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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