RayStation Automation is the Future of Planning. Carmen Sawyers, MS, DABR Ackerman Cancer Center

Transcription

1 RayStation Automation is the Future of Planning Carmen Sawyers, MS, DABR Ackerman Cancer Center

2 Overview Why Automation? o RayStation Automation Tools A Different Approach o RayStation Advanced Automation Tools Pros/Cons Future of Planning

3 Ackerman Cancer Center Private practice in Jacksonville & Amelia Island 3 Elekta Linacs 1 Mevion Proton Unit (vault 2 in progress) 100 patients/day between 2 sites 3D-CRT, IMRT, VMAT, Protons 5 Physicists, 5 Dosimetrists RayStation user since 2013; Clinical since Feb 2014

4 Why Automation? Goal is to create quality plans to meet clinical objectives Efficient Process o Automate standard procedures Clinic time constraints o Spend valuable time on complex cases o Evaluate different treatment techniques Help department workflow

5 RayStation Tools Automation of Standard Procedures o Automate specific portions of the planning process Tools are generally problem solvers o Templates o Protocols o Scripting o 3D Optimization o Automatic Breast Planning

6 Templates Physical work can be automated and simplified as much as possible o ROI Naming and Colors o Beam Arrangements o Isodose Lines o Optimization Objectives o Clinical Goals, RTOG Protocols

7 Protocols Templates grouped together for standardized planning o Create ROI o Load beam list o Load IMRT objectives o Load clinical goals o Run optimization o Compute final dose One, Two, Three mouse clicks to achieve a plan

8 Scripting Provides automation, connectivity, and flexibility beyond the standard user interface IronPython programming language o Create data files o Start processes o Execute optimization, deformable registration o Communicate with other programs and computers

9 3D Optimization Direct optimization of 3D-CRT treatment parameters o Leaf positions, Beam weights, Wedge angles o Collimator angle, Gantry angle, Couch angle

10 Automated Breast Planning Created by Princess Margaret Hospital o Study shows added efficiency, standardization, and quality to current planning process Uses markers place during CT (sup, inf, med, lat) 3 button clicks to automatically: o Locate markers o Create target and OAR o Set beam angles (gantry and collimator) o Optimize and create segments T.G. Purdie et al., Automated Planning of Tangential Breast Intensity-Modulated Radiotherapy Using Heuristic Optimization, Int.J. Radiation Oncology Biol.Phys.Vol. 81, No.2, pp , 2011

11 A Different Approach Future is knowledge-based planning o Use previous experience to drive the solution Plan optimization driven by big data o Multi-variate problem with complex, 3D Pareto fronts Pareto fronts/surface o A plane in space where the perfect combination of objectives sit Computer Speed o Need advanced hardware, algorithms, and techniques Future of adaptive therapy o Need quick automatic assessment and replanning

12 Raystation Advanced Tools Beginning of true computer driven solutions o Fallback Planning o Multi-Criteria Optimization (MCO) o Reduce Organ at Risk (OAR) o Plan Explorer

13 FallBack Planning Create contingency plans for other machines and modalities Uses a Dose Mimicking algorithm to replicate DVHs Example: VMAT IMRT and 3DCRT Reduce planning time, stress on staff, and avoid treatment interruption for patients Alternate uses o o Determine what modality is best (IMRT vs Proton) Proof for insurance companies Import any dose and mimic it o other TPS, TOMO, Cyberknife, proton

14 MCO Pareto Optimization Pareto fronts: find the plans that satisfy all the objectives and work within this space o Navigate this solution space o Moving sliders o Lock ROI, narrow the solution space o Guided by clinical goals Real time effect on the plan

15 Reduce OAR One click post processing tool Improve OARs without negatively impacting PTV Assessment tool see if better plan is possible Run it, if you don t like it, click UNDO Key piece to what computers need to do to ensure the best possible plan

16 Plan Explorer Automated generation of a large number of treatment plans for defined clinical goals and combinations of treatment techniques and machines Capability to filter and browse among plan candidates to find the most desired one Generate plans for different machines: VMAT, 7-field IMRT, 9- field IMRT, and filter by beam delivery time or clinical goals met Explore more a solution space to ensure highest quality plan Maximize the use of current delivery machines

17 Concerns Use of automation is an up front time investment o Work to setup templates, protocols, learning how to use MCO/optimization tricks Determine how to use protocols/which cases Cooperation and organization Cost of licenses (Automated Breast Planning, MCO, FallBack, VMAT, Proton, Plan Explorer) o Why purchase these auto-planning license when I have qualified CMDs on staff?

18 Does Speed Affect Quality? Automated tools affect the planner s speed Study to show that given a high performing system, a dosimetrist will produce a higher quality plan compared to one equipped with a slow system Study shows direct relationship between speed and plan quality Dosimetrists planning on the faster computer had significant increase in fulfilment of clinical goals

19 Future of Planning Computers will get better at finding solutions to multi-variate problems Dosimetrists will be needed to drive computer solutions and for clinical plan evaluation and decisions More patients needing adaptive therapy will increase workload o Day to day dose tracking o Implementing multiple changes over the course of treatment Automation will help bring efficiency to these processes and higher quality care to the clinic

20 Future of RaySearch RaySearch Goal: higher quality plans for ALL patients, ALL disease sites, ALL oncology centers The future workflow (next 2-7 years) will see computer created plans for 50-75% of patients Automated dosimetric and physical assessment during treatment will become the norm Automation will also include clinic specific operational efficiency Next steps include patient specific solutions based on genomics and big data Need for powerful OIS, RayCare, to handle data

21 Thank you Special thanks to o Dayna Bodensteiner, Director of Product Management, RaySearch Americas o Freddie Cardel, Director of Customer Support, RaySearch Americas o Marc Mlyn, President and CEO, RaySearch Americas