Author: Sorour Hosseini, YuHuei Jessica Huang, Jeremy Kunz, Nicholas Pierre Nelson, Ryan G. Price, Prema Rassiah, Hui Zhao 👨🔬
Affiliation: University of Utah, Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah 🌍
Purpose: To investigate the feasibility and clinical implications of creating customized workflows in a new SGRT system: LUNA 3D (LAP, Florida).
Methods: Three clinical SGRT workflows were designed. We investigated the feasibility of creating these customized workflows in the LUNA 3D system and explored their clinical implications. First, inter-fractional patient positioning with Intra-fractional Motion Monitoring. Second, DIBH Workflow includes five steps. Step 1: inter-fractional patient positioning based on free-breathing DICOM surface reference from CT-simulation. Step 2: Patient DIBH verification based on DIBH DICOM reference from CT-simulation. Steps 3-5: Patient surface monitoring during treatment delivery based on DIBH DICOM or captured (if shifts applied) surface reference. Each tangent and supraclavicular treatment field is assigned as one treatment step. Third, Cranial Spinal Irradiation (CSI) Workflow includes nine steps. Step 1: Patient setup based on brain DICOM surface reference. Step 2: Patient position verification based on upper spine DICOM reference. Step 3: Patient position verification based on lower spine DICOM reference. Steps 4-9: Patient intra-fractional motion monitoring during brain, up spine, and low spine treatment delivery (3 isocenters, 6 VMAT fields).
Results: All three workflows were successfully created in the LUNA 3D, covering every step from patient setup to treatment delivery. These customized workflows enable step-by-step verification of patient positioning for different isocenters in multi-isocenter plans, such as CSI, or assessment of breathing stages in DIBH treatments, ensuring a seamless process before treatment delivery. Once patient setup is complete, the workflows transition to intra-fraction motion monitoring during treatment. This approach was efficiently implemented and fully integrated into the radiation therapy process.
Conclusion: The unique functionality of customized workflow creation in the LUNA 3D SGRT system is feasible and flexible. The created workflows have the potential to significantly impact clinical practice by facilitating and streamlining SGRT procedures, thereby improving radiation therapy efficiency.