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Offline Radiation Therapy Best Practices

With the proliferation of complex plans comes the need for enhanced plan QA in radiation oncology. Over the course of treatment, the patient’s internal anatomy can change substantially, reducing the efficacy of the initial treatment plan and potentially introducing hurdles to treatment and increasing patient risk.While online adaptive solutions are beginning to enter the market, these often require large start-up costs and can require significant time and resources from the clinical team. Offline solutions which perform dosimetric checks on a per-fraction basis can be a more feasible alternative for many centers to improve patient safety, increase clinical efficiency, and limit unexpected replanning without a significant change in the clinical workflow.

Currently, replanning is often triggered by externally-observable changes to patient anatomy—such as significant weight loss, a loose mask, or some gross change in the daily image. This approach lacks quantitative rigor and leaves clinicians in the dark about internal anatomy changes, which compromise the accuracy and safety of the entire plan. Some centers opt to calculate dose directly on their daily images. While aiming at a more quantitative approach, the quality of these images precludes any possibility of an accurate dose calculation. Furthermore, calculating dose on every fraction for every patient—particularly when most will not need replanning – is an inefficient use of valuable clinical time.

MIM’s track record in improving the clinical feasibility of complex clinical processes is unparalleled, and adaptive assessment is no exception. MIM SureCalc MonteCarlo® enables fully automated dose-guided adaptive assessment on a per-fraction basis. Daily images are automatically imported from the OBI or OIS and put through a proprietary image enhancement process. This results in a daily image suitable for Monte Carlo dose calculation, with over 90% accuracy compared to a same-day replan CT. After adapting the plan contours to match the enhanced daily image and performing the dose calculation, we can provide a robustly quantitative and up-to-date assessment of our plan.

Our automated report generation offers a wealth of insight to help determine if a patient will require replanning. Dose constraints, DVH comparisons between the TPS and the Monte Carlo check, trending volumes of our targets and OARs over time, dose delivery on a per-fraction and cumulative scale – all this and more is possible with MIM SureCalc’s adaptive assessment, exported automatically from MIM to your OBI or OIS. For a demonstration of this process, using our sample cases or your own anonymized patient data, reach out at the link below.

Raghav Sharma
Written by Raghav Sharma

Raghav is an Account Executive I at MIM Software Inc.