Advanced therapy in-room imaging
Advanced therapy in-room imaging is closely connected to image-guided radiation therapy (IGRT) – it is, in essence, the basis of the latter’s imaging functionality.
The treatment room of tomorrow and its medical system software should support all imaging devices and functionalities, such as:
- CBCT (gantry- and PPS-mounted, on-rails);
- X-ray (gantry- and floor-mounted);
- in-room CT (PPS-mounted, on-rails);
- proton imaging.
Each type of imaging brings its specific improvement to the overall treatment system. For example, proton imaging boosts the effectiveness of proton therapy by increasing the accuracy of the relative stopping power (RSP) calculation.
The resulting proton treatment plans can be more accurate, allowing for much narrower beam fields while providing more conformable treatment. Furthermore, measured doses for proton imaging are 10 to 100 times lower than for CT imaging. This could enable frequent proton imaging before each treatment fraction, with negligible adverse effects on the patient.
The PositionOne software supports current and future imaging modalities and devices used in a variety of treatment room configurations. The module utilises advanced algorithms to perform the required imaging in real-time and for specialised modes. In-room imaging software should integrate seamlessly with the treatment workflow, allowing for simple upgrades and support of new imaging modalities.
Patient orientation and positioning
More and more clinicians are now rethinking how to best set the patient up for particle treatment. Is it best for the patient to be resting and prone, or does one put them in a seated, perched position or fully upright? Of course, it depends on the type of the beam and the specific cancer and tumour location. For treatment rooms with a gantry and variable beam direction, a lying down position for the patient on the treatment couch is the best.
However, when a clinic needs a lower total cost of ownership and shorter installations times, fixed-beam treatment and the patient’s “upright and rotating” positioning has several advantages. For example, upright positioning facilitates faster imaging and patient setup in treatment rooms without a gantry.
The next revolution awaiting the treatment room – already supported by The PositionOne module of OncologyOne – is augmented patient positioning systems with “smarter” and faster verification and increased use of robotic positioners and transporters, especially for boron neutron capture therapy.
Treatment management enhancements with innovative software
Tomorrow’s treatment room will demand software innovation to manage the whole treatment process, including planning, dose delivery and clinical workflow.
A few years ago, offline adaptive radiation therapy consisted of treatment planning and quality assurance. If you found your patient was deviating after you started a course of treatment, you had to perform replanning, which is a time-consuming task. Even today, oncologists rarely perform online adaptive radiation therapy, as most treatments are associated with high-toxicity risks. These issues will be relieved by new software solutions for treatment planning, such as automatic delineation, that are based on artificial intelligence.
Deep learning solutions can speed up and standardise the contouring of organs, based on CT or MRI, to automatically annotate, for example, more than 150 structures in the brain in a few dozens of seconds. Advanced software can generate a fully planning-compatible synthetic CT within seconds from MRI images. Soon, AI-based treatment planning solutions will automatically determine the specific constraints that can be used for a patient given the tumour’s location and the physician’s prescription.
Future-proofed software solutions such as TreatmentOne, PositionOne and WorkflowOne are tightly intermeshed with therapy device functionality and will be fully capable to exploit the device’s potential and increase patient throughput. TreatmentOne is an easily configurable treatment control system for radiation therapy, ready to be integrated into any oncology workflow. On the other hand, WorkflowOne is a management product for adaptive therapy workflows, tightly interoperable with other hospital informational systems.
Artificial intelligence will, eventually, streamline the whole treatment workflow and minimise user interaction, especially in online adaptive radiation therapy, which will become a regular feature in the treatment room of the future.
