Evaluation of daily online contour adaptation by radiation therapists for prostate cancer treatment on an MRI-guided linear accelerator

Willigenburg, T.; Keizer, Daan M. de Muinck; Peters, Max; Claes, An; Lagendijk, J J W; Boer, Hans C.J. de; Zyp, Jochem R.N. van der Voort van

doi:10.1016/j.ctro.2021.01.002

Cited by 39 publications

(68 citation statements)

References 20 publications

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“…Online re-optimisation workflows currently necessitate the presence of an oncologist, a medical physicist and a treatment radiographer [17]. Training to enable this work to be radiographer led are in development [50,128].…”

Section: Practicalities Of Clinical Implementationmentioning

confidence: 99%

Image-guided Adaptive Radiotherapy for Bladder Cancer

et al. 2021

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Technological advancement has facilitated patient-specific radiotherapy in bladder cancer. This has been made possible by developments in image-guided radiotherapy (IGRT). Particularly transformative has been the integration of volumetric imaging into the workflow. The ability to visualise the bladder target using cone beam computed tomography and magnetic resonance imaging initially assisted with determining the magnitude of inter-and intra-fraction target change. It has led to greater confidence in ascertaining true anatomy at each fraction. The increased certainty of dose delivered to the bladder has permitted the safe reduction of planning target volume margins. IGRT has therefore improved target coverage with a reduction in integral dose to the surrounding tissue. Use of IGRT to feed back into plan and dose delivery optimisation according to the anatomy of the day has enabled adaptive radiotherapy bladder solutions. Here we undertake a review of the stepwise developments underpinning IGRT and adaptive radiotherapy strategies for external beam bladder cancer radiotherapy. We present the evidence in accordance with the framework for systematic clinical evaluation of technical innovations in radiation oncology (R-IDEAL).

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Section: Practicalities Of Clinical Implementationmentioning

confidence: 99%

Image-guided Adaptive Radiotherapy for Bladder Cancer

et al. 2021

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“…In such a workflow contours from simulation or pre-treatment scans are warped to the daily pre-treatment scan using a contour propagation algorithm. These warped contours are then adjusted where deemed necessary by attending radiation oncologists or radiotherapy technicians [8] , [9] .…”

Section: Introductionmentioning

confidence: 99%

On-line daily plan optimization combined with a virtual couch shift procedure to address intrafraction motion in prostate magnetic resonance guided radiotherapy

Keizer

Zyp

Breugel

et al. 2021

Physics and Imaging in Radiation Oncology

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Background and purpose: In daily adaptive magnetic resonance (MR)-guided radiotherapy, plans are adapted based on the patient's daily anatomy. During this adaptation phase, prostate intrafraction motion (IM) can occur. The aim of this study was to investigate the efficacy of always applying a subsequent virtual couch shift (VCS) to counter IM that occurred during the daily contour and plan adaption (CPa) procedure. Material and Methods: One hundred fifty patients with low and intermediate risk prostate cancer were treated with 5x7.25 Gy fractions on a 1.5 T MR-Linac. In each fraction, contour adaptation and dose re-optimization was performed using the session's first MR-scan. IM that occurred here was countered using two methods. One patient group had selective VCS (sVCS) applied if the CTV reached outside the PTV on a second MR acquired during plan optimization. The other group had always VCS (aVCS) applied for any prostate shift greater than 1 mm. Remaining IM during beam delivery was determined using 3D cine-MR. Results: Percentage of fractions where a VCS was applied was 28% (sVCS) vs 78% (aVCS). Always applying VCS significantly reduced influences of systematic prostate IM. Population random and systematic median values in all translations directions were lower for the aVCS than sVCS group, but not for the population random cranialcaudal direction. Conclusion:Applying VCS after daily CPa reduced impact of systematic prostate drift in especially the posterior and caudal translation direction. However, due to the continuous and stochastical nature of prostate IM, margin reduction below 4 mm requires fast intrafraction plan adaption methods.

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“…This study compliments other studies around the world as many MRL departments investigate the feasibility of RO lite workflow for MRL treatment. 6 Currently, a RO needs to be present for every MRL treatment to contour targets and approve the adapted radiation plan. Therefore, studies similar to this one could reduce the amount of time the RO is required to be present for a MRL treatment.…”

Section: Mr Considerations In Radiation Therapy Planningmentioning

confidence: 99%

Considerations when introducing MRI into a radiation therapy environment

Shirley

Baines

2021

J of Medical Radiation Sci

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This issue of Journal of Medical Radiation Sciences includes two papers presenting different uses of magnetic resonance (MR) in radiation therapy (RT). With the advancement of MR‐simulators and Magnetic resonance linear accelerators (MRL), in addition to the use of diagnostic MR becoming more common place in the radiotherapy setting, there are a number of challenges to be considered. In this article, we present the perspectives of radiation therapists and medical physicists involved in the commissioning of an MRL in our centre. Image shows in‐house 3D printed supports mounted on the vendor‐supplied QA platform. The supports locate an array so that it is centred in the radiation field.

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Evaluation of daily online contour adaptation by radiation therapists for prostate cancer treatment on an MRI-guided linear accelerator

Cited by 39 publications

References 20 publications

Image-guided Adaptive Radiotherapy for Bladder Cancer

Image-guided Adaptive Radiotherapy for Bladder Cancer

On-line daily plan optimization combined with a virtual couch shift procedure to address intrafraction motion in prostate magnetic resonance guided radiotherapy

Considerations when introducing MRI into a radiation therapy environment

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