Secondary 3D Dose QA Fully Automated using MOSAIQ's IQ Engine. MOSAIQ User Meeting May Antwerp

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1 Secondary 3D Dose QA Fully Automated using MOSAIQ's IQ Engine MOSAIQ User Meeting May Antwerp

2 Contents Project goal and collaboration Secondary 3D Dose QA project justification Secondary 3D Dose QA project: objectives and results Works in progress Summary and release plan

3 Collaboration Between Elekta and Erasmus MC (Rotterdam) development in code base of MOSAIQ (2.5) Erasmus MC and Elekta developers testing and clinical implementation in Erasmus MC using Erasmus MC's Plan100 experience (presentation by Wilco S.) Currently working on adding a second collaboration site (possibly St James s Institute of Oncology, Leeds)

4 Project goals 1. Independent MU check MU check based on 3D dose comparison comparison with plan in MOSAIQ fully automated 2. Plan consistency check track changes in MOSAIQ based on 3D dose comparison fully automated 3. Validation and clinical implementation without waiting for formal MOSAIQ release

5 Radiotherapy process Treatment preparation processes Prep. cloud RT-Plan Portal Imaging XVI/TheraView MOSAIQ Approvals dosimetrist physicist physician RT-board

6 Disconnect between RT-Plan and treatment data RT-Plan MOSAIQ Disconnect treatment data

7 Objective: fully automated 3D dose comparison CT RT-SS RT-Plan RT-Dose TPS RT-Plan RT-Dose treatment data Results before, during and after fractionated treatment timed and/or on request

8 Basic requirements 1. Software platform based on or interact with the MOSAIQ data (BOM) highly customizable components (user defined workflows) MOSAIQ's IQ Engine (Workflow Manager) 2. Independent 3D dose calculation engine independent: does not share code, source data or algorithms with the TPS dose engine(s) 3. DICOM PACS data repository with the TPS data (CT, RT-SS, etc.)

9 Service Bus Dose QA architectural overview GPU dose engine MOSAIQ Dose analysis Reporting tools IQ Engine... Rx2Dcm PDF Gamma Bio. (indep.) PACS com. DVH (indep.)... external services/programs IQ Activities to deploy Dose QA

10 MOSAIQ IQ Engine Activities Examples: Rx Site to DICOM PACS Echo, Query/Retrieve, read DICOM object Create PDF document Send Patients on treatment / Rx Sites scheduled for treatment Execute external process......with more to follow

11 MOSAIQ IQ Engine Trigger Points Treatment field definition Also web service trigger point (execute script from external application) Treatment RTP-import...with more to follow

12 Independent 3D Dose Calculation Engine Extracted the Oncentra External Beam (OTP) dose engine to run stand-alone GPU based Collapsed Cone Convolution algorithm Dose calculation based on DICOM RT data verification and I/O CalcDose.exe OTP GPU CC physics data machine data CT, RT-SS, Plan objects 9 beam StepNShoot plan (64 segments) I/O 6 sec. dose calculation 16 sec. Dose objects Total 22 sec.

13 CalcDose.exe

14 DICOM (TPS) Data Storing your reference data in DICOM RT format in a PACS is essential!" Monaco/XiO Automated DICOM export of all clinical plans 08:00 PM PACS

15 Dose comparison strategies 1. Compare "TPS Dose" (primary) with "MOSAIQ Dose" (secondary) Detect changes in plan after import in MOSAIQ Detect changes (differences) in primary or secondary dose engine Replace (manual) independent MU check Need to accurately asses expected differences between primary and secondary dose engines (possibly per treatment site) 2. Compare "MOSAIQ Dose" (secondary) with "MOSAIQ dose" (secondary) Detect changes in MOSAIQ plan between first and most recent version Both secondary dose engine: all differences must be accounted for 3. Compare TPS or MOSAIQ Dose with MOSAIQ treatment record (secondary) Calculate dose based on what is recorded by the accelerator/mosaiq Also detect overrides, machine malfunction(s), etc. Post treatment QA (offers automatic dose accumulation service) Display accumulated dose on CBCT/(follow-up) CT = operational = works in progress

16 Current clinically running IQ Scripts 1. Independent MU Check Script 2. Plan Consistency Check Script

17 Independent MU Check workflow Primary vs. Secondary RxSite2DICOM RT-SS UID RTPlan object RT-SS object CT objects Secondary DOSE objects Δ RESULT PACS Primary DOSE objects

18 Results: daily run for all new IMRT plans

19 Plan Consistency Check workflow Secondary vs. Secondary RTPlan V0 RT-SS object CT objects RTPlan V1 Secondary DOSE objects Δ Secondary DOSE objects RESULT V0 V1

20 Plan Consistency Check for 17 (Prostate IMRT) cases Secondary vs. Secondary dose

21 Fully Automated Daily MU Check (Erasmus MC) Clinical environment Shadow environment Backup, restore and conversion 11:00 PM Dose QA Script import Start MOSAIQ (dev. ) Execute IQ Script (web service) QA Rx Sites scheduled for treatment 01:00 AM Results

22 Independent MU Check "on the fly"* Shadow environment Approved plan Auto-import 2.5 Run MU check for imported plan Send MU Check result to physics * works in progress

23 Closer look at the independent MU Check What does an MU Check tell us? two dose distributions are on top or within expectable range of each other What does an MU Check NOT tell us? - how does the dose distribution compare to similar plans/protocols? - do we exceed the (physical) dose limitation of a certain organ at risk? - do we exceed some "common sense" dose limitation? - general plan quality

24 Evidence-based QA Structure Distribution* PTV (Prostate Gy) Rectum Bladder analysis of xx ( ?) plans for each treatment protocol... * for Dmean, Dmax, Dx, Vx, etc.

25 probability Where is my plan for this structure?* (Rectum V65 population based histogram) * works in progress V [cm 3 ]

26 QA checks summary Independent 3D MU Check running clinically fully automated (nightly run) all IMRT plans (StepNShoot) 3DCRT plans to follow shortly 3D gamma evaluation to follow shortly MOSAIQ Plan Consistency Check on demand (IMRT plans, 3DCRT soon) 3D gamma evaluation to follow shortly Extremely valuable when checking/upgrading TPS version Real-time MU check & evidence based QA works in progress

27 Release plan for MOSAIQ Currently no release plan exist IQ Engine activities and trigger points will remain in prototype build IQ Engine Designer on-hold come to full "clinical" usage at several sites (solid proof of concept) publish articles on work/results (Erasmus MC) strategy for independent (and remain independent) 3D dose engine(s) start talking about a (potential) release plan