Lamb James, Cao Minsong, Kishan Amar, Agazaryan Nzhde, Thomas David H, Shaverdian Narek, Yang Yingli, Ray Suzette, Low Daniel A, Raldow Ann, Steinberg Michael L, Lee Percy
Department of Radiation Oncology, University of California, Los Angeles.
Department of Radiation Oncology, University of Colorado, Denver.
Cureus. 2017 Aug 27;9(8):e1618. doi: 10.7759/cureus.1618.
Onboard magnetic resonance imaging (MRI) guided radiotherapy is now clinically available in nine centers in the world. This technology has facilitated the clinical implementation of online adaptive radiotherapy (OART), or the ability to alter the daily treatment plan based on tumor and anatomical changes in real-time while the patient is on the treatment table. However, due to the time sensitive nature of OART, implementation in a large and busy clinic has many potential obstacles as well as patient-related safety considerations. In this work, we have described the implementation of this new process of care in the Department of Radiation Oncology at the University of California, Los Angeles (UCLA). We describe the rationale, the initial challenges such as treatment time considerations, technical issues during the process of re-contouring, re-optimization, quality assurance, as well as our current solutions to overcome these challenges. In addition, we describe the implementation of a coverage system with a physician of the day as well as online planners (physicists or dosimetrists) to oversee each OART treatment with patient-specific 'hand-off' directives from the patient's treating physician. The purpose of this effort is to streamline the process without compromising treatment quality and patient safety. As more MRI-guided radiotherapy programs come online, we hope that our experience can facilitate successful adoption of OART in a way that maximally benefits the patient.
机载磁共振成像（MRI）引导放疗目前在全球九个中心已投入临床使用。这项技术推动了在线自适应放疗（OART）的临床应用，即能够在患者位于治疗台上时，根据肿瘤和解剖结构的实时变化调整每日治疗计划。然而，由于OART具有时间敏感性，在大型繁忙诊所实施存在诸多潜在障碍以及与患者相关的安全考量。在这项工作中，我们描述了加利福尼亚大学洛杉矶分校（UCLA）放射肿瘤学系实施这一新型护理流程的情况。我们阐述了基本原理、最初面临的挑战，如治疗时间考量、重新勾画轮廓、重新优化、质量保证过程中的技术问题，以及我们目前克服这些挑战的解决方案。此外，我们描述了实施一种覆盖系统，由当日值班医生以及在线计划师（物理学家或剂量师）根据患者主治医生针对特定患者的“交接”指令监督每次OART治疗。这项工作的目的是在不影响治疗质量和患者安全的前提下简化流程。随着更多MRI引导放疗项目上线，我们希望我们的经验能够促进OART的成功采用，从而最大程度地惠及患者。
