automatic treatment planning and quality assurance for...
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3/21/19
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Xun Jia, Ph.D., DABRDepartment of Radiation Oncology
Automatic treatment planning and quality assurance for gynecological high dose-rate brachytherapy
Disclosure
This work is supported by Varian Medical Systems
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Outline
§ Motivation
§ AutoBrachy system
–Treatment planning
–Treatment plan QA
–Database
§Conclusion
Motivation
§Conventional practice
–Treatment planning
–Pre-treatment QA
–Documentation–Record plan information in a spreadsheet
Screen captures~10 captures for different purposes
Run secondary dose calculation
A dose report
Bind to a single pdf
Upload to MOSAIQ
Secondary physics manual check and approval
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Motivation
§Problems:
–Human errors
–Low efficiency
–Plan quality variation
–Organized and comprehensive data documentation–Document 7 variables per minimum standard for reporting (Level 1)–33 variables per advanced standard for reporting (Level 2)–~100 per research-oriented reporting (Level 3)
[1] Allan et al., 1995 Human Factors Evaluation of Remote Afterloading Brachytherapy volNUREG/CR-6125(1-3)[2] Mayadev et. al., 2014 Implant time and process efficiency for CT-guided high-dose-rate brachytherapy for cervical cancer, Brachytherapy 13, 233[3] ICRU REPORT 89, Prescribing, Recording, and Reporting Brachytherapy for Cancer of the Cervix, 2016
An automated workflow
1. Data server
Parameters
Treatment deliveryFDA approved TPS
CT scan
2. AutoBrachyweb interface
3. AutoBrachyplanning module 4. AutoBrachy QA 5. AutoBrachy
database
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AutoBrachy
Cylinder
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Tandem and Ovoid
Polynomial Fitting of Cluster
Automatically Segmented ApplicatorsRectum Pt
PosteroInferior Border of the pubic Symphysis (PIBS pt) is found using projections through subregion
Threshold based clustering
Adaptive threshold starting from primary
clusters
AutoBrachy
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Secondary dose calculation
§Export Dicom-RT data to QA server
§Launch dose calculation in web and generate a pdf report
Auto QA
Upload to MOSAIQ
Secondary physicscheck and approval
Comprehensive testsGenerate a report
l Comprehensively validate the plan from over 20 dosimetric and geometry aspects
l Summarize QA results with suspicious issues highlightedl A streamlined work flow with ~3 min
Export plan dataStandard DICOM-RTformat
QA
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Tandem and Ovoid
AutoBrachy
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HDR database
§A database containing:
–Patient name and MRN, connected to MOSAIQ
–External beam therapy dose and HDR treatment images/plans
–Treatment toxicity
§Estimate HDR + External beam therapy dose for treatment planning
HDR database
§Automatically document dosimetric results, when QA report is generated
§Document treatment toxicity
§Query and report for research purpose
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Ongoing works
§New (AI-based) modules
–Syed and Y-tandem treatment planning
–Syed preplanning
–Automatic organ contouring
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