19. SGRT in Planning: Our Clinical Experience in Surface Guided Clearance Mapping – S Wang, SGRT USA 2024
MapRT is protected under various granted and pending patents including US Issued Patent 10,549,116 (Filed January 3rd, 2016)
Surface Guidance for Better Radiation Therapy Planning
Making Non-Coplanar Treatments Easier to Plan
MapRT helps to make treatments fast, easy and safe. It uses SGRT to deliver a “clearance map”, which planners use to check which beams are deliverable during plan creation. This is especially important for non-coplanar VMAT plans, which are becoming more popular due to the possibilities for organ-at-risk dose improvements.
Click here to find out more about the benefits of non-coplanar treatments.
MapRT images the entire surface of the patient and accessories to detect collisions in the most frequent problem areas such as elbows. In addition, the clearance map checks safety for all couch and gantry angles, so planners have guidance to increase couch kicks and lengthen arcs – for better plans with confidence in delivery*.
Benefits of using MapRT:
Studies show non-coplanar treatments can deliver clinically relevant improvements to treatment plans1, specifically in lung cancer 2,3,4,5 breast cancer 6,7,8,9 head and neck cancer 10,11,12,13,14, lymphoma15,16 and high-grade glioma 17
A recent study 18 showed improved assessment of deliverability using MapRT. Standard planning methods missed 11% of potential collisions and identified only 64% of clear beams/arcs. With MapRT 0% of potential collisions were missed and 100% of clear beams/arcs were identified.
With MapRT’s new Application Programming Interface (API)* you can integrate and extend your use of MapRT together with your Treatment Planning System.
*Not currently available for sale in the USA.
“More freedom, better plans…better outcomes, less side effects.”
Kirsten Hierholz Senior Medical Physicist, Klinikum Darmstadt, Germany
“We see significant value in three areas: checking patient position at CT to ensure a robust setup and avoid unnecessary dose from scans in an unusable position; enhancing planning through increasing the range of beam options; improving the use of resources and the patient experience by avoiding dry runs and delays due to last minute replans.”
Helen Convery Senior Dosimetrist (Development & Clinical Trials)
Frequently Asked Questions
The published evidence suggests that while VMAT treatments give good dosimetry, non-coplanar VMAT treatments can yield even better results, for example in lung cancer [1],[2],[3], breast cancer [4],[5],[6], and head / neck cancer[7],[8],[9].
[1] Kim ST, An HJ, Kim JI, Yoo JR, Kim HJ, Park JM. Non-coplanar VMAT plans for lung SABR to reduce dose to the heart: a planning study. Br J Radiol. 2020 Jan;93(1105):20190596. doi: 10.1259/bjr.20190596. Epub 2019 Oct 22. PMID: 31625759; PMCID: PMC6948076..
[2] Sheng K, Cao M, Godley A, Lin MH, Henze L, Hammond L, Delombaerde L, Hierholz K, Kouptsidis J. Quantification of Dosimetry Improvement With or Without Patient Surface Guidance. Adv Radiat Oncol. 2024 Jul 14;9(9):101570. doi: 10.1016/j.adro.2024.101570. PMID: 39188998; PMCID: PMC11345286.
[3] Lincoln JD, MacDonald RL, Syme A, Thomas CG. Static couch non-coplanar arc selection optimization for lung SBRT treatment planning. Phys Med Biol. 2023 Jul 21;68(15). doi: 10.1088/1361-6560/ace23f. PMID: 37369237.
[4] J, F., et al. (2023). Locoregional breast radiotherapy including IMN: optimizing the dose distribution using an automated non-coplanar VMAT-technique. Acta oncologica (Stockholm, Sweden), [online] 62(10). doi:https://doi.org/10.1080/0284186X.2023.2264488.
[5] Xu, Y., Ma, P., Hu, Z., Tian, Y., Men, K., Wang, S., Xu, Y. and Dai, J. (2021). Non-coplanar volumetric modulated arc therapy for locoregional radiotherapy of left-sided breast cancer including internal mammary nodes. Radiology and Oncology, 55(4), pp.499–507. doi:https://doi.org/10.2478/raon-2021-0045.
[6] A, B., et al. (2023). Dosimetric Comparision of Coplanar versus Noncoplanar Volumetric Modulated Arc Therapy for Treatment of Bilateral Breast Cancers. Journal of medical physics, [online] 48(3). doi:https://doi.org/10.4103/jmp.jmp_36_23.
[7] Biau J, Lopez L, Thivat E, Casile M, Millardet C, Saroul N, Pham-Dang N, Molnar I, Bourhis J, Lapeyre M. Postoperative SBRT in the treatment of early-stage oropharyngeal and oral cavity cancers with high-risk margins: A dosimetric comparison of volumetric modulated arc therapy with or without non-coplanar arcs and acute toxicity outcomes from the STEREOPOSTOP GORTEC 2017-03 phase 2 trial. Clin Transl Radiat Oncol. 2022 Nov 14;38:169-174. doi: 10.1016/j.ctro.2022.11.007. PMID: 36466746; PMCID: PMC9712819.
[8] Woods KE, Ma TM, Cook KA, Morris ED, Gao Y, Sheng K, Kishan AU, Hegde JV, Felix C, Basehart V, Narahara K, Shen Z, Tenn S, Steinberg ML, Chin RK, Cao M. A Prospective Phase II Study of Automated Non-Coplanar VMAT for Recurrent Head and Neck Cancer: Initial Report of Feasibility, Safety, and Patient-Reported Outcomes. Cancers (Basel). 2022 Feb 14;14(4):939. doi: 10.3390/cancers14040939. PMID: 35205686; PMCID: PMC8870161.
[9] Gayen S, Kombathula SH, Manna S, Varshney S, Pareek P. Dosimetric comparison of coplanar and non-coplanar volumetric-modulated arc therapy in head and neck cancer treated with radiotherapy. Radiat Oncol J. 2020 Jun;38(2):138-147. doi: 10.3857/roj.2020.00143. Epub 2020 May 26. PMID: 33012157; PMCID: PMC7533406.
Capturing the entire patient and accessory surface during simulation typically takes 1-2 minutes. Some of the recent MapRT work has shown clinically meaningful plan improvements with a 30 second increase in treatment time 19. MapRT may help avoid the need for physical clearance checks, and with the new API (not currently for sale in the USA) enables clinics to create scripts within their Treatment Planning Systems which access clearance data.
MapRT is a very new technology but one paper, showing marked improvements in planning performance, is available here, as well as on our evidence page. Many users around the world are available to consult on the value of MapRT – contact Vision RT if you’d like us to arrange a reference site call.
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