Bestrahlungsplanung und Dosisverifikation für die kombinierte interne und externe Strahlentherapie (CIERT)

Zusammenfassung Ziel Die kombinierte interne und externe Radiotherapie (CIERT) mittels offenen Radionukliden und externer Bestrahlung ermöglicht die Ausnutzung der Vorteile beider Bestrahlungsansätze. Hierzu zählen steile Dosisgradienten und eine geringe Normalgewebstoxizität durch die Bestrahlung mit offenen Radionukliden sowie die homogene Dosisdeposition innerhalb des Tumors durch externe Bestrahlung. Für eine kombinierte Bestrahlungsplanung soll eine Infrastruktur zur Berücksichtigung der Dosisbeiträge aus beiden Modalitäten geschaffen werden. Anschließend soll die physikalische Verifikation der Dosisverteilung messtechnisch mittels OSL-Detektoren erfolgen. Methode Die interne Bestrahlung erfolgte durch Re-188 in einem Zylinderphantom mit drei zylindrischen Einsätzen. Nach Akquisition von SPECT-Aufnahmen wurde die interne Dosis mittels der Software STRATOS berechnet und als DICOM-RT-Datensatz exportiert. Mittels der Planungssoftware Pinnacle wurde diese Dosisverteilung als Vorbestrahlung berücksichtigt und die externe Bestrahlung mit 6 MV Photonen geplant. Die Messung der Dosisbeiträge erfolgte mittels OSL-Detektoren aus Berylliumoxid für die kombinierte Bestrahlung und für beide Modalitäten getrennt. Ergebnisse Die geplante Kombinationsbestrahlung mit 1 Gy, 2 Gy und 4 Gy konnte innerhalb der Messunsicherheit der Detektoren sowohl für die getrennten als auch die kombinierte interne und externe Bestrahlung verifiziert werden. Das mittlere Ansprechvermögen der Detektoren bei der internen Bestrahlung mit Re-188 betrug dabei (88,6 ± 2,4) % gegenüber der Kalibrierung mit 200 kV Röntgenstrahlen, wogegen das Ansprechvermögen für 6 MV Photonen bei (146,0 ± 4,9) % lag. Schlussfolgerung Es wurde ein Ablaufschema für die Bestrahlungsplanung bei der kombinierten internen und externen Radiotherapie entwickelt und erfolgreich getestet. Messtechnisch konnte die Dosisverifikation mittels OSL-Detektoren erfolgreich umgesetzt werden, so dass die physikalisch-technischen Grundlagen für die Dosimetrie bei Kombinationsbestrahlungen gelegt sind.

Transparency in Quality of Radiotherapy for Breast Cancer in the Netherlands: a National Registration of Radiotherapy-parameters

Background: Radiotherapy (RT) is part of the curative treatment of approximately 70% of breast cancer (BC) patients. Wide practice variation has been reported in RT dose, fractionation and its treatment planning for BC. To decrease this practice variation, it is essential to first gain insight into the current variation in RT treatment between institutes. This paper describes the development of the NABON Breast Cancer Audit-Radiotherapy (NBCA-R), a structural nationwide registry of BC RT data of all BC patients treated with at least surgery and RT.Methods: A working group consisting of representatives of the BC Platform of the Dutch Radiotherapy Society selected a set of RT parameters deemed to be surrogate outcome parameters. Two pilot studies were carried out in six RT institutes: First, data were manually entered into a secured web-based system, and second, data were entered using an automatic Digital Imaging and Communications in Medicine (DICOM) RT upload module.Results: The NBCA-R dataset was created by selecting RT parameters describing given dose, target volumes, coverage and homogeneity, and dose to organs at risk (OAR). Entering the data was made mandatory for all dutch RT departments. In the first pilot study (N=1093), quite some variation was already detected. Application of partial breast irradiation varied from 0%-17% between the 6 institutes and boost to the tumour bed from 26.5%-70.2%. For patients treated to the left breast or chest wall only, the average mean heart dose (MHD) varied from 0.80 Gy – 1.82 Gy; for patients treated to the breast/chest wall only, the average mean lung dose (MLD) varied from 2.06 Gy – 3.3 Gy. In the second pilot study 6 departments implemented the DICOM-RT upload module in daily practice. Anonymised data will be available for researchers via a FAIR (Findable, Accessible, Interoperable, Reusable) framework.Conclusions: We have developed a set of RT parameters and implemented registration for all dutch BC patients. With the use of an automated upload module registration burden will be minimized. Based on the data in the NBCA-R analyses of the practice variation will be done, with the ultimate aim to improve quality of BC RT. Trial registration: Retrospectively registered

Evaluation Treatment Planning for Breast Cancer Based on Dose-Response Model

The delivery of radiation therapy to patients requires prior planning made by medical physicists to achieve radiotherapy goals. Radiotherapy has a plan to eradicate the growth of cancer cells by giving high doses and minimizing the radiation dose to normal tissue. Evaluation of planning is generally done based on dosimetric parameters, such as minimum dose, maximum dose, and means dose obtained from the DVHs data. Based on the same DVHs, data were evaluate dinterms of biological effects to determine the highest possible toxicity in normal tissue after the tumor had been treated with radiation using the NTCP model. The evaluation was conducted by selecting three DICOM-RT data of post-mastectomy right breast cancer patients who had been prescribed a dose of 50 Gy obtained from the Hospital MRCCC Siloam Semanggi database. All data were processed using open-source software DICOManTX to get the DVH and isodose information. Matlab-based CERR software was used to calculate the NTCP model. The results show that the three patients' DVH and isodose treatment planning result in a homogeneous dose distribution result because the PTV area obtains adose limit of ≥ 95%. Moreover, normalt issue still gets adose below the tolerance limit based on the standard from RTOG 1005 and ICRU 83. Analysis of NTCP shows a complication probability below 1% for each organ, suggesting that any organ which has been irradiated has a low likelihood of complications. Therefore, it can be concluded that the treatment planning which has been made in the three patients using the IMRT technique has achieved the objectives of radiotherapy, which is to minimize toxicity to healthy organs. |Keywords: DVH, isodose, NTCP, radiotherapy.

ORBIT-RT: A Real-Time, Open Platform for Knowledge-Based Quality Control of Radiotherapy Treatment Planning

PURPOSE Access to knowledge-based treatment plan quality control has been hindered by the complexity of developing models and integration with different treatment planning systems (TPS). Online Real-time Benchmarking Information Technology for RadioTherapy (ORBIT-RT) provides a free, web-based platform for knowledge-based dose estimation that can be used by clinicians worldwide to benchmark the quality of their radiotherapy plans. MATERIALS AND METHODS The ORBIT-RT platform was developed to satisfy four primary design criteria: web-based access, TPS independence, Health Insurance Portability and Accountability Act compliance, and autonomous operation. ORBIT-RT uses a cloud-based server to automatically anonymize a user's Digital Imaging and Communications in Medicine for RadioTherapy (DICOM-RT) file before upload and processing of the case. From there, ORBIT-RT uses established knowledge-based dose-volume histogram (DVH) estimation methods to autonomously create DVH estimations for the uploaded DICOM-RT. ORBIT-RT performance was evaluated with an independent validation set of 45 volumetric modulated arc therapy prostate plans with two key metrics: (i) accuracy of the DVH estimations, as quantified by their error, DVHclinical − DVHprediction and (ii) time to process and display the DVH estimations on the ORBIT-RT platform. RESULTS ORBIT-RT organ DVH predictions show < 1% bias and 3% error uncertainty at doses > 80% of prescription for the prostate validation set. The ORBIT-RT extensions require 3.0 seconds per organ to analyze. The DICOM upload, data transfer, and DVH output display extend the entire system workflow to 2.5-3 minutes. CONCLUSION ORBIT-RT demonstrated fast and fully autonomous knowledge-based feedback on a web-based platform that takes only anonymized DICOM-RT as input. The ORBIT-RT system can be used for real-time quality control feedback that provides users with objective comparisons for final plan DVHs.