Elekta Ab Class B · OMXSTO:EKTA_B
Elekta Ab Class B — Technical Presentation (March 2018)
40 slides from Elekta Ab Class B's technical presentation, Mar 19, 2018
Slide 1: The TROG 2018 Plan Challenge
THE TROG 2018 PLAN CHALLENGE 5-met single fraction SRS • TRW Committee and planning • ProKnow challenge sub-group: – Ben Nelms – Nick Hardcastle – Laura O’Connor – John Shakeshaft – Annette Haworth – Olivia Cook – Monica Harris
Slide 2: Background of the plan challenge
Background of the plan challenge • In 2017, TROG held their first planning challenge, a single fraction spine SABR based on the NIVORAD protocol • 149 plans from 26 countries were represented
Slide 3: Background of the plan challenge
Background of the plan challenge • The ProKnow Systems team agreed to host a second public plan study for TROG • Open from 4 December 2017 – 2 February 2018 • Open for participation around the world • Plan Quality Metrics use for scoring • Presentation at the TRW, TROG ASM, March 19th 2018 We cannot
Slide 4: This year's case inspired by Local HER-O
This year’s case inspired by Local HER-O
Slide 5: This year's case: Local HER-O
This year’s case: Local HER-O 20 mm 6 mm 8 mm 16 mm 5 mm
Slide 6: Scoring metrics and weights
# METRIC WEIGHT 1 Structure(s) not fully covered by dose grid --- 2 Volume (%) of the GTV1-20GY covered by 20 (Gy) 10 3 Volume (%) of the GTV2-20GY covered by 20 (Gy) 10 4 Volume (%) of the GTV3-20GY covered by 20 (Gy) 10 5 Volume (%) of the GTV4-20GY covered by 20 (Gy) 72 points for target structur
Slide 7: The scoring matrix
: F The scoring matrix CANCER RESEARCH Score [02] Volume (%) of the GTV1-20GY covered by 20 (Gy) [18] Volume (cc) of the NORMAL BRAIN covered by 10 (Gy) (99,10) (12,10) wf 3 8 7 a 6 gs 4 (95,2, 3 2 j 0) "95 136 137 8 199 2 3s ta ts tte 7 Tie Te 0 Tar Tae 3s Tee 5 26 Ter Tae Tap T30 Metric Value > Me
Slide 8: Further instructions
Further instructions Zero GTV-PTV margin were used – difference between GK and remaining techniques
Slide 9: Participation
Participation 160 submissions 28 countries Other, 15 Australia, 31 Brazil, 1 United States, 30 Canada, 6 China, 12 United Kingdom, 4 The Netherlands, 1 Croatia, 1 Switzerland, 8 Czech Republic, 1 Sweden, 2 France, 2 Spain, 3 Italy, South Korea, 1 7 Hong Japan, 12 Germany, 3 Slovakia, 1 Portugal, 2 K
Slide 10: Results: Total score histogram
Results: Total score histogram Gobal Au/NZ N 160 32 Median 124.8 127.6 Mean 123.6 126.3 St. Dev. 15.1 12.7 Min 86.2 103.0 Max 146.2 143.7
Slide 11: Techniques used
Techniques used Static Photon, 1 TomoTherapy, DCAT, 5 1 Australia/NZ Photon Arc, 1 Particle, 2 Photon Arc + VMAT, Static 5 Photon, 1 DCAT, 4 CyberKnife, 16 Particle, 1 CyberKnife,IMRT, 5 IMRT, 1 7 GammaKnife, 20 Photon Arc DCAT = Dynamic + VMAT, 3 Conformal Arc Therapy GammaKnife, 4 Photon arc = con
Slide 12: Treatment planning systems
Treatment planning systems iPlan, 6 RayStation, 5 CyberKnife, 16 Australia/NZ iPlan, 4 CyberKnife, 5 TomoTherapy, 1 GammaPlan, 20 Pinnacle, 3 GammaPlan, 4 Pinnacle, 1 Eclipse, Eclipse,62 9 Monaco, 47 Monaco, 9
Slide 13: Plan score vs Monitor Units
Total Points TRYG Plan score vs Monitor Units CANCER RESEARCH @ VMAT @ Photon Arc + VMAT @ IMRT (Dynamic) @ Static Photon © IMRT (Step-and-Shoot) @ Robotic @ Photon Arc oo o,° ee eo? ay ) 8 e % ee ° t) bd ° ) e e 2° ° e ee ee e e ° e ° e °° ° “ ee ° e ) ee ° ° e ° 5 ) ° gee? ee ° ° ° ee °e oe ® e e
Slide 14: Conformity score
Conformity 100 Paddick Index CI100% CI50% conformity score 10 1 80 90 100 110 120 130 140 150 total score 0.1
Slide 15: Total score vs Max Dose
Total Points TRYG Total score vs Max Dose CANCER RESEARCH @ VMAT @ Static Radioisotope @ Robotic @ Photon Arc + VMAT © IMRT (Dynamic) @ Static Photon @ IMRT (Step-and-Shoot) @ Static Proton (or Other lon) @ Photon Arc 150, 1454 ce 0 Fhe Ge ele ° 4% ° e ° . ° 1404 . ° . . e fe 6 Se Pd é e . e e e 135
Slide 16: Brain V12 Gy vs Total points
[19] Volume (cc) of the NORMAL BRAIN covered by 12 (Gy) TRYG Brain V12 Gy vs Total points CANCER RESEARCH 805 70+ @ VMAT © IMRT (Dynamic) @ Photon Arc @ Static Radioisotope @ Static Photon e e © S00 S% geet @ Robotic @ IMRT (Step-and-Shoot) e e e oe*% &8 e o @ Photon Arc + VMAT @ Static Proton (or O
Slide 17: MLC Size: 2.5 mm vs 5.0 mm (all linac plans)
MLC Size: 2.5 mm vs 5.0 mm (all linac plans) 28/33 linac plans in top 50 were 2.5 mm MLC
Slide 18: Photon vs Proton
Frequency Frequency TReG Photon vs Proton CANCER RESEARCH Histogram of Total Points for Photon N: 158 | Min: 86.21 | Max: 146.23 | Median: 124.75 | Mean: 123.69 | Std Dev: 15.13 85 90 95 100 105 110 115 120 125 Histogram of Total Points for lon Beam N: 2| Min: 107.26 | Max: 128.25 | Median: 117.75 |
Slide 19: The Top 50
Frequency IP MEHE The Top 50 CANCER RESEARCH Histogram of Total [POINTS] N: 160 | Min: 86.21 | Max: 146.23 | Median: 124.75 | Mean: 123.61 | Std Dev: 15.09 13 Top 50 10 10 9 9 9 8 8 8 7 7 7 6 6 5 5 5 4 4 2 2 1 T T T T T T T T T T T T T 1 85 90 95 100 105 110 115 120 125 130 135 140 145 Total [POINTS
Slide 20: Top 50 by technique
Top 50 by technique Photon Arc + VMAT(5), 4 DCAT(5), 1 Number in brackets is CyberKnife(16), 10 number of total submissions GammaKnife(20), 7 IMRT(7), 6 VMAT(101), 23
Slide 21: Top 50: By technique
total score 128 130 132 134 136 138 140 142 144 148 146 CyberKnife IMRT (Dynamic) IMRT (Dynamic) IMRT (Dynamic) IMRT (Step-and-Shoot) IMRT (Dynamic) VMAT VMAT VMAT VMAT VMAT VMAT CyberKnife GammaKnife VMAT VMAT Photon Arc + VMAT CyberKnife CyberKnife VMAT Photon Arc + VMAT VMAT VMAT IMRT (Dynamic) V
Slide 22: Top 50 Linac: # Isocentres (linac)
Top 50 Linac: # Isocentres (linac) Linac GammaKnife
Slide 23: Top 50: Couch angles (linac)
Total Points BUG Top 50: Couch angles (linac) CANCER RESEARCH @ VMAT © Static Radioisotope @ Photon Arc + VMAT @ IMRT (Dynamic) © Static Photon @ IMRT (Step-and-Shoot) @ Static Proton (or Other lon) © Robotic @ Photon Arc 150- 145+ ° 8 a e e ° ° 1404 ° e e 3 . e . e e ° ° e ° e e . 135 e © 6 . 1304
Slide 24: Top 50: Paddick Score (larger is better)
Top 50: Paddick Score (larger is better) TVPIV2/[PVxTV] TVPIV = Target volume covered by prescription isodose PV = Prescription isodose volume TV = Target volume
Slide 25: Top 50: CI100% (smaller is better)
Top 50: CI100% (smaller is better)
Slide 26: Top 50: CI50% (smaller is better)
Top 50: CI50% (smaller is better)
Slide 27: Top 50: Normal brain receiving 12 Gy
Top 50: Normal brain receiving 12 Gy
Slide 28: Top 50: Treatment Time
Top 50: Treatment Time 2 hours
Slide 29: Top 50: Number of fields (linac)
Top 50: Number of fields (linac)
Slide 30: Top 50: Number of isocentres (linac)
Top 50: Number of isocentres (linac)
Slide 31: Top 50: Number of couch angles (linac)
Top 50: Number of couch angles (linac)
Slide 32: Top Performers: Australia/NZ
Top Performers: Australia/NZ Alphabetical order! Alan Brown Sir Charles Gairdner Hospital CyberKnife Andrew Le Royal North Shore Hospital VMAT Ben BH YAP Sir Charles Gairdner Hospital CyberKnife Clare Porteous Elekta Photon Arc + VMAT Daniel Papworth Genesis Cancer Care VMAT David Stewart Prince of
Slide 33: Feedback from the Top 5 ANZ highest scorers
Practical Feedback Feedback from the Top 5 ANZ highest scorers …
Slide 34: What special preparation did you have to carry out to the anatomy?
1. What special preparation did you have to carry out to the anatomy? e.g. add, or edit the supplied contours? Create special contours for optimisation? Response 1 Linac: No additional contours were used for the final plan. Initially tried creating surrounding volumes to improve dose conformity but
Slide 35: What was your approximate score on your first plan attempt?
3. What was your approximate score on your first plan attempt? Response 1 Linac: First score was around 100. Response 2 CyberKnife: My first score was approximately 136 Response 3 Linac: 110 Response 4 CyberKife: Can't remember... Response 5 GammaKnife: 139 from memory
Slide 36: Time spent to get your final plan
4. Approximately how much time did you spend to get your final plan? Roughly how many iterations of scoring on ProKnow? Response 1 Linac: I'd say it was about 10 submissions of entirely different plans. Each plan took about 1 hour but that was in between waiting for the TPS to optimise and my normal
Slide 37: Techniques used to improve your score
5. What techniques did you use to improve your score from your first attempt to your final submission? Response 1 Linac: I spent a bit of time on refining the cone sizes I used. The majority of the improvements were made in really pushing the VMAT plans and assessing where the TPS was finding confli
Slide 38: Words of wisdom about this plan
6. Any other relevant information/words of wisdom about this plan you may like to share with your peers? Response 1 Linac: Really study the geometry closely before starting planning, take your time to figure out the beams that will and won't work for you. Don't be afraid to start over from a clean s
Slide 39: Plans to review
Plans to review • #1:146.23: Top CK and Top Overall • #2:145.83: Single iso, 6 floor, 24,000 MU IMRT • #12:144.48: 6 field, 1 iso, 6 floor, 10,200 MU VMAT • #15:142.96: Top GK
Slide 40: The Winners: Australia/NZ
The Winners: Australia/NZ 1 Peter Devlin Sir Charles Gairdner Hospital CyberKnife 143.68 Princess Alexandra Hospital Radiation 2 Michael Jenkins GammaKnife 142.96 Oncology 3 James O'Toole Royal North Shore Hospital Linac 142.64