sabr lung workflow at arc - elekta › dam › jcr:e68f681b-1e64-4bdf... · sabr lung workflow at...
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SABR lung Workflow at ARCThere’s more than one way to skin a Cat…
Luis Munoz ∙ Tiffany Knight ∙ Anup Kumar
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Background
• Stereotactic team consisting of representatives from all
craft groups → credentialed internally
• SABR/SRS - Lung, liver, brain, spine → 70 SABR lung
• Majority SABR lungs VMAT and 6FFF
• 5 x Elekta Agility BLDs
– 1 with Hexapod all others have precise
– 3 FFF
– XVI 5.0.3 – Symmetry, Intrafraction
– ABC3 capable – currently not gating
• Completed GC internal and external audits and trials
throughout for credentialing/accreditation
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SABR Lung – Clinical intent
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Deliver tumoricidal
doseReduce
toxicity to OARS and
normal tissue
exposure
Ablative dose – Precision – Accuracy
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Elekta Versa HD
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• 2014 a whole new world…
– VMAT and FFF
– Hexapod 6DOF couch
– MV & kV imaging + 4D CBCT
Improve patient outcome and experience
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• Key aspects
– Appropriate
TPS/dose engine
– Immobilisation
– Target delineation
– QA procedures
– Motion management
SABR Program Inception - 2014
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Sans 4D Computed Tomography
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• Dose escalation → tight treatment margins
– Too large → introduce complications to normal tissue
– Too small → Inadequate dose coverage
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End to End verification
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Motion management - Investigation
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End to End Results
Timeliness?
Efficiency?
Fully leveraging available
technologies?
What about the patient?
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Elekta Symmetry – silver bullet
• Key tool for end to end verification
• Offered imaging on a relevant
platform
• No need for external markers or
complex set-up
• Powerful tool for margin verification
and reduction
• On treatment day → uninterrupted
patient set-up and treatment
delivery
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Current workflow with tweaks…
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Standard CT image Symmetry Acquisition
Physics QA – IC and MapCheck
RO target
Patient Treatment
MIM workflow RO appraisal and
Planning
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In conclusion…
• Symmetry was the key piece of
equipment for validating SABR
lung protocol
• Symmetry has been a valuable
tool in achieving quality and
safety in current practice
• RTs spruik the ease of use for
matching and registration for
treatments
• Positive feedback from
Oncologists incorporating MIM
maestro
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Future work…
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The great flooding of 2017
- In the hours between 22:00-23:00…
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Future work…
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• Wide bore
• 4D capability
• Metal artifact
reduction
• Investigation of 4D
image acquisition
across two
platforms
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Symmetry in action…
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