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Alert System for Monitoring Changes in Patient Anatomy During Radiation Therapy of Head and Neck Cancer

B Schaly1, 2*, J Kempe1, V Venkatesan1, 3, S Mitchell1, J Chen1, 2, (1) London Regional Cancer Program, London, ON, CA, (2) Departments of Medical Biophysics and Oncology, Western University, London, ON, CA, (3) Department of Oncology and Schulich School of Medicine and Dentistry, Western University, London, ON, CA


(Sunday, 7/12/2020)   [Eastern Time (GMT-4)]

Room: AAPM ePoster Library

Purpose: To validate a previously developed algorithm for alerting clinicians when to consider re-CT simulation due to changes in the patient’s anatomy during radiation therapy of head-and-neck cancer.

Methods: Cone-beam computed tomography (CBCT) data were collected prospectively for 77 patients. Each CBCT was mathematically compared to a reference CBCT using the gamma index. We defined the match quality parameter (MQP) as an indicator of CBCT image similarity, where a negative MQP value indicates a poorer CBCT match than the match between the first two CBCT acquired during treatment. If three consecutive MQP values were below a chosen threshold, an “alert” is triggered to indicate action required, e.g., possible re-CT simulation. The timing of image review requests made by the radiation therapists and any re-CT/re-plan decisions were documented for each patient’s treatment course retrospectively. The MQP for each patient (including any re-plans) was calculated in a manner that was blinded from the clinical process. The MQP as a function of fraction number was compared to the actual treatment progress to determine alert system performance.

Results: There was a total of 93 plans (including re-plans): 34 positives (action required) and 59 negatives (no action required). The sensitivity of the alert system was 0.76 and the false positive rate was 0.37. Only one patient out of the 34 positive cases would have been missed by both the alert system and our clinical process. Despite the false negatives and false positives, analysis of the timing of alert triggers showed that the alert system could have resulted in seven fewer clinical misses.

Conclusion: The alert system has the potential to be a valuable tool to complement human judgment and to provide a quality assurance safeguard to help improve the management of radiation treatment of head and neck cancer.


Cone-beam CT, Radiation Therapy


TH- External Beam- Photons: adaptive therapy

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