ESTRO 2024 - Abstract Book

S4200

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

ESTRO 2024

Dose Check Reference Point(s) - (manually created)

C1_DoseCheck

Secondary

Yes*

Track physical dose at a specific location delivered by all plans in course Prescription Tracking Reference Point(s) - (manually created)

C1_PTV_High C1_PTV_Low

Secondary

No

Track cumulative delivery of all prescribed dose levels by all plans in course

*if possible with commercial system combination

Table 1: Reference points types and naming recommendations

During quality assurance processes, such as plan checks, standardized naming simplifies confirming that the requisite reference points have been created with respect to the prescription. We also recommend Treatment Plan Reference Points be named to simplify connection with the treatment plan. When information is transferred to the EHR for display, standardized naming allows automating parsing the string names to correspond with desired display in the EHR. Functionality has been added to the HL7-FHIR interface to transmit references points and the approach described requires minimal modification to existing commercial systems, since they already have mechanisms for creating reference points manually.

Conclusion:

Reference points represent a unique case whereby applying a standardized methodology to existing functionality in commercial TPS and ROIS can be used to fill an infrastructure gap. It is clear that the use of primary treatment plan reference points is not sufficient to correctly accumulate dose in some of the more complex clinical scenarios. The guidelines described here allow the flexibility of accurately describing these situations while still maintaining standardization. Standardized naming of structures in AAPM's TG-263 was necessitated by the frequent exchange among radiation oncology practices of dose volume histogram data, for clinical trials, re-irradiation, etc. That standardization subsequently became the basis for developing interoperable tools for automation, including within treatment planning. As manufacturers create interfaces that allow sharing of reference point information more easily, then standardization of nomenclature as described here will also increase in importance.

Keywords: reference point tracking, dose tracking, guideline

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