Method for adjustable radiation therapy delivery

Abstract

Computer-implemented methods, systems, and computer-readable media are disclosed for selecting a first workflow path, where the first workflow path includes replacing at least a portion of a planned radiotherapy treatment plan with at least a portion of a previously generated radiotherapy treatment plan. A previously generated radiotherapy treatment plan is identified based on the determined structural features.

Description

TECHNICAL FIELD

[0001] The present disclosure relates to radiation therapy workflows, and in particular to systems and methods for use in radiation therapy workflows. BACKGROUND

[0002] Radiation therapy can be described as the use of ionizing radiation, such as X-rays, to treat the human or animal body. Radiation therapy is often used to treat a tumor within a patient or subject. In such treatments, ionizing radiation is used to irradiate cells forming part of the tumor, thereby destroying or damaging these cells. In radiation therapy treatments, it is desirable to deliver a prescribed radiation dose to a target region of the patient, such as a tumor, and limit irradiation to other parts of the patient, such as healthy tissue and organs at risk (OAR).

[0003] A treatment planning procedure typically involves obtaining one or more medical images, such as a CT image of the patient, and segmenting them to identify the target region and organs at risk near the target region. The segmentation process can be performed manually or using automated segmentation techniques. A clinician determines radiation treatment parameters, such as by prescribing a radiation dose to be delivered to the target region and a maximum dose that can be safely delivered to each organ at risk. The treatment planning procedure can then involve optimizing various radiation delivery variables to meet the prescribed radiation treatment parameters, such as determining a number of treatment sessions (or "fractions") that the radiation therapy should be performed, angles at which radiation beams should be applied during each fraction, angles of radiation beam energy, duration of application of the radiation beam at these angles, and beam shape(s) for each delivery angle. The clinician can be assisted by software during some or all of the steps. This aspect of the treatment planning, which is performed prior to the treatment of the patient (and sometimes also between treatment fractions if there are gradual changes in the condition that require foreseeable plan adjustments), can be described as an "offline" treatment plan as part of an offline-adjusted treatment workflow.

[0004] However, characteristics of the tumor, such as its shape and size, can change over the course of multiple fractions of the treatment. Similarly, other patient information and patient anatomical characteristics can change between fractions, both in ways that are difficult to predict. Accordingly, a "online" adjustable radiation therapy technique can be used to update and re-optimize the radiation therapy treatment plan and / or delivery variables immediately prior to the treatment of the patient. According to the online adjustable radiation therapy technique, the patient is re-imaged immediately prior to the treatment, and the treatment plan for the fraction of the day is adjusted and / or re-optimized according to the most recent available medical images. Thus, as part of an online treatment workflow, the online adjustable radiation therapy technique can take into account changes in the anatomy between fractions.

[0005] Traditional offline and online adaptive treatment workflows each have their advantages. The choice between these two available workflows (offline or online ART) depends on a variety of factors, including available time, clinical goals(s), available expertise and technology, and available resources. Currently available online adaptive treatment workflows require numerous manual steps and decisions, each demanding appropriate skills and clinical experience at the time of treatment delivery. In other words, current online adaptive workflows require a high level of expertise and experience to be effective, and experienced clinicians must be present on-site for the workflow to function, which is very time-consuming and resource-intensive. Furthermore, current adaptive treatment workflows require clinicians to pre-determine the appropriate care path for the patient. In other words, clinicians must decide before treatment begins whether the patient will experience a "standard" (or "traditional") IGRT workflow or an online adaptive workflow.

[0006] The present invention aims to address these and other drawbacks encountered in the prior art by providing an improved method and system for use in radiotherapy workflows. Summary of the Invention

[0007] The invention is described in the independent claims. Optional functions are described in the dependent claims. Attached Figure Description

[0008] Now, we will describe a specific example with reference to the attached diagram, where:

[0009] Figure 1 A radiotherapy device or apparatus according to this disclosure is shown;

[0010] Figure 2 The radiotherapy treatment workflow according to this disclosure is shown;

[0011] Figure 3 A computer implementation method according to this disclosure for use in a radiotherapy workflow is shown;

[0012] Figure 4 An example portion of a radiotherapy user interface according to this disclosure is shown;

[0013] Figure 5 Another example portion of the radiotherapy user interface according to this disclosure is shown;

[0014] Figure 6 Another example portion of the radiotherapy user interface according to this disclosure is shown;

[0015] Figure 7 Another example portion of the radiotherapy user interface according to this disclosure is shown;

[0016] Figure 8 A block diagram illustrating an implementation of a radiotherapy system is shown;

[0017] Figure 9 This illustrates a computer-readable medium, or more generally, a computer program product;

[0018] Figure 10 The method according to this disclosure is shown;

[0019] Figure 11 The method according to this disclosure is shown; and

[0020] Figure 12 A computer implementation method for use in a radiotherapy workflow according to this disclosure is shown. Detailed Implementation

[0021] SUMMARY

[0022] In the non-limiting overview provided, to aid understanding, a computer-implemented method and system are provided that can progressively transform from a standard, predetermined image-guided radiation therapy (IGRT) workflow into an online, adjustable radiation therapy workflow.

[0023] Using this method and / or system, clinicians no longer need to pre-determine whether to use online adjustable radiation therapy when determining the initial treatment plan. Furthermore, this method and / or system can be implemented without requiring clinicians to be present on-site during treatment delivery to manually assess any deviations from the original treatment plan. This allows less experienced and / or less skilled medical personnel to deliver online adjustable radiation therapy over specific treatment sessions, thereby providing improvements in the cost, efficiency, and / or resources of radiation therapy without compromising patient safety or treatment effectiveness.

[0024] Furthermore, by providing visual indicators to show whether the radiotherapy treatment plan delivered when the ROI is in the second position meets the selected treatment plan quality standards, users can very quickly determine the workflow to be followed for patient safety or to improve treatment outcomes, again saving time in treatment delivery without compromising treatment quality. This is especially important in cases where patients may experience discomfort or pain. For reasons of patient comfort and convenience, it is generally desirable to reduce the time patients spend on patient support systems, and therefore, it is undesirable to manually evaluate or reassess treatment plans in every case.

[0025] In another non-limiting overview provided, to aid understanding, this document also provides a computer-implemented method and system capable of progressively selecting a first workflow path, wherein the first workflow path includes replacing at least a portion of a planned radiotherapy treatment plan with at least a portion of a previously generated radiotherapy treatment plan, the previously generated radiotherapy treatment plan being identified based on determined structural features of acquired patient images. Using this method and / or system, the time required to modify and / or adjust a planned radiotherapy treatment plan can be reduced, while also providing the improved accuracy offered by adjustable radiotherapy.

[0026] Further examples and advantages are described below.

[0027] DETAILED DESCRIPTION

[0028] This document discloses systems, equipment, methods, and apparatuses related to radiotherapy. Because linear accelerator-based radiotherapy equipment is highly complex and comprises many interconnected parts, the terms "system," "equipment," "apparatus," and "machine" are used interchangeably to describe radiotherapy equipment as a whole or a collection of components.

[0029] Figure 1 An exemplary radiotherapy (RT) device 100 is shown. This device and its components are well known to those skilled in the art, but are described in a generalized manner herein to provide supplementary information useful to this disclosure. The radiotherapy device 100 is based on a linear accelerator (linac).

[0030] Figure 1 The device shown combines magnetic resonance (MR) imaging capabilities with linear accelerator-based radiotherapy capabilities, eliminating the need for what is known as an MR-linac device. MR-linacs are particularly well-suited for delivering customized treatments because MR images can be taken immediately before or during treatment. A general description of the device and its components will be provided to offer useful additional information for this invention. Figure 1 The apparatus described herein is consistent with this disclosure and is suitable for use with the systems and apparatus of this disclosure. However, this disclosure can be implemented in any radiotherapy apparatus, such as a linear accelerator-based radiotherapy apparatus with CBCT imaging capabilities.

[0031] Figure 1The device 100 includes an MR imaging unit 112 and a radiotherapy (RT) unit, wherein the RT unit may include a linac device. A cross-section of the MR imaging unit 112 is shown in the figure. In operation, the MR scanner generates MR images of the patient, and the linac device generates and forms a radiation beam, which is directed to the target area within the patient's body according to the radiotherapy treatment plan. The depicted device does not have the typical "casing" that would cover the MR imaging unit 112 and the RT unit in a commercial environment such as a hospital.

[0032] Figure 1 The MR-linac device depicted includes a radio frequency source 102, a waveguide 104, an electron source 106, a radiation source 106, a collimator 108 (e.g., a multi-leaf collimator configured to collimate and shape the beam), an MR imaging unit 112, and a patient support surface 114. In use, the device will also include a housing (not shown) that defines an aperture together with a ring gantry. The movable support surface 114 can be used to move a patient or other subject into the aperture when an MR scan is to be initiated and / or when radiotherapy is to be initiated. The MR imaging unit 112, the RT unit, and the patient support surface actuator are communicatively coupled to a controller or processor. The controller is also communicatively coupled to a storage device that includes computer-executable instructions executable by the controller.

[0033] The RT device includes a radiation source and a radiation detector (not shown). Typically, the radiation detector is located diagonally opposite the radiation source. This radiation detector is adapted and configured to generate radiation intensity data. Specifically, the radiation detector is defined and configured to detect the intensity of radiation passing through the subject. The radiation detector can also be described as a radiation detection device and can form part of a portal imaging system.

[0034] The radiation source may include a beam generation system. For linac, the beam generation system may include an RFF energy source 102, an electron gun 106, and a waveguide 104. The radiation source is attached to a rotatable gantry 116 so that it rotates together with the gantry 116. In this way, the radiation source can rotate around the patient, thereby applying a therapeutic beam 110 from different angles around the gantry 116. In a preferred implementation, the gantry can rotate continuously. In other words, the gantry can rotate 360 ​​degrees around the patient, and in fact, can continue to rotate more than 360 degrees. The gantry may be annular. In other words, the gantry may be a ring-shaped gantry.

[0035] A radio frequency (RF) source 102 (e.g., a magnetron) is configured to generate RF waves. The RF source 102 is coupled to a waveguide 104 via a circulator 118 and is configured to inject RF wave pulses into the waveguide 104. The RF waves can travel from the RF source 102 through an RF input window and into an RF input connector or tubular structure. An electron source 106 (e.g., an electron gun) is also coupled to the waveguide 104 and is configured to inject electrons into the waveguide 104. In the electron gun 106, electrons are thermally emitted from the cathode filament when it is heated. The temperature of the filament controls the number of injected electrons. The injection of electrons into the waveguide 104 is synchronized with the pumping of RF waves into the waveguide 104. The design and operation of the RF source 102, the electron source, and the waveguide 104 enable the RF waves to accelerate electrons to very high energies as they propagate through the waveguide 104.

[0036] The design of waveguide 104 depends on whether the linac uses standing waves or traveling waves to accelerate electrons, although waveguides are typically composed of a series of units or cavities, each connected by an aperture or "aperture" through which the electron beam can pass. The cavities are coupled to each other to generate a suitable electric field mode that accelerates electrons propagating through waveguide 104. As electrons are accelerated in waveguide 104, the electron beam path is controlled by appropriately arranged steering magnets or steering coils around waveguide 104. The arrangement of the steering magnets can include, for example, two sets of quadrupole magnets.

[0037] Once the electrons are accelerated, they may enter a flight tube. The flight tube is connected to the waveguide via a connecting tube. This connecting tube or connection structure can be called a drift tube. The electrons travel towards a heavy metal target, which may be composed of, for example, tungsten. As the electrons travel through the flight tube, a set of focusing magnets guides and focuses the electron beam onto the target.

[0038] To ensure that the electron beam does not impede electron propagation as it travels toward the target, a vacuum system, including a vacuum pump or vacuum pumping device, is used to evacuate the waveguide 104. This pumping system can generate ultra-high vacuum (UHV) conditions in the waveguide 104 and the flight tube. The vacuum system also ensures UHV conditions within the electron gun. In the evacuated waveguide 104, electrons can be accelerated to near the speed of light.

[0039] A radiation source is configured to direct a therapeutic radiation beam 110 toward a patient located on a patient support surface 114. The radiation source may include a heavy metal target toward which high-energy electrons emitted from a waveguide are directed. When the electrons strike the target, X-rays are generated in various directions. A master collimator can block X-rays traveling in a specific direction and allow only forward-traveling X-rays to pass through, thereby generating the therapeutic beam 110. The X-rays may be filtered and may pass through one or more ionization chambers for dose measurement. As the beam passes through the patient as part of a radiotherapy treatment, it can be shaped in various ways using beam-shaping devices, such as by using a multi-leaf collimator 108.

[0040] In some implementations, the radiation source is configured to emit either an X-ray beam or an electron particle beam. This implementation enables the device to provide electron beam therapy, an external beam therapy in which electrons (instead of X-rays) are directed to the target area. By adjusting the components of the linac, it is possible to “switch” between a first mode emitting X-rays and a second mode emitting electrons. Essentially, this switching between the first and second modes is achieved by moving a heavy metal target into or out of the electron beam path and replacing it with a so-called “electron window.” The electron window is substantially transparent to electrons and allows electrons to exit the flight tube.

[0041] The subject or patient support surface 114 is configured to move between a first position substantially outside the aperture and a second position substantially inside the aperture. In the first position, the patient or subject may sit on the patient support surface. The support surface 114 and the patient can then be moved to the second position inside the aperture to image the patient via the MR imaging apparatus 112 and / or to image or treat using an RT apparatus. The movement of the patient support surface is achieved and controlled by a patient support surface actuator, which can be described as a drive mechanism. The drive mechanism is configured to move the subject support surface in a direction parallel to and defined by the central axis of the aperture. In this document, the terms "subject" and "patient" are used interchangeably, and therefore the subject support surface can also be described as a patient support surface. The subject support surface may also be referred to as a movable or adjustable treatment bed or treatment table.

[0042] Figure 1The radiotherapy apparatus / device depicted also includes an MR imaging device 112. The MR imaging device 112 is configured to acquire images of a patient or subject placed (e.g., located on) a subject support surface 114. The MR imaging device 112 may also be referred to as an MR imager. The MR imaging device 112 can be a conventional MR imaging device that operates in a known manner to acquire MR data (e.g., MR images). Those skilled in the art will understand that such an MR imaging device 112 may include a main magnet, one or more gradient coils, one or more receiving coils, and an FR pulse applicator. The operation of the MR imaging device is controlled by a controller.

[0043] The controller is a computer, processor, or other processing device. The controller may be formed from multiple discrete processors; for example, the controller may include: an MR imaging device processor for the MR imaging device 110; an RT device processor for controlling the operation of the RT device; and a subject support surface processor for controlling the operation and actuation of the subject support surface. The controller is communicatively coupled to a memory (e.g., a computer-readable medium).

[0044] The Linac device also includes several other components and systems, as will be understood by those skilled in the art. For example, appropriate shielding is provided to ensure that the linac does not leak radiation.

[0045] In traditional radiotherapy, the dose to the target / tumor is determined and specified, and then delivered in fractions over several treatment cycles to reduce the impact of radiation delivered to the patient's healthy tissues. Accordingly, clinicians determine and schedule a radiotherapy treatment plan before treatment begins. As mentioned above, this plan can be determined and scheduled using traditional IGRT or online adjustment workflows. Additionally, offline plan adjustments may be arranged. This decision is typically made during the initial planning phase before any fractionated radiotherapy cycle, partly due to time and / or resource considerations.

[0046] In the methods and / or systems disclosed herein, a planned radiotherapy treatment plan for delivering a prescribed dose is determined during the initial planning phase prior to the commencement of any treatment. The planned radiotherapy treatment plan may include a treatment arrangement portion (e.g., how the dose is divided into fractions and when these fractions are delivered) and a radiotherapy delivery plan (determining specific system variables or parameters for delivering specific dose fractions to a specific site, such as appropriate beamshaping assembly location or configuration, beam angle, beam energy, and / or irradiation duration). Furthermore, during the initial planning phase, at least one treatment plan quality criterion may be predefined, which can be considered the most important criterion for evaluating the plan, and further details of which are provided below. At least one treatment plan quality criterion may correspond to one or a subset of the parameters or variables upon which the planned radiotherapy treatment plan is based, such as a specific maximum dose value delivered to a particular OAR. Unlike conventional methods, the methods and / or systems disclosed herein are capable of progressively modifying the radiotherapy workflow.

[0047] Figure 2 A radiotherapy treatment workflow 200 according to this disclosure is shown. The radiotherapy treatment workflow 200 (also referred to as a radiotherapy workflow) begins at frame 202, i.e., patient placement in the treatment room. Patient placement includes placing the patient on an adjustable patient support for the radiotherapy device, for example, regarding… Figure 1 The support structures discussed herein. Patients may be positioned for treatment in specific fractions (including, but not limited to, the first fraction) of their prescribed and / or planned radiotherapy treatment plan. In other words, patients may be placed in specific locations according to the planned radiotherapy treatment plan, and radiation delivery devices may be positioned and / or prepared according to the planned radiotherapy treatment plan to deliver the prescribed dose.

[0048] The radiotherapy workflow 200 continues to box 204, where at least one image of the patient located on an adjustable patient support is acquired. The image can be acquired using known patient imaging techniques, such as X-ray imaging, CBCT imaging, and / or MR imaging. The at least one image of the patient is compared to a reference image associated with the planned radiotherapy treatment plan. For example, the reference image may be acquired, generated, and / or selected during the initial planning phase. The comparison between images can be performed according to known image registration techniques. The reference image indicates the reference location of the patient's region of interest (ROI). The ROI may include the location and associated size of the target / tumor, as well as other anatomical features of the patient, such as the location and associated size of nearby organs (especially organs at risk). In many cases, the comparison of images may indicate a difference or variation between the location of the ROI in the acquired image of the patient on the adjustable patient support and the reference location of the ROI in the reference image associated with the planned radiotherapy treatment plan. This difference may be due to, for example, inter-fractional variations in the patient's anatomy, such as swelling, fluid retention, or other anatomical changes, such as due to movement of internal organs or different levels of filling. Weight gain or loss during treatment may also cause this difference to gradually increase. Based on comparison, the positional adjustment of the adjustable patient support is determined; in the example where the patient treatment bed is used as the adjustable patient support, this can be referred to as "treatment bed repositioning." Positional adjustment moves the current position of the ROI to a second position where the ROI is more closely aligned with its reference position. This adjustment is intended to improve the accuracy and / or precision of radiation delivery to the target.

[0049] In box 206, the planned radiotherapy treatment plan is evaluated by determining whether delivery of the planned radiotherapy treatment plan when the ROI is in the second location will meet at least one predefined treatment plan quality criterion. The predefined treatment plan quality criterion may include the minimum prescribed dose to the target and / or the maximum prescribed dose to at least one nearby organ at risk (OAR), calculated by the dosing planning system using Monte Carlo or other suitable high-quality algorithms. For example, delivery location adjustments to compensate for deviations in the target location on the day of treatment from its planned location within the treatment plan mean that delivering radiation according to the plan (e.g., using a specific multi-leaf collimator position or arrangement) may result in unacceptably high doses being delivered to nearby OARs, which could cause problems. Therefore, the planned treatment plan will be determined to not meet the quality criteria associated with the maximum dose to be delivered to that OAR. Accordingly, the determination in box 206 may include calculating or evaluating the geometric and / or anatomical location and dose depth characteristics of the proposed delivery when the ROI is in the second location. At frame 208 of the radiotherapy workflow 200, it is determined whether the implementation of the planned treatment plan proposed when the ROI is in the second position is equivalent to a reference plan in terms of at least one treatment plan quality standard. At this point in 208, it is advantageous that the radiotherapy workflow 200 can be divided into a first workflow path 210 or a second workflow path 250.

[0050] In block 208, the methods and systems disclosed herein include displaying a visual indicator to indicate whether the planned radiotherapy treatment plan delivered when the ROI is in a second location meets at least one treatment plan quality criterion, and enabling the user to select a first workflow path 210 or a second workflow path 250. Figures 4-7 Suitable visual indicators are depicted and described in the appendix to the instruction manual.

[0051] The first workflow path 210 includes performing 212 position adjustment to move the ROI to a second position and delivering 214 treatment according to the initially scheduled radiotherapy treatment plan. The patient is then released in box 216, after which the workflow ends. Therefore, the first workflow path 210 corresponds to conventional IGRT, where the treatment plan is formulated prior to treatment and then delivered without online adjustments.

[0052] The second workflow path 250 also includes performing a position adjustment 252 to move the ROI to a second position. In the next box 254, an adjusted radiotherapy treatment plan to be delivered when the ROI is in the second position is calculated. Such calculations can be performed by determining new radiation delivery parameters (e.g., beam shaping parameters, which may be related to the collimator assembly, which may be a multi-leaf collimator) that will deliver the prescribed dose to the target while meeting prescribed clinical objectives. For example, new radiation delivery parameters could allow delivery of the prescribed dose without exceeding the maximum dose that can be delivered to the nearby OAR according to treatment plan quality standards. Calculating a new radiotherapy treatment or delivery plan can be quite time-consuming and typically requires optimization of many variables, such as beam energy, dose rate, beam orientation, movement speed, and fluence modulation, and includes clinician oversight; generally, calculating a new plan for the patient in situ is not a preferred method. However, the current method reduces the complexity of calculating a new plan by developing a position adjustment earlier, comparing it to a reference image to place the ROI in a second position (in which the ROI is closer to the reference position). Accordingly, the optimization problem is reduced, and therefore the computation time is also reduced. Furthermore, instead of performing a full plan evaluation of all OARs or standards, fewer plan evaluation criteria (or one or more predefined treatment plan quality criteria) can be used, which are the same as the most important criteria(s) already established as the reference plan. Using simplified plan criteria for evaluation and comparing them to the reference plan, rather than performing a full plan quality analysis as if it were a completely new plan, provides confidence that the adjusted radiotherapy plan meets the constraints considered most important. Accordingly, the adjusted radiotherapy plan is calculated based on a subset of the parameters / variables used to calculate the planned radiotherapy plan, rather than based on all variables, thus reducing the computational burden. For example, the adjusted radiotherapy plan can be calculated based on parameters corresponding to at least one predefined treatment plan quality criterion. In a specific example, the adjusted radiotherapy plan can be calculated based only on parameters corresponding to one or more predefined treatment plan quality criteria that would not be met by a radiotherapy plan planned when the ROI is in a second position. In summary, the current approach allows workflows to switch from conventional IGRT to online adjustable radiotherapy in fractional increments without excessively prolonging the time patients are held in the treatment position.

[0053] Although Figure 2Not shown in the diagram, but in some examples, after calculation 254, the adjusted radiotherapy treatment plan is delivered to the patient, who is then released, ending the workflow. Optionally, however, a second workflow may include another box 256 that checks the adjusted plan in the same manner as boxes 206 and 208 for a double check. In box 257, it is determined whether the adjusted radiotherapy treatment plan is acceptable or equivalent to the reference plan. If the adjusted radiotherapy treatment plan is found to be acceptable or equivalent to the reference plan in at least one predefined treatment plan criterion, the plan is terminated 258 before delivery 214. Optionally, a remote approval procedure 259 allows experienced clinicians to approve the final plan without physical presence. If the adjusted radiotherapy treatment plan is found to be unacceptable or inequivalent to the reference plan in at least one predefined treatment plan criterion, a review 260 is conducted. Review 260 may involve careful examination and may modify the outline to achieve better results after further re-optimization, and / or may involve providing the plan for remote review 261, for example, by an experienced clinician, to assess any potential compromises if the plan quality criteria cannot be fully met. The new adjusted radiotherapy treatment plan is then evaluated against at least one treatment plan quality criterion as described in the previously evaluated box 256. In some examples, adjusted radiotherapy treatment plans that already meet at least one treatment quality criterion are provided for remote review, for example, by an experienced clinician. Similarly, if desired, an optional remote approval step may be provided at box 262 to finalize the adjusted plan. "Remote review" means the review process is conducted off-site, not at the radiotherapy treatment site.

[0054] Figure 3 A computer-implemented method 300 is shown. This method is applicable to the delivery of fractionated radiation to the patient's region of interest on the same day as radiotherapy treatment, according to the patient's planned treatment schedule. Figure 2 The radiotherapy workflow 200 in the example is an exemplary implementation of method 300. Each block of method 300 can be configured according to... Figure 2 The radiotherapy workflow 200 is performed in one or more corresponding boxes, including optional exemplary implementations associated with specific boxes. However, method 300 is more general and does not necessarily include... Figure 2 All stages of the radiotherapy workflow 200.

[0055] Method 300 includes: in frame 302, obtaining at least one image of a patient placed on an adjustable patient support. (As described above...) Figure 2The image can be an MR image, CT image, CBCT image, or other medical imaging modality. At box 304, method 300 includes comparing at least one acquired image with at least one reference image associated with the patient's planned radiotherapy treatment plan, wherein the at least one reference image indicates a reference location of the patient's region of interest (ROI). For example, the at least one reference image could be an image used during the generation of the patient's radiotherapy treatment plan. As described above, the comparison may include registering at least one image acquired at box 302 with at least one reference image acquired at box 304.

[0056] Alternatively, comparing images may include determining the similarity of patient anatomical structures in the images. Similarity can be, for example, the Dice similarity coefficient or the Jaccard index. Similarity can also be determined only for the tumor, OAR, or other anatomical region of interest; in this case, an automated contouring tool can be used to isolate one or more structures of interest before calculating the similarity.

[0057] At box 306, method 300 includes determining a positional adjustment of an adjustable patient support based on comparison. This adjustment moves the current position of the Region of Interest (ROI) to a second position where the ROI is more closely aligned with a reference position. For example, based on registered images, a difference or "offset" between the position of the ROI in one or more reference images and the position of the ROI in one or more newly acquired images can be determined. It can be further determined that this offset can be "corrected" or minimized by repositioning the patient via the desired positional adjustment on the patient support surface. Figure 4 and Figure 7 An example of a position adjustment is shown and described in the corresponding explanatory paragraph below.

[0058] At box 308, the method includes determining whether the planned radiotherapy treatment plan delivered when the ROI is in the second position meets at least one predefined treatment plan quality criterion. In the example, the predefined treatment plan quality criterion is the prescribed dose to be delivered to the target during the fractionation. In some examples, multiple predefined treatment plan quality criteria may be used, which may include the prescribed dose to be delivered to the target (also known as the planned target volume, PTV, or dose), and the maximum permissible dose to one or more nearby organs at risk. The following is combined with... Figures 4-7 More examples are provided.

[0059] In another example, a predefined quality criterion for the treatment plan is a similarity threshold between patient anatomy when comparing at least one reference image and at least one acquired image (i.e., at least one treatment sequence image). If the image similarity score is above the threshold, treatment can proceed as planned without adjustment or replanning. In this case, a first workflow path can be followed and / or recommended to the clinician. If the similarity is below the threshold, adjustment and replanning may be necessary. In this case, a second (adjusted) workflow path can be followed and / or recommended to the clinician.

[0060] Two different quality standards for the treatment plan were used during delivery. For example, a dose-related standard and a similarity-related standard. If the similarity score was above a first similarity threshold, the plan continued, or continued, as planned, was recommended. If the similarity score was below the first similarity threshold but above a second similarity threshold, whether the dosimetry criteria / thresholds were met was determined in the manner described elsewhere in this document. Even if the first similarity threshold was not met, treatment could continue, or continued, as planned, was recommended, if the dosimetry criteria were still met. Finally, if the second (lower) similarity threshold was not met, adjustments to the plan were recommended.

[0061] At box 310, the method includes displaying a visual indicator to indicate whether delivery of a planned radiotherapy treatment plan when the ROI is in a second location meets at least one predefined treatment plan quality criterion, and enabling the user to select one of a first workflow path and a second workflow path, wherein the first workflow path includes performing a location adjustment and delivering treatment according to the planned radiotherapy treatment plan, and the second workflow path includes performing a location adjustment and calculating an adjusted radiotherapy treatment plan, which, when delivered when the ROI is in the second location, will meet at least one treatment plan quality criterion. Selecting a visual indicator provides the advantage of allowing the user to interpret it very quickly and easily, and reducing the cognitive load required for the user to interpret complex situations. For example, the visual indicator may include colored icons. The visual indicator may be one of a set of possible visual indicators, each including multiple colors, wherein a first color indicates that delivery of a planned radiotherapy treatment plan when the ROI is in the second location will meet at least one predefined treatment plan quality criterion, while a second color indicates that delivery of a planned radiotherapy treatment plan when the ROI is in the second location will not meet at least one predefined treatment plan quality criterion. In an example that uses multiple predefined quality standards for treatment plans, visual indicators may include corresponding colors or colored icons for each standard.

[0062] Colors may correspond to whether the planned (or adjusted) treatment plan meets at least one predefined quality standard for treatment plans; for example, green indicates compliance and red indicates non-compliance. In some examples, yellow or amber may be used, for example, to indicate that the planned treatment plan being delivered when the ROI is in a second position may not correspond to the initially expected quality, but the quality is acceptable. Advantageously, design specifications for radiotherapy systems allow the use of color (e.g., a green, red, amber "traffic light" arrangement), and this is a widely understood convention. Furthermore, the use of color reduces the cognitive burden on clinicians and renders previously numerous complex factors into a single, simple indicator. Figures 4-7 Examples of visual indicators are provided in the accompanying notes below.

[0063] In some examples, the visual indicators may include those for each of a plurality of treatment plan quality criteria, showing whether the radiotherapy treatment plan delivered when the ROI is in the second position meets the corresponding treatment plan criteria. For example, each of the plurality of treatment plan quality criteria may be indicated in red or green respectively.

[0064] Method 300 may optionally include an additional box 312 for determining in the second workflow path 250 whether the delivery of the adjusted radiotherapy treatment plan when the ROI is in the second location meets at least one predefined treatment plan quality criterion.

[0065] Method 300 may further include: displaying a visual indicator indicating whether the delivery of the adjusted radiotherapy treatment plan meets at least one treatment plan quality criterion when the ROI is in the second position, and allowing the user to select one of the following: delivering treatment according to the adjusted radiotherapy treatment plan, or calculating a further adjusted radiotherapy treatment plan, for example in box 260.

[0066] As described above, at least one treatment plan quality criterion includes one or more of a minimum target dose threshold and a maximum organ-at-risk dose threshold. In some examples, multiple organs use their respective maximum organ-at-risk dose thresholds. In some examples, the treatment plan quality criterion uses fewer parameters or variables than those used when developing the initial treatment plan, thus allowing for rapid and efficient plan evaluation. In some examples, calculating the adjusted radiotherapy treatment plan includes calculating the parameters of the multi-leaf collimator assembly used in the delivery treatment, and / or other radiotherapy delivery variables, such as gantry parameters.

[0067] Each implementation of method 300 can be performed in a fractionated radiotherapy session, i.e., in a single session, the patient is placed on an adjustable patient support.

[0068] Next, we will refer to Figures 4-7 describe Figure 3 Here are a few example implementations. Figures 4-7 This relates to an exemplary patient in connection with a treatment plan and clinical goals. In the exemplary scenario described below, a planned treatment plan has been developed for the patient, containing predefined treatment plan quality standards related to the target dose and the maximum OAR dose. Figures 4-7 Special and Figure 3 The exemplary implementations of blocks 308 and 310 of method 300 are related.

[0069] Figure 4 An example portion 400 of a radiotherapy user interface according to this disclosure is shown. Portion 400 of the user interface shows details of the planned radiotherapy treatment plan for this exemplary scenario. The left side indicates “Targets,” corresponding to several predefined treatment plan quality criteria, including a planned target volume (PTV) dose of at least 6.00 Gy, and a maximum dose of 1.8 Gy each to the two organs at risk (OARs) of the right lung (R) and left lung (L). It should be understood that other values ​​and predefined treatment plan quality criteria may be used in other examples. Each target is accompanied by a color-coded icon indicator to indicate whether the planned treatment plan meets that criterion. Figure 4 The right side of section 400 is an image of the reference plan, showing the patient's ROI, including the target and both lungs. Again, it is understood that separate images will be shown for other targets and / or ROIs.

[0070] Figures 5-7 Further example portions 500, 600, and 700 of exemplary radiotherapy user interfaces according to this disclosure are shown. The user interface can be implemented using a display screen (e.g., a touchscreen) or other screens. This document also provides... Figure 1 and Figure 8 More examples of related user interface input and / or output devices.

[0071] The user interface enables users to select a first workflow path or a second workflow path according to the methods and systems disclosed herein. Figure 5 The image shows exemplary target / quality standards and plan quality visual indicators. The first column on the left shows the visual indicator for the reference plan, and the second column on the right shows the "Today" visual indicator, which is based on comparing patient images obtained during the course of treatment with... Figure 4 The evaluation was made by comparing it with a reference image, and as... Figure 3The determined positional adjustment of the ROI is made as in method 300. The "Correct" and "Rotation" sections are shown below, illustrating exemplary determined positional adjustments (as defined in box 306) for the X, Y, Z coordinates of the adjustable patient support, as well as pitch, roll, and yaw angles. The user will see buttons corresponding to "Adjust Plan" or "Accept," which in this example are located near the bottom of the user interface, but are not necessarily there. Therefore, the user can select either a first workflow path or a second workflow path, as shown in box 310. Due to the... Figure 5 In the example section, the planned treatment plan meets all predefined treatment plan quality standards, and the "Accept" button is highlighted as an additional visual indicator, prompting the user to select the first workflow path 210 and continue with routine treatment. On the other hand, in Figure 6 In the example, OAR1: If the determined location adjustment is delivered, it does not meet the R-Lung standard. Accordingly, the "Adjust Plan" button will be highlighted as a visual indicator for the user, who will select the "Adjust Plan" button to initiate a second workflow path and adjust the plan according to the method described herein. Subsequently, the adjusted plan will be calculated and presented to the user as follows: Figure 7 The user interface shown. Figure 7 The visual indicators show that the newly calculated "Today" plan meets the predefined treatment quality standards for PTV and OAR1:R lung. The standards for OAR2:L lung are shown in yellow or amber, which may indicate that the parameter values ​​provided by the adjusted plan are not ideal, but acceptable. Accordingly, the user can use the highlighted "Accept" button to accept and submit the adjusted plan, or select "Re-optimize" to calculate a further adjusted plan, as described in the optional box of the second workflow path 250.

[0072] In each example, the user can immediately see the provided visual indicators(s), thus reducing the user's cognitive load. Furthermore, the method disclosed herein can reduce the computational burden of adjustable radiotherapy treatment planning, for example, by performing positional adjustments, thereby eliminating the need to recalculate patient positioning and / or reacquire reference images. Accordingly, the time the patient is held in a potentially uncomfortable position is reduced.

[0073] Figures 4-7 Each of them can be used Figure 3 Method 300 and / or Figure 2 Radiotherapy workflow 200.

[0074] This article mentions determining the quality standards of treatment plans based on the similarity between anatomical structures in the original images and the same anatomical structures in images obtained on the day of treatment. Figure 10 and Figure 11The flowchart illustrates an example function that utilizes similarity.

[0075] At box 1002, the similarity is determined. In this example, the similarity is the Dice similarity coefficient (DSC). If the anatomical structures are sufficiently similar, i.e., if the DSC is above a first threshold, treatment can proceed as planned in box 1004, for example, according to the first workflow path.

[0076] If the DSC is below the first threshold but above the second (lower) threshold, the dose that the anatomical structure (region of interest) might receive, based on the current treatment plan, will be determined using known methods such as the Monte Carlo method. The original plan can be recalculated using new patient images, and the dose value for the region of interest can be determined. If the dose value meets the dosimetry criteria at box 1008, treatment can continue according to the original plan at box 1004. However, if the dosimetry criteria are not met, the method continues to box 1010. In box 1010, instructions are shown to the clinician that the plan should be adjusted. These instructions can be derived from the above descriptions of boxes 30 and... Figures 4-7 The format described herein allows clinicians to select the appropriate workflow path. Alternatively, a modified plan can be created automatically. Once the modified plan is created, instructions / notifications may be output to the clinician for review at box 1012.

[0077] In one particular implementation, the method can automatically quantify the similarity between the original image and the new image for the same anatomical structures (targets or organs at risk) using the Dice similarity coefficient (DSC), and automatically or semi-automatically trigger the most appropriate next step based on a user-defined threshold. This process may involve manual preparation tasks such as importing new data and contour plotting, or it can be automated in the system backend using advanced deformable structure propagation or automatic contour plotting tools to prepare the data.

[0078] Based on clinical protocols, the most important structures can be identified. If their similarity scores are above a threshold, no corrective or adjustment actions are needed, and the treatment can continue as planned. If the similarity score is below the threshold but still within an appropriate range, the system can automatically trigger an evaluation workflow of the original plan on new data to verify its appropriateness. If no significant differences are observed, the system will report the evaluation results to the clinical team; if significant dosimetry differences are observed, the system will trigger a replanning adjustment and notify the clinical team to review the output of the original plan evaluation and the adjusted plan. If the similarity score is significantly below the threshold, the plan adjustment activity will be automatically triggered, and the clinical team will be notified that the original plan is no longer applicable, and the adjusted plan is ready for review.

[0079] This automated assessment tool allows for a streamlined decision-making process and eliminates the subjective element in choosing the next step for a patient.

[0080] 1. Because the structural similarity review task is automated, the workload (and related costs) of clinicians are reduced, and subsequent actions are triggered based on the results of the task, thereby eliminating subjective or stressful assessments by unqualified staff.

[0081] 2. Improved patient outcomes through automation of many typically manual processes, and more opportunities for more frequent use of replanning assessments and replanning adjustments.

[0082] 3. Reducing the variability of adaptive workflows allows clinics to quantify when to perform these tasks to insurance / reimbursement agencies, thereby creating opportunities for financial benefits for the agencies.

[0083] Similarity metrics can be incorporated into the methods and systems of this disclosure in any appropriate manner that can be understood by those skilled in the art. For example, similarity can form the basis for the quality criteria of the treatment plan at box 308.

[0084] Figure 11 This is a flowchart depicting method 1100 according to this application. Boxes 102 and 104 may be equivalent to boxes 302 and 304. At box 106, a similarity is determined. At box 108, it is determined whether the planned radiotherapy treatment plan delivered when the ROI is in the second position meets at least one predefined treatment plan quality criterion, which is based on the similarity determined at box 106. For example, this box may contain the above information regarding... Figure 10 The aforementioned similarity threshold.

[0085] Finally, box 110 includes a visual indicator to show whether the delivered radiotherapy treatment plan meets at least one treatment plan quality criterion and allows the user to select either a first workflow path or a second workflow path. This box may be related to... Figure 3 Box 310 in the example is equivalent. In this example, if the first similarity threshold is met, a green visual indicator can be displayed, allowing selection of the first workflow path. If the first similarity threshold is not met, an amber or red visual indicator may be displayed, allowing selection of the second workflow path and adjustment of the schedule.

[0086] As mentioned above, currently available online treatment adjustment workflows require numerous manual steps and decisions, each demanding appropriate skills and clinical experience in treatment delivery. In other words, current online adjustment workflows require a high level of expertise and experience to function effectively, and experienced clinicians must be present on-site for the workflow to run, which is very time-consuming and resource-intensive. Typically, the patient is in the treatment-ready position during the time required to calculate the adjusted treatment plan. Therefore, some implementations may need to increase the speed of changing, modifying, adjusting, and / or replacing treatment plans to improve patient experience, increase patient throughput, and reduce the time and resources required by clinicians.

[0087] Furthermore, since treatment plans are typically generated based on images of the patient in the treatment position, it is desirable that the patient not move between image generation and the application of the resulting daily treatment plan. However, generating treatment plans is computationally complex and time-consuming. For example, it can take 5–20 minutes from taking an image to preparing the adjusted treatment plan for delivery. During this time, the patient may experience discomfort and may unintentionally move relative to their position when the image was generated, and is more likely to move during the treatment itself. This may result in the adjusted treatment plan being less suitable for the patient's new position. The greater the difference between the patient's position and internal anatomy and the reference image upon which the initial treatment plan was based, the greater the adjustments required to generate the adjusted treatment plan, and the longer it will take.

[0088] Furthermore, previous methods for adjusting treatment plans may not have been as flexible as expected. For example, previous methods might have simply adopted the most recently generated treatment plan, which may not have been optimal. Additionally, previous methods may have limitations in the imaging modalities used as the basis for generating treatment plans, and these modalities may not be optimal for tumors located in different parts of the subject's anatomy. Moreover, it should be recognized that, as mentioned above, some delay between image acquisition and treatment initiation may be due to clinicians evaluating various features of the treatment plan and navigation workflows, which may take longer than previously anticipated with previous methods.

[0089] Accordingly, there is a need for more efficient generation of radiotherapy treatment plans. The complexity involved in generating radiotherapy treatment plans also needs to be reduced. The generation of radiotherapy treatment plans also requires greater flexibility and / or stronger versatility. Increasing the accuracy and / or efficiency of radiotherapy treatment is also beneficial.

[0090] Figure 12Method 1200 for use in a radiotherapy workflow is shown. Method 1200 may be a computer-implemented method. Method 1200 is suitable for use on a radiotherapy treatment day when a patient receives fractions of radiation delivered to the region of interest according to their planned treatment plan.

[0091] At box 1202, method 1200 includes acquiring at least one image of the patient, wherein the at least one image of the patient indicates the current location of the patient's region of interest (ROI). The patient may be positioned to receive treatment in a specific fraction of their prescribed and / or planned radiotherapy treatment plan (including, but not limited to, the first fraction). In other words, the patient can be positioned at a specific location according to the planned radiotherapy treatment plan, and the radiation delivery device can be positioned and / or prepared according to the planned radiotherapy treatment plan to deliver the prescribed dose. The acquired images may be MR images, CT images, CBCT images, or images from other medical imaging modalities.

[0092] At box 1204, method 1200 includes comparing at least one acquired image with at least one reference image associated with the patient's planned radiotherapy treatment plan, wherein the at least one reference image indicates the reference location of the patient's ROI. Boxes 1202 and 1204 can be related to... Figure 3 Boxes 302 and 304 and / or Figure 11 Boxes 102 and 104 in the text are equivalent (and vice versa).

[0093] At box 1206, method 1200 further includes determining the difference between the current position of the ROI and the reference position of the ROI based on the comparison at box 1204.

[0094] Such discrepancies may indicate that adjustments and / or modifications to the planned radiotherapy treatment plan are preferable. For example, based on the difference between the current location of the ROI and its reference location, it can be determined that delivering the planned radiotherapy treatment plan while the patient is in the current location will not meet at least one predefined treatment plan quality standard.

[0095] Such differences may include positional differences and / or shape differences. In some examples, the differences include at least one of the following: positional differences of the ROI, location differences of the ROI, and / or shape differences of the ROI. For example, when comparing at least one acquired image with at least one reference image associated with a patient's planned radiotherapy treatment plan, the difference may correspond to a positional difference of at least one point and / or portion of the ROI. For example, since the reference image was acquired, the ROI may have moved to another location and / or position within the patient. This difference can be addressed by employing a "positional adjustment" approach, such as by delivering the patient's displacement on an adjustable patient support. The positional adjustment approach may involve rigid registration of the two images and recalculating the treatment plan to improve target coverage at the new location. Additionally or alternatively, this difference may be a shape difference, i.e., a difference in shape between the ROI of the acquired at least one image and the ROI of the reference image. This difference can be addressed by employing a "shape adjustment" approach, which may involve deformable image registration. Differences or variations in shape may be caused by, for example, changes in the patient's internal organs, such as a change in bladder fullness in the current situation compared to when the reference image was acquired.

[0096] At box 1208, method 1200 further includes determining structural features of at least one obtained image.

[0097] Structural features can be based on image segmentation and / or statistical analysis. In some examples, the identified structural features represent at least one of the following: region of interest, therapeutic target and / or organ at risk, Hausdorff distance, volume, and / or overlap volume histogram. For example, Hausdorff distance can represent the maximum distance between structures in an image. An overlap volume histogram can be used to define the amount of overlap between structures, such as the overlap between a target and an organ at risk. Structural features can represent the volume of a therapeutic target, region of interest, and / or organ at risk.

[0098] In some examples, the identified structural features represent multiple anatomical structures and / or may represent the structure and / or statistical indicators or scores of an image. The structure and / or statistical indicators or scores may represent the image as a whole or a portion of the image, such as one or more structures and / or volumes as described herein. In some examples, the structural features can be used for similarity comparisons with another image and / or may correspond to the Dice similarity coefficient (DSC). Method 1200 may include automatically quantifying the similarity between the acquired image and another image (e.g., a reference image and / or an image associated with a previously generated radiotherapy treatment plan) for the same anatomical structures (target, region of interest, and / or organ of danger). Additionally or alternatively, other methods or tools may be used to determine the similarity between two images, such as the Jaccard index, or a comparison between one or more Hausdorff distances, target volume, and / or overlap volume histograms. In some examples, based on clinical protocols, the most important structures can be identified in one or more acquired images, as well as in other images, and the structural features of the corresponding images can be based on these structures.

[0099] At box 1210, method 1200 further includes identifying a previously generated radiotherapy treatment plan based on the determined structural features.

[0100] In some examples, identifying a previously generated radiotherapy plan involves comparing identified structural features of at least one acquired image with structural features associated with a previously generated radiotherapy plan. In some examples, identifying a previously generated radiotherapy plan also includes determining the similarity between identified structural features of at least one acquired image and structural features associated with a previously generated radiotherapy plan. Similarity can be determined as a similarity score, similarity index, and / or similarity degree, including any similarity or comparison index and structural features described herein. In some examples, identifying a previously generated radiotherapy plan also includes determining the Dice similarity coefficient between at least one acquired image and an image associated with a previously generated radiotherapy plan. Similarity can only be determined for tumors, OARs, or other anatomical regions of interest, in which case an automatic contouring tool can be used to isolate the structures(s) of interest before calculating the similarity.

[0101] For example, a previously generated radiotherapy treatment plan may be associated with a previous image used to generate and / or calculate the plan, and that previous image may have its own structural features(s). In these examples, the previously generated radiotherapy treatment plan can be identified based on the determined structural features by evaluating or comparing the structural features of the image obtained at box 1202 with the structural features of the previous image associated with the previously generated radiotherapy treatment plan. Such evaluation or comparison can take the form of the similarity comparison examples described above, such as calculating the DSC and / or Jaccard index, and / or comparing the Hausdorff distance in at least one obtained image with the Hausdorff distance in the previous image associated with the previously generated radiotherapy treatment plan. In each example, the previously generated radiotherapy treatment plan can be identified and / or selected based on a similarity score, index, and / or degree exceeding a predefined threshold.

[0102] Previously generated radiotherapy plans may be suitable for delivering the prescribed dose to the patient, particularly for the current ROI setup. The suitability of a previously generated radiotherapy plan can be determined based on structural features and / or structural similarity comparisons. As described herein, generally, with respect to other radiotherapy plans, previously generated radiotherapy plans may include a treatment arrangement component (e.g., how the dose is divided into fractions and when these fractions are delivered) and a radiotherapy delivery plan (determining specific system variables or parameters for delivering specific dose fractions to a specific site, such as appropriate beamshaping assembly location or configuration, beam angle, beam energy, and / or irradiation duration). Previously generated radiotherapy plans may include multiple beam segments.

[0103] As described above, a previously generated radiotherapy treatment plan may be associated with an image initially used to calculate the previously generated plan, and that image may in turn have associated structural features. The previously generated radiotherapy treatment plan may be similar to and / or of the same type as the structural features identified in the acquired image, and can be identified and / or selected accordingly. For example, one or more structural features of the acquired image can be compared to the structural features of the image used to generate the previously generated radiotherapy treatment plan. If the images show sufficient similarity in their one or more structural features, the previously generated radiotherapy treatment plan can be considered suitable for delivering the planned prescribed dose to the patient based on their current condition. Accordingly, taking into account the differences identified at box 1206, the previously generated radiotherapy treatment plan may deliver the prescribed dose more effectively than the planned radiotherapy treatment plan.

[0104] The previously generated radiotherapy treatment plan may be associated with the same patient as the patient used to obtain the acquired image at box 1202, or it may be associated with another patient. The other patient may be part of the same patient group as the patient used to obtain the acquired image. For example, all data for a specific treatment group can be stored, and plans previously created for different patients can be reused for other patients (if their structures are similar), provided that the prescription and protocol parameters are generally standardized.

[0105] At box 1212, method 1200 further selects a first workflow path, wherein the first workflow path includes replacing at least a portion of the planned radiotherapy treatment plan with at least a portion of the previously generated radiotherapy treatment plan.

[0106] In some examples, the selection may be based on the following: given the differences identified at box 1206, it is determined that a previously generated radiotherapy treatment plan is preferred over a planned radiotherapy treatment plan for delivering the prescribed dose. For example, it may be determined that the previously generated radiotherapy treatment plan meets at least one predefined treatment plan quality criterion.

[0107] The first workflow path enables rapid modification, adjustment, alteration, and / or replacement of planned radiotherapy treatment plans to account for differences without requiring full calculation of the adjusted plan. By replacing the planned radiotherapy treatment plan with at least a partial replacement of the previously generated plan, the prescribed dose can be delivered to the patient in their current state more efficiently. Accordingly, the planned radiotherapy treatment plan can be effectively “adjusted” without the time burden of fully calculating and / or validating the adjusted plan. The method disclosed herein allows for matching stored previously generated radiotherapy treatment plans with the patient’s current anatomical state based on historical structural data associated with the stored plan. The method disclosed herein may be particularly beneficial for cancers of the pelvic region, as changes in the anatomical structure of the pelvic region are observed daily based on the patient’s solid and fluid intake. If the patient requires adaptive radiotherapy, this approach can reduce the burden on the clinical team to create “new” treatment plans. Furthermore, the method disclosed herein can improve patient outcomes by automating many typically manual processes and allows for more frequent and effective adoption of adaptive practices. Furthermore, the method proposed in this paper can reduce the need for large amounts of computing resources, thereby creating adjusted plans and enabling faster adjustment processes, minimizing total treatment time, and allowing clinics to increase patient throughput.

[0108] A planned radiotherapy treatment plan can be at least partially replaced by modifying at least one of the calculation parameters disclosed elsewhere in this document (e.g., multi-leaf collimator parameters) and / or modifying the beam segment to be delivered. In some examples, the specified dose to the target can be modified. In some examples, a planned radiotherapy treatment plan can be completely replaced by a previously generated radiotherapy treatment plan.

[0109] Method 1200 may also include steps for performing a first workflow path, but these steps are not required in all examples. In some examples, the first workflow path includes delivering treatment to the patient according to a previously generated radiotherapy treatment plan.

[0110] In some examples, identifying previously generated radiotherapy plans involves retrieving these plans from a repository containing multiple previously generated radiotherapy plans. This repository can be a reference library or other storage containing multiple previously generated radiotherapy plans, each of which can be either a previously adjusted radiotherapy plan or an unadjusted radiotherapy plan. Each stored plan can be associated with a corresponding stored image used to generate the plan, and / or with structural features of the corresponding storage.

[0111] In some examples, a previously generated radiotherapy treatment plan can be selected from multiple candidate previously generated radiotherapy treatment plans based on the associated structural features that are most similar to the structural features of the obtained patient image.

[0112] In some examples, method 1200 further includes: the first workflow path further includes determining that the identified previously generated radiotherapy treatment plan is suitable for delivery of the prescribed dose associated with the planned radiotherapy treatment plan.

[0113] In some examples, method 1200 further includes determining that the previously generated radiotherapy treatment plan meets at least one predefined treatment plan quality criterion, the at least one predefined treatment plan quality criterion including one or more of the following: a minimum target dose threshold, a maximum organ at risk dose threshold, and a region of interest (ROI) that exhibits threshold similarity between at least one acquired image and at least one reference image.

[0114] In some examples, method 1200 also includes displaying information representing dose characteristics associated with a previously generated radiotherapy treatment plan at the identified location. For example, dosimetry targets, 3D dosimetry, and dose-volume histogram (DVH) information may be displayed to allow clinicians to verify that the selected previously generated radiotherapy treatment plan is suitable for use during the patient's treatment course. If the plan is unsuitable, the user can adjust the plan using a plan adjustment workflow, including the workflow described herein. The display may be part of a user interface similar to or conforming to the exemplary radiotherapy user interface examples sections 500, 600, and 700 described above. The user interface may be implemented using a display screen (e.g., a touchscreen) or other screen. This document also provides... Figure 1 and Figure 8 Further examples of input and / or output devices for the relevant user interface. The user interface enables users to select workflow paths according to the methods and systems disclosed herein.

[0115] In some examples, the selection at box 1212 is based on user input. In other words, method 1200 includes enabling the user to select a first workflow. In other examples, the first workflow can be selected automatically without user input. In some examples, method 1200 includes automatically identifying a previously generated radiotherapy treatment plan, replacing at least a portion of the planned radiotherapy treatment plan with the previously generated radiotherapy treatment plan, and determining and displaying information related to dose delivery of the previously generated radiotherapy treatment plan.

[0116] In some examples, method 1200 is performed during fractionated radiotherapy sessions.

[0117] In some examples, the method also includes enabling the user to select at least one of a first workflow path and a second workflow path, wherein the second workflow path includes calculating an adjusted radiotherapy treatment plan based on the differences. Advantageously, the user can adjust the planned radiotherapy treatment plan either by using a previously generated radiotherapy treatment plan (thus saving time) or by calculating a new radiotherapy treatment plan (thus enabling more granular adjustments).

[0118] In the second workflow path, depending on the specific differences in the ROI, methods for adjusting position or shape, or both, may be used. The second workflow path may include calculating the adjusted radiotherapy treatment plan according to any methods disclosed herein and any methods known to those skilled in the art.

[0119] Method 1200 may also include a box of one or more other methods disclosed herein, such as Figure 2 Workflow 200 or Figure 3Method 300. For example, the second workflow might include performing... Figure 2 Workflow 200 includes boxes 252 and / or 254, as well as subsequent boxes in the workflow, to adjust the planned treatment plan. In other examples, the steps in these boxes can be used to adjust a previously generated radiotherapy treatment plan. In another example, the second workflow may include... Figure 2 Workflow 200 includes box 206 and one or more subsequent boxes to evaluate plan quality. Method 1200 may include, in some examples, boxes 206 and 206. Figure 3 Method 300 includes one or more of boxes 306 to 312, which are related to at least one of the planned radiotherapy treatment plan and a previously generated radiotherapy treatment plan. In some examples, after identifying the previously generated radiotherapy treatment plan, it can be used as... Figure 2 and Figure 3 The example demonstrates a planned radiotherapy treatment plan. For instance, a previously generated radiotherapy treatment plan can be... Figure 3 Box 308 is used to determine whether the delivery of a previously generated radiotherapy treatment plan meets at least one predefined treatment plan quality criterion, and to enable the user to select whether to deliver the previously generated radiotherapy treatment plan or to adjust the previously generated radiotherapy treatment plan. More examples are illustrated below.

[0120] In some examples, method 1200 further includes determining an adjustable position adjustment of the patient support based on comparing at least one obtained image with at least one reference image, the adjustable position adjustment of the patient support moving the current position of the ROI to a second position in which the ROI is more closely aligned with the reference position of the ROI.

[0121] In some examples, method 1200 also includes displaying a visual indicator to indicate whether the delivery of the planned radiotherapy treatment plan when the ROI is in the second location meets at least one predefined treatment plan quality criterion. In some examples, the enabling step of method 1200 also includes enabling the user to select a third workflow path, wherein the third workflow path includes performing location adjustments and delivering treatment according to the planned radiotherapy treatment plan.

[0122] In some examples, calculating the adjusted radiotherapy treatment plan includes calculating beam shaping parameters for delivering the treatment, as described in other parts of this document.

[0123] In some examples, the adjusted radiotherapy treatment plan is calculated based on one or more parameters corresponding to at least one predefined treatment plan quality standard, and if the planned radiotherapy treatment plan is delivered when the ROI is in the second position, it will not meet the at least one predefined treatment plan quality standard.

[0124] In some examples, the second workflow path also includes providing a modified radiotherapy treatment plan for remote review.

[0125] This document also provides a system for use in radiotherapy workflow 200 and / or other radiotherapy workflows. The system is configured to perform the methods disclosed herein, such as... Figure 3 Method 300 and / or Figure 12 The method 1200 includes one or more methods and comprises at least one processor and one or more non-transient computer-readable media storing computer-executable instructions that, when executed by the one or more processors, cause the one or more processors to perform any one or more methods disclosed herein. The system may include a radiotherapy apparatus, including a radiotherapy delivery device, such as... Figure 1 and Figure 8 The apparatus shown. Accordingly, the system may include a computing system, image acquisition equipment, medical equipment, input devices and / or output devices, such as Figure 8 Those shown.

[0126] Figure 8 A block diagram illustrating one implementation of a radiotherapy system 800 is shown. The radiotherapy system 800 includes a computing system 810, which can execute a set of instructions to cause the computing system 810 to perform any or more methods discussed herein.

[0127] The computing system 810 should include any number or set of machines, such as one or more computing devices, that individually or collectively execute a set (or more) of instructions to perform any or more of the methods discussed herein. That is, the hardware and / or software may be provided in a single computing device or distributed across multiple computing devices within the computing system. In some implementations, one or more elements of the computing system may be connected (e.g., networked) to other machines, such as a local area network (LAN), intranet, extranet, or the Internet. One or more elements of the computing system may operate as server or client machines in a client-server network environment, or as peer machines in a peer-to-peer (or distributed) network environment. One or more elements of the computing system may be a personal computer (PC), tablet computer, set-top box (STB), personal digital assistant (PDA), mobile phone, network device, server, network router, switch, or bridge, or any machine capable of executing a set of instructions (sequentially or otherwise) specifying the operation to be performed by that machine.

[0128] The computing system 810 includes controller circuitry 811 and memory 813 (e.g., read-only memory (ROM), flash memory, dynamic random access memory (DRAM), such as synchronous DRAM (SDRAM) or Rambus DRAM (RDRAM)). Memory 813 may include static memory (e.g., flash memory, static random access memory (SRAM)) and / or auxiliary memory (e.g., data storage devices), which communicate with each other via a bus (not shown).

[0129] The controller circuit 811 represents one or more general-purpose processors, such as microprocessors, central processing units, accelerated processing units, etc. More specifically, the controller circuit 811 may include a Complex Instruction Set Computing (CISC) microprocessor, a Reduced Instruction Set Computing (RISC) microprocessor, a Very Long Instruction Word (VLIW) microprocessor, a processor implementing other instruction sets, or a processor implementing combinations of instruction sets. The controller circuit 811 may also include one or more special-purpose processing devices, such as application-specific integrated circuits (ASICs), field-programmable gate arrays (FPGAs), digital signal processors (DSPs), network processors, etc. The one or more processors in the controller circuit may employ a multi-core design. The controller circuit 811 is configured to execute the processing logic of the operations and steps discussed herein.

[0130] The computing system 810 may also include network interface circuitry 818. The computing system 810 may be communicatively coupled to input device 820 and / or output device 830 via input / output circuitry 817. In some implementations, input device 820 and / or output device 830 may be elements of the computing system 810. Input device 820 may include alphanumeric input devices (e.g., keyboard or touchscreen), cursor control devices (e.g., mouse or touchscreen), audio devices (e.g., microphone), and / or haptic input devices. Output device 830 may include audio devices (e.g., speakers), video display units (e.g., liquid crystal display (LCD) or cathode ray tube (CRT)), and / or haptic output devices. In some implementations, input device 820 and output device 830 may be provided as a single device or as separate devices.

[0131] In some implementations, the computing system 810 may include an image processing circuit 819. The image processing circuit 819 may be configured to process image data 880 (e.g., image or imaging data), such as medical images obtained from one or more imaging data sources, medical devices 850, and / or image acquisition devices 840. The image processing circuit 819 may be configured to process or preprocess image data. For example, the image processing circuit 819 may convert received image data into a specific format, size, resolution, etc. In some implementations, the image processing circuit 819 may be used in conjunction with a controller circuit 811.

[0132] In some implementations, the radiotherapy system 800 may also include an image acquisition device 840 and / or a treatment device 850, as described herein. Figures 1-3 The examples disclosed herein. Image acquisition device 840 and treatment device 850 may be provided as a single device. In some implementations, treatment device 850 is configured to perform imaging, for example, imaging outside of and / or during treatment. Treatment device 850 includes the main radiation delivery components of a radiotherapy system, such as linac.

[0133] The image acquisition device 840 can be configured to perform positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI) or other suitable imaging techniques.

[0134] Image acquisition device 840 can be configured to output image data 880, which is accessible to computing system 810. Treatment device 850 can be configured to output treatment data 860, which is accessible to computing system 810.

[0135] The computing system 810 can be configured to access or obtain treatment data 860, planning data 870, and / or image data 880. Treatment data 860 can be obtained from internal data sources (e.g., from memory 813) or external data sources (e.g., treatment device 850 or an external database). Planning data 870 can be obtained from memory 813 and / or external sources (e.g., a planning database). Planning data 870 may include information obtained from one or more image acquisition devices 840 and treatment devices 850. Accordingly, the computing system 810 is arranged to implement the methods disclosed herein related to processing treatment plans and treatment quality criteria.

[0136] All of the above methods can be implemented by a computer program. The computer program may include computer code (e.g., instructions) 910, which is arranged to instruct a computer to perform the functions of one or more of the above methods. The steps of the above methods can be performed in any suitable order. The computer program and / or the code 910 for performing such methods may be provided to an apparatus (e.g., a computer), provided on one or more computer-readable media, or more generally, provided to... Figure 9 The computer program product 900 is depicted. The computer-readable medium can be transient or non-transient. One or more computer-readable media 900 can be, for example, electronic, magnetic, optical, electromagnetic, infrared, or semiconductor systems, or can be a propagation medium for data transmission, such as for downloading code via the Internet. Alternatively, one or more computer-readable media can take the form of one or more physical computer-readable media, such as semiconductor or solid-state memory, magnetic tape, removable computer floppy disk, random access memory (RAM), read-only memory (ROM), rigid disk, and optical disk, such as CD-ROM, CD-R / W, or DVD. Instructions 910 may also reside wholly or at least partially in memory 813 and / or controller circuitry 811 during execution of the computing system 810, which also constitute computer-readable storage media.

[0137] In implementation, the modules, components and other functions described herein can be implemented as discrete components or integrated into the functions of hardware components such as ASICs, FPGAs, DSPs or similar devices.

[0138] A "hardware component" refers to a tangible (e.g., non-transitory) physical component (e.g., a collection of one or more processors) capable of performing certain operations and which can be configured or arranged in a physical manner. A hardware component may include dedicated circuitry or logic that is permanently configured to perform certain operations. A hardware component may include dedicated processors, such as FPGAs or ASICs. A hardware component may also include programmable logic or circuitry that can be temporarily configured by software to perform certain operations.

[0139] Furthermore, these modules and components can be implemented in hardware devices as firmware or functional circuitry. Moreover, modules and components can be implemented as any combination of hardware devices and software components, or solely as software (e.g., code stored or otherwise embedded in a machine-readable or transmission medium).

[0140] Unless otherwise expressly stated, as will be apparent from the following description, it should be understood that throughout the description, the use of terms such as “receive,” “determine,” “compare,” “enable,” “maintain,” “identify,” “calculate,” and “display” refers to the operation and process of a computer system or similar electronic computing device that manipulates and converts data represented in physical (electronic) quantities in computer system registers and memories into other data represented in physical quantities in computer system memory or registers or other such information storage, transmission, or display devices.

[0141] It should be understood that the above description is intended to be illustrative and not limiting. Many other implementations will become apparent to those skilled in the art upon reading and understanding the above description. While this disclosure has been described with reference to specific example implementations, it should be recognized that this disclosure is not limited to the described embodiments, but can be modified and varied within the spirit and scope of the appended claims. Accordingly, the specification and drawings should be considered illustrative and not limiting. Therefore, the scope of the disclosure should be determined by reference to the appended claims and the full scope of their equivalents.

Claims

1. A computer-implemented method for use in a radiotherapy workflow, comprising: Obtain at least one image of the patient, wherein the at least one image of the patient indicates the current location of the patient's region of interest (ROI); The obtained at least one image is compared with at least one reference image associated with the patient’s planned radiotherapy treatment plan, wherein the at least one reference image indicates the reference location of the patient’s ROI; The difference between the current position of the ROI and the reference position of the ROI is determined based on the comparison. Determine the structural features of at least one obtained image; Identify previously generated radiotherapy treatment plans based on the determined structural features; and Select a first workflow path, wherein the first workflow path includes replacing at least a portion of the planned radiotherapy treatment plan with at least a portion of the previously generated radiotherapy treatment plan.

2. The method according to claim 1, wherein, Identifying previously generated radiotherapy treatment plans involves retrieving the previously generated radiotherapy treatment plans from a repository containing multiple such plans.

3. The method according to any one of the preceding claims, wherein, Identifying a previously generated radiotherapy treatment plan involves comparing the determined structural features of at least one obtained image with the structural features associated with the previously generated radiotherapy treatment plan.

4. The method according to any one of the preceding claims, wherein, Identifying a previously generated radiotherapy treatment plan includes determining the similarity between identified structural features of at least one obtained image and structural features associated with the previously generated radiotherapy treatment plan.

5. The method according to any one of the preceding claims, wherein, Identifying the previously generated radiotherapy treatment plan also includes determining the Dice similarity coefficient of at least one obtained image to an image associated with the previously generated radiotherapy treatment plan.

6. The method according to any one of the preceding claims, wherein, The identified structural features represent at least one of the following: region of interest, therapeutic target, organ at risk, Hausdorff distance, volume and / or overlapping volume histogram.

7. The method according to any one of the preceding claims, wherein, The identified structural features represent a variety of anatomical structures.

8. The method according to any one of the preceding claims further includes information displaying dose characteristics representing the dose associated with the identified previously generated radiotherapy treatment plan.

9. The method according to any one of the preceding claims, wherein, The method is performed during fractionated radiotherapy sessions.

10. The method according to any one of the preceding claims, wherein, The differences include at least one of the following: differences in the location of the ROI, differences in the location of the ROI, and / or differences in the shape of the ROI.

11. The method according to any one of the preceding claims further includes determining that the previously generated radiotherapy treatment plan meets at least one predefined treatment plan quality criterion, the at least one predefined treatment plan quality criterion including one or more of the following: a minimum target dose threshold, a maximum organ at risk dose threshold, and a region of interest (ROI) that exhibits threshold similarity between at least one acquired image and at least one reference image.

12. The method according to any one of the preceding claims, wherein, The first workflow path also includes determining that the identified previously generated radiotherapy treatment plan is suitable for delivering the prescribed dose associated with the planned radiotherapy treatment plan.

13. The method according to any one of the preceding claims, wherein, The selection is based on user input.

14. The method according to any one of the preceding claims, wherein, The method further includes enabling a user to select at least one of a first workflow path and a second workflow path, wherein the second workflow path includes a radiotherapy plan calculated based on the differences.

15. The method according to any one of the preceding claims, further comprising: Based on comparing at least one obtained image with the at least one reference image, an adjustable position adjustment of the patient support is determined, which will move the current position of the ROI to a second position, in which the ROI is more closely aligned with the reference position of the ROI.

16. The method according to claim 15, wherein, Include at least one of the following: The method further includes: displaying a visual indicator to indicate whether the delivery of the planned radiotherapy treatment plan when the ROI is in the second location meets at least one predefined treatment plan quality standard; and / or The method further includes enabling a user to select a third workflow path, wherein the third workflow path includes performing the location adjustment and delivering treatment according to the planned radiotherapy treatment plan.

17. The method according to any one of claims 14 to 16, wherein, Calculating the adjusted radiotherapy plan includes calculating the beamforming parameters used to deliver the treatment.

18. The method according to any one of claims 14 to 17, wherein, The adjusted radiotherapy plan is calculated based on one or more parameters corresponding to at least one predefined treatment plan quality standard, and if the planned radiotherapy treatment plan is delivered when the ROI is in the second position, it will fail to meet the at least one predefined treatment plan quality standard.

19. The method according to any one of claims 14 to 18, wherein, The second workflow path also includes providing the adjusted radiotherapy treatment plan for remote review.

20. A system for use in a radiotherapy workflow, the system comprising: At least one processor; as well as One or more non-transitory computer-readable media storing computer-executable instructions that, when executed by one or more processors, cause one or more processors to perform a method comprising the following steps: Obtain at least one image of the patient, wherein the at least one image of the patient indicates the current location of the patient's region of interest (ROI); The obtained at least one image is compared with at least one reference image associated with the patient’s planned radiotherapy treatment plan, wherein the at least one reference image indicates the reference location of the patient’s ROI; The difference between the current position of the ROI and the reference position of the ROI is determined based on the comparison. Determine the structural features of at least one obtained image; Identify previously generated radiotherapy treatment plans based on the determined structural features; and Select a first workflow path, wherein the first workflow path includes replacing at least a portion of the planned radiotherapy treatment plan with at least a portion of the previously generated radiotherapy treatment plan.

21. The system according to claim 20, wherein, When the instructions are executed by the one or more processors, the one or more processors are caused to perform the method of any one of claims 2 to 19.

22. A computer-readable medium comprising instructions that, when executed by a processor, cause to perform the method of any one of claims 1 to 19.

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