ESTRO 2024 - Abstract Book

S4199

Physics - Intra-fraction motion management and real-time adaptive radiotherapy

ESTRO 2024

Purpose/Objective:

The dose delivered to a patient is an important metric to track and is included in multiple locations in a patient’s electronic record including, but not limited to, on-treatment notes and treatment course summaries. As such, it would be beneficial to standardize and automate the reporting of these values. However, commercial radiation oncology information systems are not well designed to identify multiple target volumes and differing doses per fraction across the phases of a treatment course and therefore cannot easily provide linkage for tracking delivered dose and subsequent reporting in hospital electronic records systems. Part of the challenge is tracking across multiple decoupled electronic systems which are designed by different competing vendors. For example, treatment plans are developed on treatment planning systems (TPS), treatments are tracked using radiation oncology information systems (ROIS), and treatment summaries and other documentation are frequently housed in electronic health records (EHR) systems. The interfaces and fields within these systems are neither uniform nor comprehensive, and extraction and transmission methodologies between systems are also often inadequate. We have compared approaches used in multiple radiation oncology practices and developed a set of guideline recommendations for current commercial systems.

Material/Methods:

Members of the American Association of Physicists in Medicine’s (AAPM) Big Data Subcommittee (52 members, 31 practices), Common Oncology Data Elements eXtensions’ Radiation Therapy Treatment Data working group (17 members, 11 practices), and EPIC steering boards (12 members, 12 practices) were surveyed about their TPS, ROIS and EHR dose reporting, and those that had were invited to participate in forming the guidelines. Processes were broken down into consistent components to enable comparisons across radiation oncology practices. Responses were assessed to determine where a single reference point was being used and deemed inadequate for constructing dose summaries for course and phase. All participating members were involved in the discussion and evaluation of suggested guidelines.

Results:

Six treatment scenarios were identified where a ROIS default of a single reference point per plan is inadequate to correctly represent dose totals: 1) Initial course and boost volume, 2) Treating multiple concomitant prescribed dose levels, 3) Multiple-matched field plans used to treat a single prescribed dose volume, 4) Plan revisions, 5) Adaptive therapy, 6) Spatially distinct targets. We identified a consistent approach that would address the requirements of all scenarios. We therefore recommend the use of three standardized reference point types: 1) Primary Treatment Plan Reference, 2) Dose Check, 3) Prescription Tracking. We also strongly recommend that radiation oncology practices standardize their naming convention for reference points. These recommendations are summarized in Table 1.

Primary

or

Physical Location

Type

Naming Example

Secondary

Primary Treatment Plan Reference Point (automatically or manually created)

1.1

Primary

No

Track planned dose delivered by individual plan used in course