Implementing a novel breast workflow utilising 6DoF through AlignRT surface guidance radiotherapy
- 1. Implementing a breast workflow utilising 6DoF through AlignRT surface guided radiotherapy Presented by : Alya Qadi Radiation Therapist GenesisCare The Mater Hospital & NorthShore
- 2. ALYA QADI • Graduated from RMIT University in Melbourne, Australia • 6 years as a radiation therapist • Interest in patient care, stereotactic techniques & SGRT
- 4. Department background • Halcyon, 2 Truebeam (Stx and Edge) & one Superficial machine • AlignRT for all patients set up • 219+ breast patients per year ~3500 fractions • Treatment techniques includes VMAT, SRS and Stereotactic
- 5. Aim and objectives • Aim: • Implementing a positioning protocol for breast cancer patients using 6DoF through AlignRT and evaluate its effectiveness vs current practice • Objectives: • To assess the accuracy of applying 6DoF in breast treatment setups. • To assess workflow efficiency and manual handling for radiation therapists.
- 7. Region of Interest (ROI) Selection Standard Breast Bolus Large Breast
- 8. Postural Alignment Real time video and visualization of patient set up
- 9. Previous Set Up Protocol: 3DoF Datasets used for set up: Free Breathing (FB) Deep inspiration Breath Hold (DIBH) • Patient is set to the acquired couch position. • AlignRT monitoring starts to set up patients on FB dataset. • Physical adjustment of RTN, PITCH & ROLL. • Manual adjustments of VRT, LNG &LAT. • DIBH dataset. • Patient is instructed to breath in. • Physical adjustment of RTN, PITCH & ROLL in BH. • LNG & LAT manually adjusted, no VRT shifts applied.
- 10. New Set Up Protocol: 6DoF • Optimal patient position correction by achieving submillimeter accuracy • Optimization of patients' rotations beyond physical abilities • Reduces staff manual handling
- 11. Methods
- 12. Project timeline 2022 October -Protocol development and research - MDT discussion organised - Set up meetings with other departments November - Patient selection to pilot protocol - Protocol adjustments based on pilot - Optimising adaptability for staff and patients December - Protocol finalised - Staff training and education - Implantation of breast 6DoF within the department Preparation and development of protocol Implementation of protocol
- 13. New breast treatment set up protocol (Datasets) 6DoF application using “Send to Couch” feature in AlignRT. FB dataset DIBH dataset Deep Inspiration breath hold (DIBH) FB dataset Free Breathing Bolus FB dataset DIBH dataset
- 14. DIBH Treatment Set Up Protocol
- 15. Inside the treatment room Patient set up as per day one Physical adjustment of RTN, PITCH & ROLL 3DoF values are sent via AlignRT “send to Couch”.
- 16. Inside the treatment room Patient in Breath hold (BH) *BH Dataset*. Within tolerance “send to Couch” 6DoF values. OR Patient in Breath hold (BH) *BH Dataset*. Over tolerance Reassess FB . DIBH dataset
- 17. Treatment tolerances FB data set RTN, ROLL & PITCH (FB) VRT, LNG & LAT (FB) 2Deg 1.5cm DIBH data set RTN, ROLL & PITCH (DIBH) LNG & LAT (DIBH) 2.5Deg 1.0cm
- 18. Outside the treatment room (Console) Patient in BH Acquire (CBCT or KV/MV) + Image match Patient in DIBH→ Apply shifts Save reference capture in BH & gating Patient in BH Imaging Reference Capture Beam Hold
- 19. FB Treatment Set Up Protocol
- 20. FB Set Up Patient in acquired couch position in FB Apply 6DoF Acquire (CBCT or KV/MV) +Image match Apply shifts Save reference capture & Beam control on
- 21. Bolus Treatment Set Up Protocol
- 22. BOLUS SET UP Patient in acquired couch position in FB Apply 6DoF Acquire (CBCT or KV/MV) +Image match Apply shifts Save reference capture & Beam control on Inside treatment room Treatment console
- 23. Results
- 24. Applied Translational Shift VRT (mm) LAT (mm) LONG (mm) 6DoF 3DoF 6DoF 3DoF 6DoF 3DoF Average ± SD 2.57 ± 2.17 1.87 ± 1.39 1.85 ± 1.62 2.99 ± 2.84 3.15 ± 2.70 3.35 ±3.38 Range 0 - 12.6 0 - 10 0 - 10.7 0 - 20.1 0 - 14.5 0 - 22.4 P-value 0.197 0.058 0.483 *Larger range in the non 6dof 0.0 1.0 2.0 3.0 .0 5.0 1 2 3 5 6 9 10 Shi (mm) Pa ent rt 3DoF 6DoF 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 1 2 3 4 5 6 7 8 9 10 Shift (mm) Patient LONG 3DoF 6DoF
- 25. Applied Rotational Shifts Pitch(°) Roll(°) Rotation(°) 6DoF 3DoF 6DoF 3DoF 6DoF 3DoF Average ± SD 0.56 ± 0.88 0.78 ± 0.69 0.14 ± 0.37 0.83 ± 0.73 0.82 ± 0.69 1.2 ± 0.92 Range 0 - 3.3 0 - 4.30 0 - 1.8 0 - 3.8 0 - 3.0 0 - 5.0 P-value 0.127 0.0003 0.033 *Larger range in the non 6dof
- 26. Time efficiency Less manual handling Less repeat images Less treatment time Average time reduction 26% for Standard Breast 15% for Breast Axilla, Chest wall & Nodes 3DoF 6DoF Breast only Breast/AX/CW/Nodes Breast only Breast/AX/CW/Nodes Time Range 18-20 minutes 20-25 minutes 12-16minutes 18-20 minutes ~45minutes are saved per day
- 27. Workflow Enhancement Increase in machine capacity Cost effective Reduced wait times Increase in work health safety
- 28. Challenges Bolus • Superflab Impacts all 6DoF values • 3D Bolus represent true values of rotations Inclined patients • Larger patients set ups • Impacts Pitch & Roll> 2.5
- 29. Conclusion Applying 6DoF for breast treatments proves to enhance workflow by reducing time, staff manual handling and increasing breast treatment accuracy and safety.
- 30. Acknowledgement • Conversation with colleagues around Australia; esp. • Katie Davidson (Peter Mac), Louis Shu (Peter Mac) • Sue McKenna (VisionRT) • But most importantly • Mark Wanklyn • Guneet Kaur • Abbey Adams • Siobhan Burke • Yeen Yeong • Rachel Gibbs
- 31. Thank you !