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Kim, Ji-Young [Author]; Tawk, Bouchra [Author]; Knoll, Maximilian [Author]; Hoegen, Philipp [Author]; Liermann, Jakob [Author]; Huber, Peter E. [Author]; Lifferth, Mona [Author]; Lang, Clemens [Author]; Häring, Peter [Author]; Gnirs, Regula [Author]; Jäkel, Oliver [Author]; Schlemmer, Heinz-Peter [Author]; Debus, Jürgen [Author]; Hörner-Rieber, Juliane [Author]; Weykamp, Fabian [Author]

Clinical workflow of cone beam computer tomography-based daily online adaptive radiotherapy with offline magnetic resonance guidance

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  • Media type: E-Article
  • Title: Clinical workflow of cone beam computer tomography-based daily online adaptive radiotherapy with offline magnetic resonance guidance : the Modular Adaptive Radiotherapy System (MARS)
  • Contributor: Kim, Ji-Young [Author]; Tawk, Bouchra [Author]; Knoll, Maximilian [Author]; Hoegen, Philipp [Author]; Liermann, Jakob [Author]; Huber, Peter E. [Author]; Lifferth, Mona [Author]; Lang, Clemens [Author]; Häring, Peter [Author]; Gnirs, Regula [Author]; Jäkel, Oliver [Author]; Schlemmer, Heinz-Peter [Author]; Debus, Jürgen [Author]; Hörner-Rieber, Juliane [Author]; Weykamp, Fabian [Author]
  • Published: 19 March 2024
  • Published in: Cancers ; 16(2024), 6, Artikel-ID 1210, Seite 1-14
  • Language: English
  • DOI: 10.3390/cancers16061210
  • Identifier:
  • Keywords: Ethos ; MR-guided radiotherapy ; online adaptive radiotherapy
  • Origination:
  • Footnote:
  • Description: Purpose: The Ethos (Varian Medical Systems) radiotherapy device combines semi-automated anatomy detection and plan generation for cone beam computer tomography (CBCT)-based daily online adaptive radiotherapy (oART). However, CBCT offers less soft tissue contrast than magnetic resonance imaging (MRI). This work aims to present the clinical workflow of CBCT-based oART with shuttle-based offline MR guidance. Methods: From February to November 2023, 31 patients underwent radiotherapy on the Ethos (Varian, Palo Alto, CA, USA) system with machine learning (ML)-supported daily oART. Moreover, patients received weekly MRI in treatment position, which was utilized for daily plan adaptation, via a shuttle-based system. Initial and adapted treatment plans were generated using the Ethos treatment planning system. Patient clinical data, fractional session times (MRI + shuttle transport + positioning, adaptation, QA, RT delivery) and plan selection were assessed for all fractions in all patients. Results: In total, 737 oART fractions were applied and 118 MRIs for offline MR guidance were acquired. Primary sites of tumors were prostate (n = 16), lung (n = 7), cervix (n = 5), bladder (n = 1) and endometrium (n = 2). The treatment was completed in all patients. The median MRI acquisition time including shuttle transport and positioning to initiation of the Ethos adaptive session was 53.6 min (IQR 46.5-63.4). The median total treatment time without MRI was 30.7 min (IQR 24.7-39.2). Separately, median adaptation, plan QA and RT times were 24.3 min (IQR 18.6-32.2), 0.4 min (IQR 0.3-1,0) and 5.3 min (IQR 4.5-6.7), respectively. The adapted plan was chosen over the scheduled plan in 97.7% of cases. Conclusion: This study describes the first workflow to date of a CBCT-based oART combined with a shuttle-based offline approach for MR guidance. The oART duration times reported resemble the range shown by previous publications for first clinical experiences with the Ethos system.
  • Access State: Open Access