A Clinical Workflow for Evaluating Dose to Organs at Risk After Biology-Guided Radiation Therapy Delivery

Area of Science:

• Medical Physics
• Radiation Oncology
• Radiotherapy Technology

Background:

• Accurate dose monitoring in biologically guided radiation therapy (BgRT) is crucial for patient safety.
• Evaluating doses to organs at risk (OARs) post-treatment is essential for assessing delivery constancy and identifying clinical concerns.

Purpose of the Study:

• To develop and implement a systematic workflow for reviewing OAR doses following BgRT.
• To monitor dose delivery constancy and detect clinically significant changes in patients undergoing BgRT.

Main Methods:

• A workflow combining qualitative review of RefleXion system's delivered-dose information and quantitative evaluation using in-house software was implemented.
• A framework was developed to calculate custom OAR dose-volume metrics from delivered-dose distributions and visualize trends.
• The workflow was retrospectively applied to three BgRT patient cases to assess clinical utility.

Main Results:

• The developed workflow efficiently integrates RefleXion TPS features and custom software for comprehensive OAR dose evaluation post-BgRT.
• A spreadsheet tool effectively graphs normalized OAR dose-volume metrics, highlighting significant dose changes or tolerance violations.
• The workflow provides a cumulative delivered-dose record, aiding in treatment monitoring and assessment.

Conclusions:

• A post-BgRT dose evaluation workflow was established, augmenting RefleXion data with custom OAR dose-volume metric calculations and graphing.
• This workflow is now routinely utilized in clinical practice for all BgRT treatments.
• Future enhancements may include automation, adaptive dose calculation for anatomical changes, PET metric integration, and target dose analysis.