Surface Guided Simulation for Improved Accuracy in Breast Treatments

SGRT US 2024
Samantha Maldonado,
RT(T) Lead Radiation Therapist
AdventHealth Orlando
Adi Robinson,
PhD
DABR Senior Medical Physicist AdventHealth Orlando

2. Surface Guided Simulation
for Improved Accuracy in
Breast Treatments
Adi Robinson Ph.D., DABR
Samantha Maldonado RT(T)
AdventHealth Orlando

3. Disclosures
•None

4. Outline
•CT Simulation
•The “standard” workflow
•Problems
•Surface Guided Simulation - SimRT
•SimRT advantages
•4D/DIBH and respiratory management
•Clinical Examples
•Breast
•Conclusions

5. AdventHealth Florida
•15 Radiation Oncology Centers
•20 Varian Linacs (2 added this year)
•15 CT Scanners (Siemens, GE, Phillips)
•SGRT systems
•6 AlignRT (2 more planned)
•SimRT (2 more planned)
•MapRT
•DoseRT
•PatientID
•Single server Aria and Eclipse system

6. The SGRT Roadmap

7. CT Simulation
•CT simulation is the first step in the RO
treatment workflow.
•It provides the necessary images for
treatment planning and delivery.
•Tumor motion visualization is necessary
in some patients
•Respiratory correlated CT (4DCT)
•Deep Inspiration Breath Hold (DIBH)

8. CT Simulation - The Standard Workflow
•Register patient within the system (CT, RGSC)
•Determine patient orientation based on physician preference
and patient mobility
•Select support and immobilization devices
•Place RGSC block on patient
•DIBH coaching (if needed)
•Acquire appropriate scan

9. CT Simulation - Problems
•Frequent trips in and out of the room to adjust the setup
•RGSC block not visible to the camera
•Multiple attempts at block placement to match patient’s breathing
•The block is not stable on the patient
•Other support devices in the way of the RGSC block
•No visual aid to the patient or staff inside the room
•Sometimes compromise needs to be made between the best treatment position and the best 4D/DIBH tracking position
•Long appointment time
•Up to an hour for a DIBH/4D scan

10. Surface Guided Simulation - SimRT
•SimRT provides deviceless CT simulation in the presence of
respiratory motion.
•SimRT is used in:
•4D CT
•DIBH

11. Surface Guided Simulation - Advantages
•SimRT does not require a device to be placed on the patient. A virtual tracking point is placed on the patient
•Quick and easy comparison between different tracking points to find the optimal spot
•Real time coach is available as visual feedback for the patient. PatientSide station is available for the therapist to evaluate the patient’s breathing trace
•Setup is more reproducible for treatment
•Appointment time is shortened to about 20 minutes

12. Surface Guided Simulation - Workflow
•Simplified automated workflow
•Set patient up on the CT couch
•Capture a surface, tracking point will be placed automatically
•Save and start tracking
•Coach patient to breath hold and monitor breathing trace
•If there are any issues with the trace, move tracking point to a
different location and repeat coaching.
•Coach the patient to breath hold and scan
•Export to workstation

13. DIBH Patient Selection
•Able to hold their breath for at least 20 seconds
•Stable flat breath hold, no air leaking
•Reproducible breath hold each time
•Patient does not arch/hunch while holding their breath

14. Surface Guided Simulation - Workflow

15. Clinical Evaluation
•SimRT was found to be a more precise
representation of the breathing patterns
•SimRT was found to have a more stable
and accurate peak and valley
recognition
•SimRT was validated for various
breathing patterns and showed a more
precise and stable tracking

16. Our Clinical Experience
•DIBH coaching is now simplified
•Using the threshold function allows the patient to see their breath
hold limits
•The therapist can see the breath hold in the sim room and make
quick adjustments if necessary
•Ensures reproducibility.
•Appointment time is shortened
•Reduced from about an hour to 20 minutes

17. Our Clinical Experience
•SimRT gives us the confidence that we are accurately
capturing the patient’s breathing motion or breath hold
•Visual feedback to the patient. Allows them to be part of the
process.
•SimRT allows for quick and easy adjustments to optimize the
patient’s waveform in real time

18. Our Clinical Experience
•DIBH simulation data
•The number of patients unable to go through with a DIBH scan was
reduced by 50%
•The number of rescans (due to BH waveform) was reduced by 80%
•Scan time was reduced by 60%
•Positive patient feedback

19. Summary
•SimRT provides a simple and easy method to capture
respiratory motion during a CT simulation
•SimRT provides a deviceless approach to 4D and breath hold CT
simulation.
•SimRT improved the quality and accuracy of our breath hold
simulations and reduced the amount of repeated simulations.

20. Acknowledgements

21. Thank you!
Questions?
Emails:
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