accelerator's on-board imaging system for patient simulation, used cone-beam computed tomography (CBCT) data for treatment planning, and delivered the first fraction of prescribed therapy, all during the patient's initial appointment. Simulation was performed in the linear accelerator vault. An acquired CBCT data set was used for scripted treatment planning protocol, providing inversely planned, automated treatment plan generation. The osseous boundaries of the brain were auto-contoured to create a target volume. Two parallel-opposed beams using field-in-field intensity modulate radiation therapy covered this target to the user-defined inferior level (C1 or C2). The method was commissioned using an anthropomorphic head phantom and verified using 100 clinically treated patients. Results: Whole-brain target heterogeneity was within 95%-107% of the prescription dose, and target coverage compared favorably to standard, manually created 3-dimensional plans. For the commissioning CBCT datasets, the secondary monitor unit verification and independent 3-dimensional dose distribution comparison for computed and delivered doses were within 2% agreement relative to the scripted auto-plans. On average, time needed to complete the entire process was 35.1 ± 10.3 minutes from CBCT start to last beam delivered. Conclusions: The real-time WBRT workflow using integrated on-site imaging, planning, quality assurance, and delivery was tested and deemed clinically feasible. The design necessitates a synchronized team consisting of physician, physicist, dosimetrist, and therapists. This work serves as a proof of concept of real-time planning and delivery for other treatment sites.

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