Developing a web-based dashboard for adaptive radiotherapy workflows

Adaptive radiotherapy (ART) is limited by the absence of reliable thresholds to trigger necessary plan adaptation. This work develops and verifies a web-based, database-backed dashboard that unifies geometric, dosimetric, and radiobiological metrics to support day-to-day ART decisions.

Ten retrospectively selected patients were analyzed (Head and Neck (H&N), n = 5, 30-35 fx; prostate MR-linac, n = 5, 5 fx). Daily dose was recalculated on CBCT-derived pseudo-CTs (pCT) (H&N) or on daily MR images (prostate). A Python/Dash dashboard with a PostgreSQL backend takes in RTStruct/RTDose, then performs structure name harmonization, computes per-fraction DVHs, and derives five radar-chart metrics: organ central point displacement, interfraction Dice (reported as 1-Dice), intrafraction Dice (OAR-PTV overlap vs reference), objective score (deviation from plan objectives), and a radiobiology score using TCP/NTCP to calculate PI, PB, and P+. Residuals, defined as the difference between the reference metric (MIM) and the corresponding dashboard calculated value (MIM-Dashboard), were calculated to assess agreement. Calculations were verified against MIM Maestro using residual plots, paired t-tests (α = 0.05), and effect sizes.

Central point residuals were negligible (mean < 0.05 mm on all axes; max 0.45 mm). Interfraction Dice mean absolute difference was 0.08 (max 0.83); intrafraction Dice differences were smaller (overall mean residual -0.01). For score card dose endpoints, the largest mean difference was at D99.9% (1.31 Gy; 2.08%-below TG-114's 5% action level). Percent-volume endpoints showed small residuals (overall mean +0.32%); absolute-volume endpoints were near zero (overall mean +0.05 cm³). Radiobiology residuals were modest (mean: PI +1.78%, P+ -1.11%, PB +0.86%) with occasional outliers (max PI 8.69%). Three metrics reached statistical significance (central point, intra-/inter-fraction Dice), but effect sizes were negligible to small.

The dashboard reproduces geometric, DVH, objective, and radiobiology metrics within acceptable limits relative to MIM, providing a credible foundation for ART decision support. Limitations include the projected DVH being a visualization (not dose accumulation) and radiobiology sensitivity to DVH sampling in steep gradients.