Division of Medical Physics, Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA.
J Appl Clin Med Phys. 2022 Jun;23(6):e13606. doi: 10.1002/acm2.13606. Epub 2022 May 10.
Biology-guided radiotherapy (BgRT) is a new external beam radiation therapy modality combining PET-CT with a linear accelerator that has the potential to track and treat one or more tumors in real-time. The use of PET and radiopharmaceutical tracers introduces new processes that are different from the existing treatment processes. In this study, we have developed a process map for the clinical implementation of a prototype BgRT machine.
A team of 13 members from various radiation therapy disciplines at our institution participated in developing a prospective process map for a prototype BgRT machine. The methodology provided by the AAPM TG 100 report was followed. In particular, the steps unique to the BgRT workflow, using hypofractionated stereotactic body radiation therapy with fluorodeoxyglucose radiolabeled with fluorine-18 (FDG) to guide beam delivery, were analyzed.
The multi-disciplinary team in the department of radiation oncology at our institution developed a prospective process map for the clinical BgRT workflow. By focusing on the appropriate level of detail, 15 major subprocesses, 133 steps, and 248 substeps were identified and the process map was agreed upon as being useful, implementable, and manageable. Seventy-four steps from nine subprocesses, 55.6% of the whole process, were analyzed to be the BgRT unique steps. They originate mainly from: (1) acquiring multiple PET images at the BgRT machine with separate patient visits, (2) creating a unique biological treatment volume for BgRT plan (PTV ), and (3) BgRT plan optimization and treatment delivery using PET images.
Using BgRT to irradiate multiple metastases in the same session will impact clinical workflow, thus a graphical process map depicting the new clinical workflow with an appropriate level of detail is critical for efficient, safe, and high-quality care. The prospective process map will guide the successful setup and use of the new BgRT system.
生物学引导放疗（BgRT）是一种新的外部束放疗模式，将 PET-CT 与线性加速器相结合，具有实时跟踪和治疗一个或多个肿瘤的潜力。放射性药物示踪剂的使用引入了与现有治疗过程不同的新过程。在这项研究中，我们为原型 BgRT 机器的临床实施开发了一个过程图。
我们机构来自不同放射治疗学科的 13 名成员组成的团队参与了原型 BgRT 机器的前瞻性过程图的开发。遵循 AAPM TG 100 报告提供的方法。特别是，分析了 BgRT 工作流程特有的步骤，使用氟代脱氧葡萄糖（FDG）标记的氟-18 （18F-FDG）进行立体定向体部放射治疗的亚分次放疗，以指导光束输送。
我们机构放射肿瘤科的多学科团队为临床 BgRT 工作流程开发了前瞻性过程图。通过关注适当的详细程度，确定了 15 个主要子过程、133 个步骤和 248 个子步骤，并认为过程图是有用的、可实施的和可管理的。9 个子过程中的 74 个步骤，占整个过程的 55.6%，被分析为 BgRT 特有的步骤。它们主要来源于：（1）在 BgRT 机器上使用单独的患者就诊获得多个 PET 图像；（2）为 BgRT 计划（PTV）创建独特的生物治疗体积；（3）使用 PET 图像进行 BgRT 计划优化和治疗传递。
在同一次治疗中用 BgRT 照射多个转移瘤将影响临床工作流程，因此，具有适当详细程度的描绘新临床工作流程的图形过程图对于高效、安全和高质量的护理至关重要。前瞻性过程图将指导新 BgRT 系统的成功设置和使用。
