Image Guidance in Palliative Radiotherapy
Radiotherapy (RT) is often used for Palliative treatment to control acute symptoms of a patient. The consortium will develop and clinically implement a Cone Beam Computed Tomography (CBCT) guided RT system based upon a conventional linear accelerator to provide Palliative RT (PRT).
The International Agency for Research on Cancer has recently projected that there will be 9.6 million cancer deaths in 2018 - a significant number will require palliative care (at Erasmus MC 20-30%). PRT has been shown to be effective in controlling pain, relieving neurological symptoms, controlling obstructive symptoms, and may provide local control of tumors. RT requires multiple trips for consultation, simulation, treatment planning and delivery which poses a huge burden on these patients.
The consortium will develop an efficient and safe workflow for PRT. Computed Tomography (CT) will be replaced for reference imaging and instead the integrated CBCT imaging tools will be used consistently for imaging, contouring and dose calculations. To achieve these, new CBCT reconstruction methods will be developed for image improvement and Artificial Intelligence methods to develop pseudo-CTs from these images. Automatic treatment planning will minimise user errors and optimize the planning time. Further automation will be developed of the dataflow between imaging, treatment planning and Oncology Information System. To further improve Quality Assurance (QA), the consortium will attempt to develop a fully automated dose recalculation system using CBCT imaging, Electronic Portal Imaging Device (EPID) dosimetry and delivery logfiles to verify plan delivery on the current patient anatomy and help adapt plans for future treatment fractions.
During the first two years the advanced CBCT imaging reconstruction will be developed, tested and validated against the current use of CT imaging. This will lay the foundation for a system using CBCT imaging for treatment planning and an offline delivery QA system (dose calculation subject to RT delivery logfiles and/or advanced EPID dosimetry system). All components will be connected in the second half of the project to an optimised clinical workflow necessary to scan, plan and treat within 30 minutes. The consortium will help Erasmus MC in their application to the independent ethics committee to implement the system into their current clinical workflow.
