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Evaluation of a workflow for cone-beam CT-guided online adaptive palliative radiotherapy planned using diagnostic CT scans. | LitMetric

AI Article Synopsis

  • The study focuses on improving single-visit radiotherapy (RT) for patients with bone metastases by using available diagnostic CT (dCT) images for treatment planning instead of a dedicated planning CT (pCT) scan, reducing delays.
  • An adaptive workflow was created where dCT images were adjusted with cone-beam CT (CBCT) scans to ensure accurate targeting and dose delivery during RT, showing consistent treatment quality.
  • Results indicated that the adapted treatment plans met clinical goals and performed better than original plans, leading to the successful implementation of this new approach in clinical practice.

Article Abstract

Purpose: Single-visit radiotherapy (RT) is beneficial for patients requiring pain control and can limit interruptions to systemic treatments. However, the requirement for a dedicated planning CT (pCT)-scan can result in treatment delays. We developed a workflow involving preplanning on available diagnostic CT (dCT) imaging, followed by online plan adaption using a cone-beam CT (CBCT)-scan prior to RT-delivery, in order to account for any changes in anatomy and target position.

Methods: Patients previously treated with palliative RT for bone metastases were selected from our hospital database. Patient dCT-images were deformed to treatment CBCTs in the Ethos platform (Varian Medical Systems) and a synthetic CT (sCT) generated. Treatment quality was analyzed by comparing a coverage of the V95% of the planning/clinical target volume and different organ-at-risk (OAR) doses between adapted and initial clinical treatment plans. Doses were recalculated on the CBCT and sCT in a separate treatment planning system. Adapted plan doses were measured on-couch using an anthropomorphic phantom with a Gafchromic EBT3 dosimetric film and compared to dose calculations.

Results: All adapted treatment plans met the clinical goals for target and OARs and outperformed the original treatment plans calculated on the (daily) sCT. Differences in V95% of the target volume coverage between the initial and adapted treatments were <0.2%. Dose recalculations on CBCT and sCT were comparable, and the average gamma pass rate (3%/2 mm) of dosimetric measurements was 98.8%.

Conclusions: Online daily adaptive RT using dCTs instead of a dedicated pCT is feasible using the Ethos platform. This workflow has now been implemented clinically.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10018665PMC
http://dx.doi.org/10.1002/acm2.13841DOI Listing

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