Publication: RADIANCE-A planning software for intra-operative radiation therapy
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Ame Publ CO
In the last decades accumulated clinical evidence has proven that intra-operative radiation therapy (IORT) is a very valuable technique. In spite of that, planning technology has not evolved since its conception, being outdated in comparison to current state of the art in other radiotherapy techniques and therefore slowing down the adoption of IORT. RADIANCE is an IORT planning system, CE and FDA certified, developed by a consortium of companies, hospitals and universities to overcome such technological backwardness. RADIANCE provides all basic radiotherapy planning tools which are specifically adapted to IORT. These include, but are not limited to image visualization, contouring, dose calculation algorithms-Pencil Beam (PB) and Monte Carlo (MC), DVH calculation and reporting. Other new tools, such as surgical simulation tools have been developed to deal with specific conditions of the technique. Planning with preoperative images (preplanning) has been evaluated and the validity of the system being proven in terms of documentation, treatment preparation, learning as well as improvement of surgeons/radiation oncologists (ROs) communication process. Preliminary studies on Navigation systems envisage benefits on how the specialist to accurately/safely apply the pre-plan into the treatment, updating the plan as needed. Improvements on the usability of this kind of systems and workflow are needed to make them more practical. Preliminary studies on Intraoperative imaging could provide an improved anatomy for the dose computation, comparing it with the previous pre-plan, although not all devices in the market provide good characteristics to do so. DICOM.RT standard, for radiotherapy information exchange, has been updated to cover IORT particularities and enabling the possibility of dose summation with external radiotherapy. The effect of this planning technology on the global risk of the IORT technique has been assessed and documented as part of a failure mode and effect analysis (FMEA). Having these technological innovations and their clinical evaluation (including risk analysis) we consider that RADIANCE is a very valuable tool to the specialist covering the demands from professional societies (AAPM, ICRU, EURATOM) for current radiotherapy procedures.
© Translational Cancer Research. All rights reserved. Artículo firmado por más de 10 autores. This work was supported by the Spanish Ministry of Science and Innovation, currently integrated in the Ministry of Economy, under grants PSE-300000-2009-5, IPT-300000-2010-003, IPT-2012-0401-300000, TEC2010-21619-C04, PI08/90473, PI09/90628, PI11/01659, PI11/02908, and FPA2010-17142, by CDTI CENIT Program (AMIT Project), and by Comunidad de Madrid grant ARTEMIS SP2009/DPI-1802.; We also acknowledge the European Union for their funding through the European Fund for Regional Development (ERDF). Finally, we would like to give a special and emotive acknowledgement and tribute to Prof. Juan Antonio Santos Miranda. Without his selfless exhausting work and brilliant knowledge this project would have never been accomplished.
1.Gunderson L, Willett C, Harrison L, et al. eds. Intraoperative irradiation: Techniques and Results. New York: Humana Press, 2011. 2. Calvo FA, Meirino RM, Orecchia R. Intraoperative radiation therapy first part: rationale and techniques. Crit Rev Oncol Hematol 2006;59:106-15. 3. Krengli M, Sedlmayer F, Calvo F, et al. ISIORT pooled analysis 2013 update: clinical and technical characteristics of intraoperative radiotherapy. Transl Cancer Res 2014;3:48-58. 4. Sole CV, Calvo FA, Ferrer C, et al. Bibliometrics of intraoperative radiotherapy: analysis of technology, practice and publication tendencies. Strahlenther Onkol 2014;190:1111-6. 5. Beddar AS, Biggs PJ, Chang S, et al. Intraoperative radiation therapy using mobile electron linear accelerators: report of AAPM Radiation Therapy Committee Task Group No. 72. Med Phys 2006;33:1476-89. 6. Medical Exposure Directive (MED). COUNCIL DIRECTIVE 97/43/EURATOM of 30 June 1997. Available online: http://eur-lex.europa.eu/legal-content/ GA/TXT/?uri=CELEX:31997L0043 7. Veronesi U, Orecchia R, Maisonneuve P, et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol 2013;14:1269-77. 8. Vaidya JS, Joseph DJ, Tobias JS, et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet 2010;376:91-102. 9. Vaidya JS, Wenz F, Bulsara M, et al. Risk-adapted targeted intraoperative radiotherapy versus wholebreast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet 2014;383:603-13. 10. Rosi A, Viti V. Istituto Superiore di Sanità Guidelines for intra-operative radiation therapy. 2003, ISTISAN 03/1 IT. 11. Ma CM, Coffey CW, DeWerd LA, et al. AAPM protocol for 40-300 kV x-ray beam dosimetry in radiotherapy and radiobiology. Med Phys 2001;28:868-93. 12. Nag S, Martinez-Monge R, Nieroda C, et al. Radioimmunoguided-intraoperative radiation therapy in colorectal carcinoma: a new technique to precisely define the clinical target volume. Int J Radiat Oncol Biol Phys 1999;44:133-7. 13. Prescribing, recording, and reporting electron beam therapy. ICRU report no. 71. Oxford: Oxford University Press, 2004. ISBN 0198566786. Available online: http:// jicru.oxfordjournals.org/content/4/1/5. 14. Digital Imaging and Communications in Medicine (DICOM) Supplement 11 Radiotherapy Objects, Final Text, NEMA Standards Publication, 1997. 15. Desco M, López J, Calvo FA, et al. Simulated surgery on computed tomography and magnetic resonance images: an aid for intraoperative radiotherapy. Comput Aided Surg 1997;2:333-9. 16. Hogstrom KR, Mills MD, Almond PR. Electron beam dose calculations. Phys Med Biol 1981;26:445-59. 17. López-Tarjuelo1 J, Lardiés M, García-Romero A, et al. Pencil Beam for Electron Intraoperative Radiotherapy. Early Results From Profile and Percentage Depth Dose Modelling. Med Phys 2010;37:3206. 18. Calama Santiago JA, Garcia-Romero A, Lardiés Fleta D, et al. 25 poster Pencil Beam for electron intraoperative radiotherapy. Results of dose calculations in heterogeneous media. Radiother Oncol 2011;99:S13. 19. Guerra P, Udías JM, Herranz E, et al. Feasibility assessment of the interactive use of a Monte Carlo algorithm in treatment planning for intraoperative electron radiation therapy. Phys Med Biol 2014;59:7159-79. 20. Walters BR, Kawrakow I, Rogers DW. History by history statistical estimators in the BEAM code system. Med Phys 2002;29:2745-52. 21. Ibáñez P, Vidal M, García-Marcos R, et al. Validation of a phase space determination algorithm for intraoperative radiation therapy. Radiother Oncol 2014;111:331. 22. Herranz E, Herraiz JL, Ibáñez P et al. Phase space determination from measured dose data for intraoperative electron radiation therapy. Phys Med Biol 2015;60:375 23. Vidal M, Ibáñez P, Cal González J, et al. Hybrid Monte Carlo dose algorithm for low energy X-rays intraoperative radiation therapy. Radiother Oncol 2014;111:117-8. 24. Pascau J, Santos Miranda JA, Calvo FA, et al. An innovative tool for intraoperative electron beam radiotherapy simulation and planning: description and initial evaluation by radiation oncologists. Int J Radiat Oncol Biol Phys 2012;83:e287-95. 25. Calvo FA, Villanueva-Martinez J, Sallabanda M, et al. Imaging in treatment planning opportunities for intraoperative electron irradiation (IOERT): developments in the context of radiance system. Accepted for publication. Rep Pract Oncol Radiother 2013;19:239-45. 26. Calvo FA, Sole CV, González ME, et al. Research opportunities in intraoperative radiation therapy: the next decade 2013-2023. Clin Transl Oncol 2013;15:683-90. 27. Calvo FA, Sallabanda M, Sole CV, et al. Intraoperative radiation therapy opportunities for clinical practice normalization: Data recording and innovative development. Rep Pract Oncol Radiother 2013;19:246-52. 28. Calvo F, Sole C, Herranz R, et al. Intraoperative radiotherapy with electrons: fundamentals, results, and innovation. Ecancermedicalscience 2013;7:339. 29. Siewerdsen JH. Cone-Beam CT with a Flat-Panel Detector: From Image Science to Image-Guided Surgery. Nucl Instrum Methods Phys Res A 2011;648:S241-S250. 30. García-Vázquez V, Marinetto E, Santos-Miranda JA, et al. Feasibility of integrating a multi-camera optical tracking system in intra-operative electron radiation therapy scenarios. Phys Med Biol 2013;58:8769-82. 31. López-Tarjuelo J, Bouché-Babiloni A, Morillo-Macías V, et al. In vivo dosimetry in intraoperative electron radiotherapy: microMOSFETs, radiochromic films and a general-purpose linac. Strahlenther Onkol 2014;190:1060-5. 32. Andersen C, Winding TN, Vesterby MS. Development of simulated arthroscopic skills. Acta Orthop 2011;82:90-5. 33. Gascón J, Espadero J. Pérez A, et al. Fast deformation of volume data using tetrahedral mesh rasterization. In: Proc. of the ACM SIGGRAPH/Eurographics Symposium on Computer Animation 2013:181-5. 34. Torres R, Espadero JM, Calvo F, et al. eds. Interactive Deformation of Heterogeneous Volume Data. Biomedical Simulation - 6th International Symposium, ISBMS 2014, Strasbourg, 2014. 35. Jimenez-Carretero D, Fernandez-de-Manuel L, Pascau J, et al. Optimal Multiresolution 3D Level-Set Method for Liver Segmentation incorporating Local Curvature Constraints". Proc 33rd Annual International IEEE EMBS Conference. Boston, USA, 2011:3419-22. 36. Fernandez-de-Manuel L, Wollny G, Kybic J, et al. Organfocused mutual information for nonrigid multimodal registration of liver CT and Gd-EOB-DTPA-enhanced MRI. Med Image Anal 2014;18:22-35. 37. Law MY, Liu B. Informatics in radiology: DICOM-RT and its utilization in radiation therapy. Radiographics 2009;29:655-67. 38. Douglas BG, Fowler JF. The effect of multiple small doses of x rays on skin reactions in the mouse and a basic interpretation. Radiat Res 1976;66:401-26. 39. Herskind C, Steil V, Kraus-Tiefenbacher U, et al. Radiobiological aspects of intraoperative radiotherapy (IORT) with isotropic low-energy X rays for early-stage breast cancer. Radiat Res 2005;163:208-15. 40. López-Tarjuelo J. Failure mode and effect analysis oriented to risk-reduction interventions in intraoperative electron radiation therapy: The specific impact of patient transportation, automation, and treatment planning availability. Radiother Oncol 2014,113:283-289.