Commissioning of a Novel, Automated Offline Adaptive Radiotherapy Assessment Software
Abstract
Purpose
Dose tracking and image review are paramount in offline adaptive radiotherapy (ART); observable changes in patient anatomy, setup, and dose can trigger plan modifications with the intent of improving clinical outcomes. Radformation’s ChartCheck Adaptive, a novel, offline ART assessment software, provides clinicians with quantitative dosimetric and volumetric insights through an automated workflow that incorporates in-vivo Monte Carlo (MC) dose calculation on synthetic CT scans derived from routine CBCT imaging. We designed a commissioning process for ChartCheck Adaptive for clinical use.
Methods
To assess the system's reproducibility and ability to catch major clinical changes, two sets of phantom studies were performed on static and changing anatomy. First, TG-119-based prostate and C-shape VMAT plans were generated and delivered repeatedly without change on solid water and processed in ChartCheck Adaptive to assess consistency of output metrics. Next, a VMAT plan was designed for unilateral neck treatment on RANDO phantom (Radiology Support Devices, Inc.). A tissue-equivalent putty was added to the neck, with volume adjustments made prior to treatment to test how the system assesses anatomical changes. Treatment data was automatically imported by ChartCheck Adaptive to perform synthetic CT generation and MC dose calculation. Results were compared to treatment plans in Varian Eclipse.
Results
ChartCheck Adaptive accurately calculated dose for the TG-119 plans. Compared to Eclipse, PTV D95% matched within 0.6% for both PTVs across delivered courses. For the neck plan, ChartCheck constraint analysis signaled significant loss of coverage to the PTVeval (D95% reduced by 13%) and increase in Body D1cc (6%), respectively, in Eclipse. ChartCheck noted the sharp dosimetric changes, signifying the need for ART.
Conclusion
The results of the phantom studies suggest that ChartCheck Adaptive provides consistent results for static, repeated measurements, and provides key in-vivo delivery information to inform clinicians of major anatomical changes.