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  4. Adaptive therapy

Adaptive therapy planning

Adaptive therapy and dose tracking

In adaptive therapy planning frequent imaging is used to compensate for anatomical differences that occur during the course of treatment. Re-planning is considered once significant changes are observed. RayStation is specifically designed to make adaptive therapy faster and easier in clinical practice. It includes modules designed for dose tracking, deformable registration, and adaptive re-planning. RaySearch has collaborated with leading cancer centers worldwide to pioneer the use of adaptive planning.

What are the latest developments in adaptive therapy solutions at RaySearch?

Listen to product manager, Anna Lundin highlight this topic from her demo station at ASTRO 2023.

 
 

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RayStation's advanced algorithms create synthetic CTs, using the original CT and the daily CBCTs as input.

Daily cone beam CTs (CBCTs) provide superior representation of patient anatomy at the time of treatment compared to the conventional planning CT. To assess the need for replanning, it should be possible to compute the dose based on the daily CBCT images. However, the quality of CBCT images is often sub-optimal in comparison to CT images. 

 

BENEFITS:

  • Provides representation of the patient anatomy at the time of treatment as opposed to the planning CT
  • Enhances CBCT-based dose computation accuracy
  • CBCT based synthetic CT dose calculation has the potential to increase efficiency of the adaptive radiotherapy (ART) pathway while removing subjectivity

White paper: Synthetic CT Generation

Click here to download and view

Tutorial 1: Introduction to adaptive therapy and dose tracking

In this first tutorial, you’ll get a general introduction to adaptive radiation therapy and on how to perform dose tracking in RayStation.

 
 

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Dose tracking

Use the dose tracking module in RayStation to evaluate the actual delivered dose to the patient. The dedicated module and the fast and diverse tools will enable you to evaluate daily changes as well as evaluating trends as the treatment progresses.

During treatment, fraction images are acquired daily or regularly for patient positioning. When treatment time images of the patient, from CT, PET/CT, cone-beam CT or MR, are acquired - it is possible to use these images to evaluate the daily delivered dose.

When treatment time images of the patient from CT, PET/CT, cone-beam CT, MVCT or MR, are acquired, you can compute dose on the daily images to evaluate the actual delivered dose to the patient. Deform and accumulate doses from different fractions in a common geometry to compute the accumulated delivered dose over the course of treatment.

  • Dose calculation based on CBCT
  • Creation of synthetic CT based on CBCT
  • Easy dose accumulation over fractions
  • Dedicated workspace for evaluating daily doses and deformable dose accumulation
  • Fraction schedule shows delivered fractions, acquired images and available doses
  • Synchronized side-by-side views of planned and delivered dose

WHITE PAPER: ADAPTIVE THERAPY IN RAYSTATION

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Tutorial 2: Preparing for dose tracking

If you’ve watched the first tutorial, you’ll have seen the basics of dose tracking in RayStation. Now, let’s take a look at the actions required to actually perform dose tracking.

 

 
 

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Deformable registration

Deformable registration in RayStation enables the matching of anatomy over multiple image data sets. The functionality enables fast workflows for fractional image segmentation as well as dose comparisons and accumulations over different images. It allows the delivered dose to be deformed back to the planning CT and accumulated for a comparison with the planned dose up to that fraction.

Deformable registration also allows for fast contouring of the fractional image data sets. Contours from the planning image set, or other fractional image set, can be propagated to the new image using the known deformation.

  • Propagation of ROI contours or meshes between images, including 4D-CT
  • Hybrid intensity and structure based deformation ANACONDA algorithm recommended for adaptive (GPU supported)
  • Biomechanical model based deformation algorithm (MORFEUS based)
  • Tools for analysis and evaluation of deformable registration

WHITE PAPER: DEFORMABLE REGISTRATION IN RAYSTATION

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Tutorial 3: Adaptive re-planning

In this tutorial, we will look at how to adapt a treatment plan in RayStation for when you want to avoid underdosage of target or dose escalation in organs at risk.

 

 
 

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Adaptive re-planning

Modification of treatment plans can be decided based on the information collected through dose tracking. The adaptive re-planning module provides a wide range of adaptive re-planning tools that consider the accumulated dose and observed deviations of the patient’s geometry. Plans can then be re-optimized and adjusted to compensate for dose coverage problems or to adapt to adjusted clinical goals. Optimization objectives can be set to assure dose levels on future fractions only or to include already delivered dose to meet total dose constraints on organs at risk.

Re-planning options range from simple adaptations, such as adjustments of beam weights, to complete re-planning that involves re-optimization of the intensity modulation.

  • Adaptive re-planning workspace
  • Fraction schedule showing delivered and re-planned fractions
  • Toolbar including relevant parts of plan creation, plan optimization and plan approval

An efficient approach to large-scale adaptive therapy

The radiation oncology department at Auckland City Hospital in New Zealand has increased efficiency and quality of its radiation therapy treatment through the acquisition of specialized digital technologies. The department is a pioneer of adaptive therapy, boasts one of largest VMAT programs in Australasia, and operates a completely paperless workflow.

Read the full story 

Advanced planning for accurate proton treatment

Proton therapy is an exciting modality in radiation oncology. The Provision Center for Proton Therapy has not only embraced proton therapy, but also the concept that it must be used in conjunction with other advanced technologies, like adaptive radiation therapy and robust optimization, that will assure treatment accuracy.

Read the full story

Implementing and planning with RayStation at Mahatma Gandhi Cancer Hospital

See what Mahatma Gandhi Cancer Hospital have to say about implementing and planning with RayStation and how they work with adaptive.

 
 

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Webinar: accounting for uncertainties in radiation therapy

During radiation therapy, the patient’s anatomical state is not static. Many different factors contribute to a shifting picture, and it is essential to account for uncertainties in order to ensure the quality of the treatment plan. Chief medical physicist Niek Scheuder shares his experience of implementing adaptive planning workflows with RayStation at the Provision Center for Proton Therapy. Senior physicist Cameron Ditty then explains the concept of robustness in RayStation, illustrating with practical examples. Robust optimization handles possible variations that are not sufficiently accounted for by PTV. The resulting plan maintains target coverage while reducing dose to critical structures, even if anatomical changes or positional errors occur.

 
 

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Podcast: Artificial intelligence in the adaptive therapy workflow

A discussion with Kristy Brock from MD Anderson and the RaySearch Laboratories development team. Broadcasted during AAPM 2021.

 
 

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Adaptive therapy is now - RayStation

Watch this video to see how adaptive therapy can help you achieve clinical goals.

 
 

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