Author: Min Geon Choi, Sean J. Domal, Ruiqi Li, Taoran Li, Mu-Han Lin, Yang Kyun Park, David D.M. Parsons, Justin D. Visak 👨🔬
Affiliation: Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, UT Southwestern Medical Center, University of Texas Southwestern Medical Center, University of Pennsylvania, Department of Radiation Oncology, UT Southwestern Medical Center 🌍
Purpose: Ethos X-ray-guided online adaptive radiotherapy (ART) enables precise, daily adaptive treatments but requires significant resources, limiting widespread adoption. Many treatment sites do not require daily adaptation but benefit from adjustments based on gradual anatomical changes. This study presents a framework integrating Ethos ART and Halcyon IGRT platforms to provide flexibility in adaptation frequency. Automated scripting enhances workflow efficiency, optimizing resource use while maintaining high-quality care.
Methods: The framework employs Ethos for creating adapted plans and Halcyon for IGRT delivery when adaptation is unnecessary. Adapted plans are exported via a DICOM node and processed using Eclipse Scripting API (ESAPI) tools. These tools automate plan transfer to the Aria system and convert them into Halcyon-compatible plans while preserving dosimetric fidelity. Validation was conducted across ten patients treated with Ethos v2.0 across various anatomical sites. Dosimetric accuracy was evaluated using ArcCheck with a 3%/2mm gamma passing criterion.
Results: Integrating Ethos and Halcyon enabled flexible adaptation schedules, such as daily, weekly, or ad-hoc adjustments, tailored to patient needs. Automated scripting reduced manual workflow time from 45 ± 8.5 minutes to 8 ± 2.3 minutes. QA results showed a 99% gamma passing rate, confirming dosimetric integrity of converted plans. The framework allocated complex adaptive treatments to Ethos and stable anatomy cases to Halcyon, optimizing resource use without compromising care quality.
Conclusion: This framework combines Ethos and Halcyon to enable flexible adaptation schedules and uses scripting to streamline plan conversion. These innovations reduce resource demands, improve efficiency, and support broader adoption of adaptive radiotherapy, offering a scalable solution for advanced clinical workflows and trials.