STAT-ART: The Promise and Practice of a Rapid Palliative Single Session of MR-Guided Online Adaptive Radiotherapy (ART)

Mittauer, K.E.; Hill, P; Geurts, Mark; Costa, Anna-Maria De; Kimple, Randall J.; Bassetti, M.; Bayouth, John E.

doi:10.3389/fonc.2019.01013

Cited by 23 publications

(15 citation statements)

References 32 publications

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“…2 With advance MR-guided online adaptive radiotherapy (MRgoART) relying on calculation-based IMRT QA, accurate and sensitive quality assurance of the multileaf collimator (MLC) becomes an increasingly essential component for routine machine quality assurance. 3,4 It is important to assure compliance with the AAPM TG142 guidelines to supplement calculationbased QA methods for an online adaptive radiotherapy program. 5 The current standard of MLC QA is the picket fence approach which has traditionally been performed with film.…”

Section: Introductionmentioning

confidence: 99%

“…As such measurement‐based IMRT QA has been substituted with potentially less comprehensive QA methods such as a calculation‐based IMRT QA, allowing for QA of the dose calculation of the treatment plan generated at hand, but eliminating the QA of the MLC performance and thus the machine deliverability of the plan . With advance MR‐guided online adaptive radiotherapy (MRgoART) relying on calculation‐based IMRT QA, accurate and sensitive quality assurance of the multileaf collimator (MLC) becomes an increasingly essential component for routine machine quality assurance . It is important to assure compliance with the AAPM TG142 guidelines to supplement calculation‐based QA methods for an online adaptive radiotherapy program…”

Section: Introductionmentioning

confidence: 99%

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Characterization of positional accuracy of a double‐focused and double‐stack multileaf collimator on an MR‐guided radiotherapy (MRgRT) Linac using an IC‐profiler array

et al. 2019

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Purpose With advance magnetic resonance (MR)‐guided online adaptive radiotherapy (MRgoART) relying on calculation‐based intensity‐modulated radiation therapy (IMRT) quality assurance (QA), accurate and sensitive QA of the multileaf collimator (MLC) becomes an increasingly essential component for routine machine QA. As such, it is important to assure compliance with the AAPM TG142 guidelines to supplement calculation‐based QA methods for an online adaptive radiotherapy program. We have developed and implemented an efficient and highly sensitive QA procedure using an ionization chamber profiler (ICP) array to enable real‐time characterization of the positional accuracy of a double‐focused and double‐stacked MLC on a clinical MR‐guided radiotherapy (MRgRT) system and to supplement calculation‐based QA for an MRgoART program. Methods An in‐house MR‐compatible jig was used to position the ICP (detector resolution 5 mm on X/Y axis) at an extended SDD of 108.4 cm to enable each MLC leaf (8.3 mm leaf width at isocenter) to be uniquely determined by two neighboring ion chambers. The MRgRT linac system utilizes a novel jawless, double‐focused, and double‐stacked MLC design such that the upper bank (MLC1) and lower bank (MLC2) are offset by half a leaf width. Positional accuracy was characterized by three methods: single bank half‐beam block (HBB) at central axis, forward slash diagonal (FSD), and backslash diagonal (BSD) at off‐axis. Measurements were performed for each bank in which each leaf occludes half of a detector. A corresponding reference field with the MLC retracted from occlusion was measured. The sensitivities of HBB, FSD, and BSD were evaluated by introducing 0.5–2.5 mm of known errors in 0.5 mm increments, in both positive and negative directions. The relationship between detector response and MLC error was established. Over a 6‐month longitudinal assessment, we have evaluated MLC performance with weekly QA of HBB among cardinal angles, and monthly QA of FSD and BSD. Results A strong correlation was found between detector response of percentage dose difference and MLC positional error introduced (N = 350 introduced errors) for both HBB and FSD/BSD with coefficient of determination of 0.999 and 0.977, respectively. The relationship between detector response to MLC positional change was found to be 20.65%/mm for HBB and 11.14%/mm for FSD and BSD. At baseline, the mean MLC positional accuracy averaged across all leaves was 0.06 ± 0.27 mm (HBB), 0.04 ± 0.52 mm (FSD), −0.06 ± 0.51 mm (BSD). The mean MLC positional accuracy relative to baseline over the 6‐month assessment was found to be highly reproducible at 0.00 ± 0.12 mm (HBB; N = 28 weeks), −0.02 ± 0.19 mm (FSD; N = 6 months), −0.03 ± 0.19 mm (BSD; N = 6 months). Conclusions Positional accuracy of a novel jawless, double‐focused, double‐stacked MLC has been characterized and monitored over 6 months with an efficient, highly sensitive, and robust method using an ICP array. This routine QA method supplements calculation‐based IMRT QA for an online adaptive radio...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Characterization of positional accuracy of a double‐focused and double‐stack multileaf collimator on an MR‐guided radiotherapy (MRgRT) Linac using an IC‐profiler array

et al. 2019

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“…However, the plan is then created from a same-day megavoltage CT scan while the patient remains on the couch. With the emergence of magnetic resonance imaging linear accelerators, there is increased interest in using on-couch adaptive treatment strategies for palliation 32 and again diagnostic imaging is used for precontouring. Several groups have described using the linear accelerator’s on-board CBCT for 1-step simulation, planning, and delivery of palliative RT.…”

Section: Discussionmentioning

confidence: 99%

Introducing Computed Tomography Simulation–Free and Electronic Patient-Reported Outcomes–Monitored Palliative Radiation Therapy into Routine Care: Clinical Outcomes and Implementation Experience

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et al. 2021

Advances in Radiation Oncology

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Purpose Our purpose was to report outcomes of a novel palliative radiation therapy protocol that omits computed tomography simulation and prospectively collects electronic patient-reported outcomes (ePROs). Methods and Materials Patients receiving extracranial, nonstereotactic, linear accelerator-based palliative radiation therapy who met inclusion criteria (no mask-based immobilization and a diagnostic computed tomography within 4 weeks) were eligible. Global pain was scored with the 11-point numerical pain rating scale (NPRS). Patients were coded as having osseous or soft tissue metastases and no/mild versus severe baseline pain (NPRS ≥ 5). Pain response at 4 weeks was measured according to the international consensus (no analgesia adjustment). Transition to ePRO questionnaires was completed in 3 phases. Initially, pain assessments were collected on paper for 11 months, then pilot ePROs for 1 month and then, after adjustments, revised ePROs from 1 year onwards. ePRO feasibility criteria were established with reference to the paper-based process and published evidence. Results Between May 2018 and November 2019, 542 consecutive patients were screened, of whom 163 were eligible (30%), and 160 patients were successfully treated. The proportion of patients eligible for the study improved from approximately 20% to 50% by study end. Routine care pain monitoring via ePROs was feasible. One hundred twenty-seven patients had a baseline NPRS recording. Ninety-five patients had osseous (61% severe pain) and 32 had soft tissue (25% severe pain) metastases. Eighty-four patients (66%) were assessable for pain response at 4 weeks. In the 41 patients with severe osseous pain, overall and complete pain response was 78% and 22%, respectively. Conclusions By study completion, 50% of patients receiving palliative extracranial radiation therapy avoided simulation, streamlining the treatment process and maximizing patient convenience. Pain response for patients with severe pain from osseous lesions was equivalent to published evidence.

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“…The idea of implementing an MR-only RT workflow would bring considerable benefits in daily clinical practice. First, it would significantly simplify the clinical workflow, making it more rapid and efficient and opening the possibility of treating the patient in the same simulation session, carrying significant advantages especially in case of patients requiring urgent palliative care or patients in pain [36].…”

Section: Synthetic Ct Generationmentioning

confidence: 99%

Artificial Intelligence in magnetic Resonance guided Radiotherapy: Medical and physical considerations on state of art and future perspectives

et al. 2021

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STAT-ART: The Promise and Practice of a Rapid Palliative Single Session of MR-Guided Online Adaptive Radiotherapy (ART)

Cited by 23 publications

References 32 publications

Characterization of positional accuracy of a double‐focused and double‐stack multileaf collimator on an MR‐guided radiotherapy (MRgRT) Linac using an IC‐profiler array

Characterization of positional accuracy of a double‐focused and double‐stack multileaf collimator on an MR‐guided radiotherapy (MRgRT) Linac using an IC‐profiler array

Introducing Computed Tomography Simulation–Free and Electronic Patient-Reported Outcomes–Monitored Palliative Radiation Therapy into Routine Care: Clinical Outcomes and Implementation Experience

Artificial Intelligence in magnetic Resonance guided Radiotherapy: Medical and physical considerations on state of art and future perspectives

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