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Technical report
peer-reviewed

Online Adaptive Radiation Therapy: Implementation of a New Process of Care



Abstract

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.



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Technical report
peer-reviewed

Online Adaptive Radiation Therapy: Implementation of a New Process of Care


Author Information

James Lamb Corresponding Author

Department of Radiation Oncology, University of California, Los Angeles

Minsong Cao

Department of Radiation Oncology, University of California Los Angeles

Amar Kishan

Department of Radiation Oncology, University of California, Los Angeles

Nzhde Agazaryan

Department of Radiation Oncology, University of California, Los Angeles

David H. Thomas

Department of Radiation Oncology, University of Colorado, Denver

Narek Shaverdian

Department of Radiation Oncology, University of California Los Angeles

Yingli Yang

Department of Radiation Oncology, University of California, Los Angeles

Suzette Ray

Department of Radiation Oncology, University of California, Los Angeles

Ann Raldow

Department of Radiation Oncology, University of California, Los Angeles

Michael L. Steinberg

Department of Radiation Oncology, UCLA Medical Center

Percy Lee

Department of Radiation Oncology, University of California, Los Angeles


Ethics Statement and Conflict of Interest Disclosures

Human subjects: This study did not involve human participants or tissue. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared the following conflicts of interest: Financial relationships: James Lamb, Minsong Cao, Yingli Yang, Percy Lee declare(s) personal fees from ViewRay, Inc.


Technical report
peer-reviewed

Online Adaptive Radiation Therapy: Implementation of a New Process of Care


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Technical report
peer-reviewed

Online Adaptive Radiation Therapy: Implementation of a New Process of Care

  • Author Information
    James Lamb Corresponding Author

    Department of Radiation Oncology, University of California, Los Angeles

    Minsong Cao

    Department of Radiation Oncology, University of California Los Angeles

    Amar Kishan

    Department of Radiation Oncology, University of California, Los Angeles

    Nzhde Agazaryan

    Department of Radiation Oncology, University of California, Los Angeles

    David H. Thomas

    Department of Radiation Oncology, University of Colorado, Denver

    Narek Shaverdian

    Department of Radiation Oncology, University of California Los Angeles

    Yingli Yang

    Department of Radiation Oncology, University of California, Los Angeles

    Suzette Ray

    Department of Radiation Oncology, University of California, Los Angeles

    Daniel A. Low

    None

    Ann Raldow

    Department of Radiation Oncology, University of California, Los Angeles

    Michael L. Steinberg

    Department of Radiation Oncology, UCLA Medical Center

    Percy Lee

    Department of Radiation Oncology, University of California, Los Angeles


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: This study did not involve human participants or tissue. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared the following conflicts of interest: Financial relationships: James Lamb, Minsong Cao, Yingli Yang, Percy Lee declare(s) personal fees from ViewRay, Inc.

    Acknowledgements


    Article Information

    Published: August 27, 2017

    DOI

    10.7759/cureus.1618

    Cite this article as:

    Lamb J, Cao M, Kishan A, et al. (August 27, 2017) Online Adaptive Radiation Therapy: Implementation of a New Process of Care. Cureus 9(8): e1618. doi:10.7759/cureus.1618

    Publication history

    Received by Cureus: July 25, 2017
    Peer review began: August 08, 2017
    Peer review concluded: August 24, 2017
    Published: August 27, 2017

    Copyright

    © Copyright 2017
    Lamb et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

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.



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Create a free account to continue reading this article.

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James Lamb, Ph.D., Assistant Professor

Department of Radiation Oncology, University of California, Los Angeles

For correspondence:
jlamb@mednet.ucla.edu

Minsong Cao

Department of Radiation Oncology, University of California Los Angeles

Amar Kishan

Department of Radiation Oncology, University of California, Los Angeles

Nzhde Agazaryan

Department of Radiation Oncology, University of California, Los Angeles

David H. Thomas

Department of Radiation Oncology, University of Colorado, Denver

Narek Shaverdian

Department of Radiation Oncology, University of California Los Angeles

Yingli Yang

Department of Radiation Oncology, University of California, Los Angeles

Suzette Ray

Department of Radiation Oncology, University of California, Los Angeles

Daniel A. Low, None

None

Ann Raldow

Department of Radiation Oncology, University of California, Los Angeles

Michael L. Steinberg, M.D.

Department of Radiation Oncology, UCLA Medical Center

Percy Lee, M.D.

Department of Radiation Oncology, University of California, Los Angeles

James Lamb, Ph.D., Assistant Professor

Department of Radiation Oncology, University of California, Los Angeles

For correspondence:
jlamb@mednet.ucla.edu

Minsong Cao

Department of Radiation Oncology, University of California Los Angeles

Amar Kishan

Department of Radiation Oncology, University of California, Los Angeles

Nzhde Agazaryan

Department of Radiation Oncology, University of California, Los Angeles

David H. Thomas

Department of Radiation Oncology, University of Colorado, Denver

Narek Shaverdian

Department of Radiation Oncology, University of California Los Angeles

Yingli Yang

Department of Radiation Oncology, University of California, Los Angeles

Suzette Ray

Department of Radiation Oncology, University of California, Los Angeles

Daniel A. Low, None

None

Ann Raldow

Department of Radiation Oncology, University of California, Los Angeles

Michael L. Steinberg, M.D.

Department of Radiation Oncology, UCLA Medical Center

Percy Lee, M.D.

Department of Radiation Oncology, University of California, Los Angeles