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    Streamlining the image-guided radiotherapy process for proton beam therapy

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    Authors
    Davies, Lucy
    McHugh, Louise
    Aznar, Marianne Camille
    Lindsay, Josh
    Eccles, Cynthia L
    Affiliation
    Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
    Issue Date
    2021
    
    Metadata
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    Abstract
    Objectives: This work evaluated the on-treatment imaging workflow in the UK's first proton beam therapy (PBT) centre, with a view to reducing times and unnecessary imaging doses to patients. Methods: Imaging dose and timing data from the first 20 patients (70% paediatrics, 30% TYA/adult) treated with PBT using the initial image-guided PBT (IGPBT) workflow of a 2-dimensional kilo-voltage (2DkV), followed by cone-beam computed-tomography (CBCT) and repeat 2DkV was included. Pearson correlations and Bland-Altman analysis were used to describe correlations between 2DkV and CBCT images to determine if any images were superfluous. Results: 229 treatment sessions were evaluated. Patient repositioning following the initial 2DkV (i2DkV) was required on 19 (8.3%) fractions. This three-step process resulted in an additional mean imaging dose of 3.4 mGy per patient, and 5.1 minutes on the treatment bed for the patient, over a whole course of PBT, compared to a two-step workflow (removing the i2DkV image). Correspondence between the mean displacements from i2DkV and CBCT was high, with R = 0.94, 0.94 and 0.80 in the anteroposterior, superiorinferior and right-left directions, respectively. Bland-Altman analysis showed very little bias and narrow limits of agreement. Conclusions: Removing the i2DkV, streamlining to a two-step workflow, would reduce treatment times and imaging dose, and has been implemented as standard verification protocol. For challenging cases (e.g. paediatric patients under GA), further investigations are required before the three-step workflow can be modified. Advances in knowledge: This is the first report assessing a preliminary imaging protocol in PBT in the UK and determining a way to reduce dose and time, which ultimately benefits the patient.
    Citation
    Davies LSC, McHugh L, Aznar M, Lindsay J, Eccles C. Streamlining the image-guided radiotherapy process for proton beam therapy. BJR. 2021 Sep 14;20210764.
    Journal
    British Journal of Radiology
    URI
    http://hdl.handle.net/10541/624575
    DOI
    10.1259/bjr.20210764
    PubMed ID
    34520675
    Additional Links
    https://dx.doi.org/10.1259/bjr.20210764
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1259/bjr.20210764
    Scopus Count
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