Tegtmeier Riley C, Clouser Edward L, Chen Quan, Buckey Courtney R, Chungbin Suzanne J, Kutyreff Christopher J, Aguilar Jose S, Labbe Amber L, Horning Brooke L, Rule William G, Vora Sujay A, Rong Yi
Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA.
Department of Radiation Oncology, University of South Florida Health Morsani College of Medicine, Tampa, Florida, USA.
J Appl Clin Med Phys. 2025 Apr;26(4):e14612. doi: 10.1002/acm2.14612. Epub 2024 Dec 23.
Conventional approaches for emergent or expedited palliative radiotherapy (RT) involve the application of cumbersome vendor-provided solutions and/or multiple patient appointments to complete the RT workflow within a compressed timeframe.
This report delineates the clinical development of an in-house, semi-automated Cone-beam computed tomography (CBCT)-based simulation-free platform for expedited palliative RT on conventional linacs, intended to supplant existing techniques employed at this institution.
The internal software, termed SimFree Wizard (SFW), was engineered utilizing a C#-based application programming interface integrated within the treatment planning system (TPS). Generated scripts were compiled as stand-alone executables, with a graphical user interface (GUI) customized via an integrated development environment. The platform was conceived as a framework for accelerated CBCT-based RT, bypassing the requirement for standard simulation imaging. SFW employs full automation where feasible to minimize user intervention, supplemented by graphical instructions for tasks requiring manual execution. During development, relevant temporal metrics from 10 end-to-end tests for palliative spine RT were quantified. User feedback was solicited via a simple questionnaire assessing the overall platform usability. Automated in-house secondary verification software was developed for validation of the TPS-calculated monitor units (MUs).
The mean duration for workflow execution was 41:42 ± 3:18 [mm:ss] (range ∼37-46 min). SFW satisfactorily generated simple, multi-field CBCT-based 3D treatment plans within seconds following delineation of the desired treatment area. User feedback indicated enhanced usability compared to previously employed solutions. Validation of the secondary verification software demonstrated accurate results for palliative spine RT and other simple cases wherein the dose calculation point resides in a predominantly homogenous medium.
A novel in-house solution for expedited CBCT-based RT was successfully developed, facilitating completion of the entire workflow within approximately 1-hour or less for simple palliative/emergent scenarios. Overall, this application is expected to improve the quality and safety of palliative RT while greatly reducing workflow duration, thereby improving access to palliative care.
用于急诊或加速姑息性放疗（RT）的传统方法涉及应用供应商提供的繁琐解决方案和/或多次患者预约，以便在压缩的时间范围内完成放疗工作流程。
本报告描述了一种基于内部半自动锥形束计算机断层扫描（CBCT）的无模拟平台的临床开发情况，该平台用于在传统直线加速器上进行加速姑息性放疗，旨在取代本机构目前使用的现有技术。
内部软件称为无模拟向导（SFW），利用集成在治疗计划系统（TPS）中的基于C#的应用程序编程接口进行设计。生成的脚本被编译为独立的可执行文件，通过集成开发环境定制图形用户界面（GUI）。该平台被设计为基于CBCT的加速放疗框架，无需标准模拟成像。SFW在可行的情况下采用完全自动化以尽量减少用户干预，并辅以针对需要手动执行的任务的图形化说明。在开发过程中，对10次姑息性脊柱放疗的端到端测试的相关时间指标进行了量化。通过一份评估平台整体可用性的简单问卷征求用户反馈。开发了内部自动化二次验证软件，用于验证TPS计算的监测单位（MU）。
工作流程执行的平均时长为41:42 ± 3:18[分钟:秒]（范围约为37 - 46分钟）。在划定所需治疗区域后的几秒钟内，SFW就能令人满意地生成基于CBCT的简单多野三维治疗计划。用户反馈表明，与之前使用的解决方案相比，可用性有所提高。二次验证软件的验证表明，对于姑息性脊柱放疗和剂量计算点位于主要均匀介质中的其他简单病例，结果准确。
成功开发了一种基于CBCT的加速放疗的新型内部解决方案，对于简单的姑息性/急诊情况，有助于在约1小时或更短时间内完成整个工作流程。总体而言，该应用有望提高姑息性放疗的质量和安全性，同时大幅缩短工作流程时长，从而改善姑息治疗服务的可及性。
