automated planning
Transcription
automated planning
ADVANCING CANCER TREATMENT RayStation is more than a treatment planning software. It is, first and foremost, a team of experts dedicated to bring scientific advancements in radiation therapy faster to the clinical world. Big and small advancements are of equal importance. What matters is to help you improve patient outcome and access to care. • Compatibility with most linear accelerators, OIS, and 3rd party QA. • Workflow-driven design, user experience is an integral part of our product development. • Extraordinary speed and accuracy that make planning easier and more effective. • Robust Optimization for all treatment techniques. • Real-time evaluation of clinical trade-offs with rayNavigator. • Automatic creation of Fallback Plans for all your machines with rayFallback. • Flexibility beyond the standard user interface with scripting, templates and protocols. • Advanced particle therapy expertise, with RayStation in use at several proton sites worldwide. • Driven to provide Cutting Edge technologies now, such as Adaptive therapy and Automatic Planning. • Partnership is key, as we focus on scientific collaboration, training and support of our customers. 2 RaySearch dedicates a large share of its revenues to Research and Development. The two, from the very beginning, have been distinctly separated. Development focuses on producing a new RayStation version every year while Research has more flexibility to work on long-term innovative projects without the time of delivery pressure. RaySearch has always strived to bring the latest innovation in the field of radiation therapy to clinical practice. As an example RaySearch’s IMRT optimization solution, created in 2000, is the most used worldwide. That same progressive philosophy has fueled RaySearch and driven the launch of its own treatment planning platform. RayStation was therefore developed as the nextgeneration TPS, with a built-in time dimension, capable of handling not only today’s needs, but also those of tomorrow such as adaptive therapy. The system also offers a big potential to automate several aspects of treatment planning so that you can spend your valuable time where it is most needed. RaySearch believes adaptive planning intelligently combined with automated planning will bring a bright future to radiation therapy. As a RayStation user you can be a part of that future now and advance cancer treatment with us. RayStation was the answer to the need for a treatment planning system (TPS) to handle adaptive therapy and other advanced techniques. 3 AUTOMATED PLANNING Fallback Planning - rayFallback Automatic Breast Planning - rayAutoBreast Scripting -IronPython PROTON PLANNING IMPT Optimization (PBS) - rayPencilScanning Uniform Scanning - rayUniformScanning Double Scattering - rayPassiveScattering PLANNING 3D-CRT - rayConformal IMRT - rayIntensity VMAT - rayArc Electron - rayElectronPlanning ADVANCED OPTIMIZATION TOOLS Multi-Criteria Optimization - rayNavigator Radiobiological Optimization and Evaluation - rayBiology PATIENT MODELLING rayAnatomy ADAPTIVE PLANNING Deformable Registration - rayDeformable Dose Tracking - rayTracker Adaptive re-Planning - rayAdaptive PLAN EVALUATION rayEvaluation A WORLD WHERE YOU ARE IN CONTROL RayStation has been designed with the user and the workflow in mind. As a user you feel “right at home” and you can plan in a more intuitive and effective way. The design speaks for itself, once you try it there is no way back. Well, actually there is. RayStation features an UNDO/REDO option because we believe you should be able to jump back and forth through multiple actions. 4 5 ONE SYSTEM. ENDLESS POSSIBILITIES. We optimize for all treatment techniques with our robust algorithms that account for density and patient setup uncertainties. rayOptimizer, RayStation’s ultrafast multi-purpose optimization engine, can solve virtually any posed optimization problem within radiation therapy using all degrees of freedom of the treatment unit. 3D-CRT rayConformal provides conventional 3D-CRT, forward treatment planning, with manual and automatic tools to create conformal treatment using treat-and-protect, beam weighting, wedges etc. It also makes modern inverse planning techniques available for creating conventional 3D-CRT plans. 3D-CRT plans can be automatically optimized with respect to any combination of segment shapes, segment monitor units, collimator, gantry and couch angles. This makes the creation of high quality 3D-CRT plans faster and more consistent. “ 6 IMRT VMAT ELECTRON rayIntensity provides state-of-the-art tools to design and optimize IMRT treatment plans. Through direct optimization of step-and-shoot segments, IMRT plans of high quality and with a minimum number of segments are created. This increases the overall treatment quality by speeding up both the planning and delivery process. Conversion for Sliding Window (i.e. dynamic MLC) IMRT is also supported. With rayArc, RayStation offers design and optimization of single or multiple-arc plans. VMAT is planned through an optimization procedure (inverse planning) where objectives and constraints for the desired dose are defined, and the system produces the plan that best matches these criteria within the limitations of the treatment machine. That means the optimized plan is directly deliverable with no quality-degrading post processing required. With rayElectronPlanning working with mixed electron and photon plans is straightforward by the application of multiple coupled or independent beams sets in a single treatment plan. The Graphical User Interface (GUI) offers a range of useful tools and a 3D visualization of the treatment setup. With the 3D view the physical perimeter of the selected applicator, in the patient geometry, can be inspected to assist the planner in collision avoidance. The electron module supports automatic generation of the cutout shape by the same treat and protect tools used in the 3D-CRT module. The cutout can also be created and edited by a manual brush tool. The system is fast and easy to use and gives us the possibility to create high quality IMRT plans. Our drivers are to provide high quality robust treatment plans. This is dependent on an efficient workflow. To use time in a smart way we have to automate things that can be automated. By employing software to perform standard operations, our specialists can focus on more creative tasks.” - Rik Westendorp, Medical Physicist, RISO Radiotherapeutic Institute, Deventer, Holland. “ Here at L’Hôpital Riviera, RayStation is our sole Treatment Planning System. Approximately 80% of our patients are treated with VMAT and we find that the plans are of excellent quality.” - Oscar Matzinger, MD, Chief Radiation Oncologist, l’Hôpital Riviera, Switzerland. 7 REVOLUTIONIZING COMPUTATION SPEED With RayStation you benefit from unrivalled computation speed that should radically transform your treatment planning process. ACCURATE AND EFFICIENT CONTOURING As the computation time is measured in seconds rather than minutes, you can efficiently produce several competing treatment plans to assess different trade-off situations instead of opening a second case or going on a break during computations. Optimization and clinical dose computation for a standard prostate IMRT case is done in less than ten seconds and in approximately 30 seconds for a more complex 9-beam IMRT head and neck case on a high resolution 2mm dose grid. * Depending on the modality, RayStation uses different beam models and dose calculation engines to quickly and accurately calculate dose. In the latest release CC-dose algorithms have been rewritten for CPU and GPU to further speed up dose computation. We’re talking SECONDS! The rayAnatomy module in RayStation contains tools for creating a rich and accurate representation of the patient anatomy used in the treatment planning process. not minutes ... *results may vary as dose computation time depends on several variables. IMRT, 7 BEAM PROSTATE 3 MM GRID 0.7 MILLION VOXELS 40 ITERATIONS IMRT, 9 BEAM HEAD & NECK 3 MM GRID 2.1 MILLION VOXELS 60 ITERATIONS 8 VMAT PROSTATE 3 MM GRID 0.7 MILLION VOXELS 40 ITERATIONS Advanced manual and semi-automatic contouring RayStation includes a comprehensive tool set for manual contouring such as polygon, freehand, paintbrush/2D rollerball and local deformations (push-and-pull). It also supports regions-of-interest (ROI) with voxel-based triangulation, 4D visualization and boolean algebra for combining ROIs. Templates can be saved with or without the geometries included which can then be recalled on future patients. Model-Based Segmentation (MBS) VMAT, DUAL ARC HEAD & NECK 3 MM GRID 2.1 MILLION VOXELS 80 ITERATIONS MBS is a semi-automatic tool for delineation of regions-ofinterest based on biomechanical and statistical information about organs. Volumetric images are segmented semiautomatically, utilizing a combination of grey-scale g radients and models with knowledge of how organs may change shape. It is possible to delineate multiple regions of interest simultaneously which increases throughput, accuracy and reproducibility. Atlas-Based Segmentation, a versatile auto-segmentation tool The idea is to take existing data from the clinic database to create templates with multiple image sets – atlases – and use these to segment new image data by locating the best matching atlas through rigid image registration and apply deformable registration to deform the ROI and POI geometries onto the new image set. The geometries contained in each atlas can be manually contoured or generated with MBS. If MBS ROIs are available in the template they may be automatically adapted after atlas-based initialization is completed. Derived ROIs created from a template will automatically be updated after initialization and MBS adaptation. Image Registration/Fusion Rigid and deformable registration of multi-modality imaging CT, CBCT, PET or MR is fully supported and integrated. It can be used for showing fused images as reference while contouring, and for mapping regions or points of interest between image sets. 9 EVALUATE CLINICAL TRADE-OFFS IN REAL TIME A constant difficulty encountered in radiation therapy treatment planning is the patient-specific trade-off between ensuring appropriate tumor coverage and avoiding excessive radiation to healthy structures. Such trade-offs are conventionally resolved by manually altering an optimization problem formulation and re-optimizing the treatment plan multiple times. Trial and error of this form is time consuming and even if a treatment plan deemed satisfactory is found, it is not clear if better treatment options exist for the current patient. Instead rayNavigator, RayStation’s Multi-Criteria Optimization’s tool (MCO), generates a set of relevant treatment plans that are Pareto optimal with respect to the user-specified set of trade-offs, objectives and constrains. These Pareto optimal plans are feasible with respect to all constraints where no objective can be improved without impairing another one. Based on these plans, the planner or physician can navigate sliders in real time to balance between conflicting clinical goals. “ The typical trade-off in radiation treatment planning is target coverage versus critical structure sparing. Traditional treatment planning proceeds by a trial and error fashion, where the planner tries to guess at system optimization parameters that might strike the best balance amongst the multiple conflicting goals. But this process can be quite time consuming. Multi-Criteria Optimization simplifies this by presenting the planner with a set of sliders which allow them to surf across the trade-off space and quickly decide on the right balance.” - David Craft, Assistant Professor at the Department of Radiation Oncology, Massachusetts General Hospital in Boston. CLINICAL BENEFITS: • Planners and physicians can find solutions they didn’t know existed • Physicians tend to select plans with higher OAR sparing at the expense of slightly under dosing target as they can see exactly where it happens • The total treatment planning time is significantly reduced without compromising plan quality • Planners with limited experience and knowledge can produce clinically acceptable plans 10 11 EXPERIENCE THE FULL POTENTIAL OF PARTICLE THERAPY Particle therapy is the most advanced form of radiation therapy and offers many benefits compared to conventional radiation therapy especially with respect to conformance of the dose to the target region and sparing of healthy tissue. RaySearch put strong focus in this area to offer full optimization of physical dose as well as biological effect of a large variety of particle therapy types. The sharp dose distribution, main benefit of proton therapy, also means that proton treatments are very sensitive to errors in the patient setup and density calibration. RayStation includes an elaborate algorithm for robust optimization to make the treatment plans robust against these uncertainties. Other issues are interfractional motion resulting in interplay effects. Evaluation of these effects and methods to mitigate “ RayStation offers a much needed improvement of the treatment planning environment for proton radiation therapy. Using RayStation helps us to improve our efficiency in producing highly optimized treatment plans for our patients and offer advanced plan evaluation tools to the clinical team. RayStation has allowed us to ramp up our patient numbers rapidly including very complex cases at a very early stage of operations. ” - Niek Schreuder, VP and Chief medical Physicist, Provision Proton Center, Knoxville, Tennessee, USA. them are crucial, and RaySearch has developed tools for this for this purpose, such as repainting. The proton module in RayStation supports a variety of proton treatment techniques and beam lines, such as pencil beam scanning (PBS), uniform scanning (US) and double scattering (DS). rayUniformScanning and rayPassiveScattering provide modern tools for efficient planning of Uniform Scanning and Double Scattering to help the user create clinical treatment plans and subsequent milling machine instructions including the automated creation of compensators and blocks with manual editing possibilities. rayPencilScanning provides tools for designing and optimizing actively scanned pencil beam proton treatment plans like IMPT, single field uniform dose and distal edge tracking. All plans are directly deliverable after optimization, since the minimum spot weight is taken into account in the optimization. Since RayStation is a complete treatment planning system, that supports many different modalities, simultaneous optimization with photons is possible. Also the Fallback planning module provides the possibility to convert a proton plan into a photon plan ensuring no interruption in the treatment. 12 13 AUTOMATED PLANNING FOR IMPROVED CARE FALLBACK PLANNING: TREATMENT GOES ON NO MATTER WHAT At RaySearch, we aim to automate parts of the treatment planning process as we truly believe it will help you improve patient outcome and access to care. We automate standard procedures so that you can spend your valuable time on complex cases and provide more personalized care to the patients who need it most. rayFallback is a tool for creating additional plans to be used in a contingency situation, enabling a patient to be treated on another machine, possibly with a different modality and/or treatment technique, in case the original machine is unavailable. The fallback plans are automatically generated after plan approval based on previously created protocols. No user interaction is required as this is a fully automated plan creation process. If needed the created fallback plans can still be modified manually after the automatic generation. Plans of any modality, including Proton plans and Tomotherapy plans, can be converted to photon plans with various modalities, such as; 3D-CRT (rayConformal), IMRT (rayIntensity) and/or VMAT (rayArc). Fallback planning uses a dose mimicking function to replicate the DVHs of a given plan, but with a different machine or treatment modality. AUTOMATED BREAST PLANNING RayStation’s automated breast planning solution, rayAutoBreast is the first step in our ambition to automate standard procedures. rayAutoBreast was initially developed at Princess Margaret Hospital (PMH) in Toronto, Canada. Between 2009 and 2012, PMH ran a largescale clinical study to evaluate the performance of their automated treatment planning methodology for tangential breast intensity modulated radiation therapy (IMRT). Automated planning was used in 97% of the patients receiving tangential breast IMRT during the time interval studied i.e. in 1661 patients. In their study results, PMH observed an increase in clinical acceptance using this fully automated method. They conclude that the method can add tremendous efficiency, standardization, and quality to the current treatment planning process and that its use will allow faster adoption of IMRT together with increased access to care improvements for breast cancer patients.1 The rayAutoBreast module provides tools for automated generation of tangential breast IMRT plans using heuristic optimization and includes features such as: • Automatic detection of radio-opaque markers defining the breast • Automatic contouring of all the relevant target and risk organs • Automatic setup of beams, including heuristic optimization of gantry and collimator angles • Automatic creation of objective functions, optimization and segmentation settings and clinical goals 1. T.G. Purdie et al., “Automated Planning of Tangential Breast Intensity-Modulated Radiotherapy Using Heuristic Optimization”, Int.J. Radiation Oncology Biol.Phys.Vol. 81, No.2, pp. 575-583, 2011. After creation, the fallback plans can be compared and evaluated using a number of visual tools (DVH curves, dose statistics, dose difference and clinical goals). A fallback plan can then be approved and used for delivery in future fractions. It is also possible to convert back to the original plan, in case the original machine is repaired. Finally, with dose summation tools, two plans can be combined using their delivered fractions so that actual composite dose can be visualized on the patient data set. The Fallback planning module can drastically reduce planning time in emergency situations when a machine is down allowing the patients´ treatment to continue and reducing stress on staff. Fallback planning can also be used to validate the modality selected for treatment, assuring that the most efficient approach is utilized for each patient. PLAN GENERATING PROTOCOLS RayStation supports several tools such as templates and plan generation protocols to automate parts of the planning process. A protocol is a list of plan generation steps which can be applied automatically. Examples of plan generation steps include atlas based segmentation, plan creation, set dose grid resolution, add beams, add optimization functions and add optimization settings. When a protocol is run it will automatically create a plan using the included steps, which drastically reduces the planning time. 14 15 TAKE THE RADIOBIOLOGICAL EFFECTS INTO ACCOUNT EVALUATE YOUR PLANS SMOOTHLY AND SIMULTANEOUSLY The use of radiobiological response models brings the planning process closer to the intent to create a plan with the highest possible probability of curing the patient while keeping the risk of complications to the surrounding healthy tissue as low as possible. The philosophy is to use the biological models to reveal effects that are difficult to understand from the dose distribution alone. rayBiology provides tools for both biological optimization and evaluation. Optimization tools provide the ability to optimize directly on the biological indices in combination with physical dose-based optimization functions. It makes it possible to configure optimization problems which more closely describe the clinical intentions, such as minimizing normal tissue complication probabilities subject to a guaranteed homogenous target dose within a specified standard deviation. rayEvaluation is a comprehensive toolbox for evaluation and comparison of treatment plans and plan approval. From a number of predefined layouts, dose distribution, dose statistics, clinical goals and dose volume histograms of up to three different plans can be simultaneously compared. Dose can directly be computed on additional image sets and summed up using the deformable registration provided in rayDeformable. For evaluation of robustness dose can also be computed for a density perturbation or isocenter shift. Evaluation tools includes Tumor Control Probability (TCP) and Normal Tissue Complication Probability (NTCP) models which can be combined with tissue repair and tumor growth models. The biological tools are integrated in the plan evaluation module. That way the physical properties of the existing plan can easily be investigated if unexpected differences in the biological response are observed between different plans. In addition there is a Biological Evaluation module dedicated to the exploration of the biological effects of altering the fractionation schedule of a single treatment plan. 16 17 IMPLEMENT ADAPTIVE RADIATION THERAPY TODAY RayStation was designed from the very beginning with a strong focus on handling the dynamic aspects of radiation therapy. By explicitly representing the time dimension throughout the domain model, RayStation provides the ultimate framework for planning and managing adaptive radiation therapy. When images of the patient in treatment position, from CT, PET/CT, cone-beam CT or MR, are acquired during the treatment course, rayDeformable makes it possible to establish a deformable registration between the new geometry and the planning geometry. Plans can then be re-optimized and adjusted to compensate for dose coverage problems or to adapt to adjusted clinical goals. The replanning options range from simple adaptations such as adjustments of beam weights to complete replanning that involves reoptimization of the intensity modulation. Through rayTracker, this can be used to recalculate, deform and accumulate doses from different fractions in a common geometry, thereby computing the dose delivered to the patient anatomy. RayStation’s adaptive re-planning tools, combined with powerful deformation algorithms, can improve your planning process. These tools allow for more accurate treatment for your patients. If there are deviations from the planned dose distribution that require action, rayAdaptive provides a wide range of adaptive offline or online replanning tools that take into account the accumulated dose and observed deviations of the patient geometry. 18 “ By implementing adaptive radiation therapy we can further improve the precision in our treatments. This requires very sophisticated software tools and RayStation really stands out as the best treatment planning solution on the market for adaptive therapy. I see this as a starting point of a deep collaboration with RaySearch for both clinical and research applications.” - Karsten Eilertsen, MD, Head of Radiotherapy Physics, Oslo University Hospital 19 SCRIPTING: YOUR IMAGINATION IS THE LIMIT Scripting in RayStation provides automation, connectivity and flexibility beyond the standard user interface. The script language, IronPython, is a complete programming language that let the user access all capabilities of the operating system and other applications, for instance to write files, start processes, communicate with other computers, and control other scriptable applications such as Microsoft Office or .NET. Automation Through scripting, the clinic specific procedures can be automated. For instance, a script can check for properties in a plan such as small segments, disconnected target volumes, hotspots, undesirable gantry and couch angles, and based on this information, display a warning message or create a report. “ Our commissioning results were within 2% at 2mm, well within the industry standard. When I work on beam commissioning in RayStation I remember why we bought it. The results are so beautiful, it makes me happy to be a physicist.” -Patricia Sansourekidou, Medical Physicist, Health Quest Radiation Oncology. COMMISSION CHECK GO Connectivity Scripting provides a way to customize the interaction between RayStation and other systems for scenarios where DICOM is not sufficient. Flexibility Scripting can be used to create capabilities which are not specifically available in the standard interface. For instance, automatic marker detection, export of images of non-standard dose planes and images of all control points can be utilized as desired. Scripting puts power in the hands of the clinicians to use RayStation in a way that best serves the needs of their department. Scripting on multiple patients- a potential research tool Through its ability to execute over multiple patients, scripting is an ideal tool for retrospective data analysis and for evaluating new treatment techniques. For instance, a script can go through a cohort of patients and systematically alter some parameter and record the effect or just extract data such as dose statistics. 20 “ Full compatibility with any existing modality and complete hardware independence RayStation is compatible with all linear accelerators commercially available. RayStation’s data model is fully compatible with the DICOM standard, allowing the system to easily import and export any DICOM RT object. This includes m ultiple CT, MR and PET image series, 4D-CT, structure sets, doses and RT Plan and RT Ion treatment plans. In addition, RayStation communicates with other data sources such as IHE RO, DICOM senders and receivers or DICOM archives, using either file transfer, DICOM storage service classes or DICOM query/retrieve. Akron General was able to streamline these processes while also avoiding human input errors, making the entire process less intense and time-consuming on the dosimetrist.” RayStation includes accurate and fast dose calculation services for any treatment modality. In the latest version, dose calculation speed has been increased further by utilizing the GPU. A dedicated graphical user interface rayPhysics is available for photon and electron modeling. This workspace allows for evaluation of models as well as treatment planning tools prior to commissioning a machine. Quality Assurance The module for Quality Assurance preparation allows the user to easily transfer the clinical plan to a phantom and recalculate dose, either beam by beam or for the entire plan. The output from the module is the dose distribution in DICOM format or a 2D dose plane, a QA report and optionally a new treatment plan with collapsed gantry angles. Key Features • Collapsed cone photon dose calculation engine for high accuracy • Singular value decomposition photon dose calculation engine for real-time purposes • State-of-the-art direct Monte Carlo code for electrons • Highly optimized proton pencil-beam algorithm with 19-fold multi tracing per spot and separate handling of the nuclear halo effect - Jeremy Donaghue, Chief physicist at Akron General Health System, Ohio, USA 21 MORE THAN SERVICE - A COMMUNITY RAYSTATION SUPPORT COMMUNITY At RaySearch, our philosophy is that everyone is part of the support team. We are proud that we have developed an organization with all types of experts; programmers, scientists, physicists, researchers, dosimetrists, interface designers, etc. In our online community, you can interact with these people to get your questions answered and to share your thoughts and needs. The online community is also an easy way to interact with RayStation users. You can ask questions, open cases, request enhancements and browse the solution database to find answers to frequently asked questions. All cases logged in the portal are investigated by a RayStation expert to provide the best solution to your problem. 22 We listen to our customers and try our best to accommodate enhancement requests for future versions of the software. All software upgrades already licensed are completely free of charge with a valid service contract, ensuring you can enjoy new improvements as soon as they are released. RaySearch will always work with you to help you implement the advanced technologies and workflows that are provided in RayStation. And if you prefer the traditional means of communication, you can rest assured that our service team is available via phone and email - worldwide and with real people answering your calls - no automated phone menus to wade through. INSTALLATION USERS’ MEETINGS AND TRAININGS We recognize that implementing a new treatment planning system or replacing an existing platform is not an easy task. Therefore we strive to streamline the installation to ensure it has very little impact on the daily work of the clinical staff. For each installation, RaySearch assigns, as a single point of contact, a project manager who leads a team of experts and communicates with the clinic through every step of the process. RaySearch regularly provides in-house and customized on-site application and physics training for RayStation users. These trainings courses are approved for Continuing Education credits in different countries. Because we want you to be part of the development process, users’ meetings are held regularly where you get to hear about the latest product developments, share best practices with other users, and interact with our management teams. 2,500 CLINICS IN 65 COUNTRIES RaySearch was founded in 2000 as a spin-off from Karolinska Institute in Stockholm, Sweden. The founders are still major shareholders in the company. In less than fifteen years, the company has established a world-leading position in the field of advanced software for radiation therapy and many products have been launched in collaboration with partners. In 2010, RaySearch successfully launched its proprietary treatment planning system, RayStation, now in use in hundreds of clinics. More than 2,500 clinics in over 65 countries are currently using RaySearch’s solutions for their treatment planning needs. This means that hundreds of thousands of cancer treatments are delivered each year utilizing RaySearch’s algorithms and software products. www.raysearchlabs.com RayStation Brochure 2015-02-25