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A Clinical Workflow for a Prototype Biology-Guided Radiation Therapy (BgRT) Machine

M Hwang*, R Lalonde , D Heron , M Huq , UPMC Hillman Cancer Center and University of Pittsburgh School of Medicine, Pittsburgh, PA


(Tuesday, 7/16/2019) 10:00 AM - 10:30 AM

Room: Exhibit Hall | Forum 3

Purpose: A new prototype PET-guided linear accelerator radiation therapy machine that uses biological guidance for the delivery of radiation therapy (BgRT) has recently been unveiled. This technology uses emission path lines of photon pairs emitted from coincident PET events for real-time biological guidance for the delivery of the therapy beam. This work presents a process map for the clinical workflow of this machine.

Methods: A team of 16 members from the RT staff at our institution participated in the development of the process map. Every member, with expertise in his/her own area, contributed to the design of the process map. It is assumed that a PET-CT simulator is physically present in the radiation oncology department. The overall goal is to treat oligometastatic tumors found in various organs including head/neck, lung, liver, and lymph nodes using the PET tracer F-18 labelled fluorodeoxyglucose (FDG) as the source for biological guidance.

Results: A total of fourteen steps were identified in the process map. Key features include acquisition of both PET and CT images, management of a newly defined unique volume, PTV(BgRT), combining the CTV with the biological guidance margin (BgM), and using the FDG to track the volume. The standard SBRT plan for a typical PTV(SBRT) is always made available as a backup plan for situations when a usable PET signal, which is evaluated by the preconfigured algorithm, is not obtained on the treatment session to deliver the BgRT plan.

Conclusion: This work presents the first clinical work flow for the implementation of BgRT. New steps, unique to BgRT, present themselves as potential sources for incurring errors in the radiation therapy processes. Detailed Failure Modes and Effects Analysis (FMEA) is currently being performed to identify the most risky and severe steps in this process map. These results will be presented at the meeting.


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