radiation-planning-assistant-streamlined-fully-automated-radiotherapy

Radiation Planning Assistant - A Streamlined, Fully Automated Radiotherapy Treatment Planning System

The Radiation Planning Assistant (RPA) is a system developed for the fully automated creation of radiotherapy treatment plans, including volume-modulated ...

University of Texas MD Anderson Cancer Center

We have designed a method for immobilizing the subjects of small-animal studies using a study group-specific 3D-printed immobilizer that significantly reduces interfraction rotational variation. A cone-beam CT scan acquired from a single specimen in a study group was used to create a 3D-printed immobilizer that can be used for all specimens in the same study group. 3D printing allows for the incorporation of study-specific features into the immobilizer design, including geometries suitable for use in MR and CT scanners, holders for fiducial markers, and anesthesia nose cones of various sizes. Using metrics of rotational setup variations, we compared the current setup in our small-animal irradiation system, a half-pipe bed, with the 3D-printed device. We also assessed translational displacement within the immobilizer. The printed design significantly reduced setup variation, with average reductions in rotational displacement of 76% ± 3% (1.57 to 0.37°) in pitch, 78% ± 3% (1.85 to 0.41°) in yaw, and 87% ± 3% (5.39 to 0.70°) in roll. Translational displacement within the printed immobilizer was less than 1.5 ± 0.3 mm. This method of immobilization allows for repeatable setup when using MR or CT scans for the purpose of radiotherapy, streamlines the workflow, and places little burden on the study subjects.

3D-Printed Small-Animal Immobilizer for Use in Preclinical Radiotherapy.

Radiotherapy in a seated position may be indicated for patients who are unable to lie on the treatment couch for the duration of treatment, in scenarios where a seated treatment position provides superior anatomical positioning and dose distributions, or for a low-cost system designed using a fixed treatment beam and rotating seated patient. In this study, we report a novel treatment chair that was constructed to allow for three-dimensional imaging and treatment delivery while ensuring robust immobilization, providing reproducibility equivalent to that in the traditional supine position. Five patients undergoing radiation treatment for head-and-neck cancers were enrolled and were setup in the chair, with immobilization devices created, and then imaged with orthogonal X-rays in a scenario that mimicked radiation treatments (without treatment delivery). Six subregions of the acquired images were rigidly registered to evaluate intra- and interfraction displacement and chair construction. Displacements under conditions of simulated image guidance were acquired by first registering one subregion; the residual displacement of other subregions was then measured. Additionally, we administered a patient questionnaire to gain patient feedback and assess comparison to the supine position. Average inter- and intrafraction displacements of all subregions in the seated position were less than 2 and 3 mm, respectively. When image guidance was simulated, L-R and A-P interfraction displacements were reduced by an average of 1 mm, providing setup of comparable quality to supine setups. The enrolled patients, who had no indication for a seated treatment position, reported no preference in the seated or the supine position. The novel chair design provides acceptable inter- and intrafraction displacement, with reproducibility equivalent to that reported for patients in the supine position. Patient feedback will be incorporated in the refinement of the chair, facilitating treatment of head-and-neck cancer in patients who are unable to lie for the duration of treatment or for use in an economical fixed-beam setup.

Reproducibility of patient setup in the seated treatment position: A novel treatment chair design.

To investigate the inter- and intra-fraction motion associated with the use of a low-cost tape immobilization technique as an alternative to thermoplastic immobilization masks for whole-brain treatments. The results of this study may be of interest to clinical staff with severely limited resources (e.g., in low-income countries) and also when treating patients who cannot tolerate standard immobilization masks. Setup reproducibility of eight healthy volunteers was assessed for two different immobilization techniques. (a) One strip of tape was placed across the volunteer's forehead and attached to the sides of the treatment table. (b) A second strip was added to the first, under the chin, and secured to the table above the volunteer's head. After initial positioning, anterior and lateral photographs were acquired. Volunteers were positioned five times with each technique to allow calculation of inter-fraction reproducibility measurements. To estimate intra-fraction reproducibility, 5-minute anterior and lateral videos were taken for each technique per volunteer. An in-house software was used to analyze the photos and videos to assess setup reproducibility. The maximum intra-fraction displacement for all volunteers was 2.8 mm. Intra-fraction motion increased with time on table. The maximum inter-fraction range of positions for all volunteers was 5.4 mm. The magnitude of inter-fraction and intra-fraction motion found using the "1-strip" and "2-strip" tape immobilization techniques was comparable to motion restrictions provided by a thermoplastic mask for whole-brain radiotherapy. The results suggest that tape-based immobilization techniques represent an economical and useful alternative to the thermoplastic mask.

Cost-effective immobilization for whole brain radiation therapy.

More than 6,500 megavoltage teletherapy units are needed worldwide, many in low-resource settings. Cobalt-60 units or linear accelerators (linacs) can fill this need. We have evaluated machine performance on the basis of patient throughput to provide insight into machine viability under various conditions in such a way that conclusions can be generalized to a vast array of clinical scenarios.

Model for Estimating Power and Downtime Effects on Teletherapy Units in Low-Resource Settings.

Automating and standardizing the contouring of clinical target volumes (CTVs) can reduce interphysician variability, which is one of the largest sources of uncertainty in head and neck radiation therapy. In addition to using uniform margin expansions to auto-delineate high-risk CTVs, very little work has been performed to provide patient- and disease-specific high-risk CTVs. The aim of the present study was to develop a deep neural network for the auto-delineation of high-risk CTVs.

Deep Learning Algorithm for Auto-Delineation of High-Risk Oropharyngeal Clinical Target Volumes With Built-In Dice Similarity Coefficient Parameter Optimization Function.

Article	Year
3D-Printed Small-Animal Immobilizer for Use in Preclinical Radiotherapy. Journal of the American Association for Laboratory Animal Science : JAALAS\| PubMed ID: 26424253	2015
Reproducibility of patient setup in the seated treatment position: A novel treatment chair design. Journal of applied clinical medical physics\| PubMed ID: 28291911	2017
Cost-effective immobilization for whole brain radiation therapy. Journal of applied clinical medical physics\| PubMed ID: 28585732	2017
Model for Estimating Power and Downtime Effects on Teletherapy Units in Low-Resource Settings. Journal of global oncology\| PubMed ID: 29094096	2017
Deep Learning Algorithm for Auto-Delineation of High-Risk Oropharyngeal Clinical Target Volumes With Built-In Dice Similarity Coefficient Parameter Optimization Function. International journal of radiation oncology, biology, physics\| PubMed ID: 29559291	2018

Rachel McCarroll

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