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A dedicated cloud system for real-time upfront quality assurance in pediatric radiation therapy

Ein spezielles Cloud-System für die Real-time‑/Vorab-Qualitätssicherung in der pädiatrischen Strahlentherapie

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Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Purpose

Pediatric radiotherapy (RT) is a highly specialized field, requiring great experience to delineate correctly tumor targets and organs at risk. To reduce treatment failures related to planning inaccuracies and to obtain robust clinical results despite the limited numbers of enrolled pediatric patients, the SIOP PNET5MB clinical trial on medulloblastoma requires a real-time, pre-radiation review of the RT treatment (craniospinal irradiation and boost plan) under the direct responsibility of the national coordinator center. Here we describe the centralized radiotherapy quality assurance (QA) program developed in Italy for this purpose.

Methods

Using the software package VODCA (MSS, Hagendorn, Switzerland, www.vodca.ch), we developed a cloud platform able to handle computed tomography (CT) images and RT objects and to support the complete workflow required by the review process in the context of the SIOP PNET5 trial.

Results

All Italian centers participating in the PNET5 trial adopted the proposed QA system. 24 patients were successfully enrolled and reviewed. For 15 patients (62.5%), one or more plan revisions were requested for the craniospinal irradiation plan and for 11 patients (45.8%) plan revisions were requested for the boost. RT was delivered after the plan was centrally approved for all enrolled patients. So far, in Italy, no patients have been excluded from PNET5 due to dosimetric incompliance to the protocol or for exceeding the RT starting time limit.

Conclusion

The cloud platform successfully supported the trial workflow, producing official review documents. This efficient QA was crucial to guarantee optimized treatments and protocol compliance for all pediatric patients enrolled in the SIOP protocol.

Zusammenfassung

Zielsetzung

Die pädiatrische Strahlentherapie (RT) ist ein hochspezialisiertes Fachgebiet, welches zum korrekten Konturieren der Zielvolumina und Risikoorgane sehr viel Erfahrung erfordert. Zur Reduktion von Behandlungsversagen, das durch Ungenauigkeiten im Planungsprozess verursacht wird, und für aussagekräftige klinische Ergebnisse trotz der begrenzten Anzahl der pädiatrischen Patienten benötigt die klinische Studie SIOP PNET5MB für Medulloblastoma eine Überprüfung der kraniospinalen und Boost-Bestrahlung bereits im Bestrahlungsplanungsprozess. Die Verantwortung der Überprüfung liegt bei den nationalen Koordinierungszentren. Zu diesem Zweck wurde ein zentralisiertes Programm zu Qualitätssicherung (QA) für die RT in Italien entwickelt, welches hier beschrieben wird.

Methoden

Mit dem Softwarepaket VODCA (MSS, Hagendorn, Switzerland, www.vodca.ch) haben wir eine Cloud-Plattform entwickelt, die zum einen in der Lage ist, Computertomographie(CT)-Bilder und RT-Objekte zu verarbeiten und zum anderen den gesamten Workflow des Review-Prozesses unterstützt, der im Rahmen der SIOP-PNET5-Studie erforderlich ist.

Ergebnisse

Alle italienischen Zentren, die an der klinischen PNET5-Studie teilnahmen, führten das vorgeschlagene QA-System ein. Insgesamt wurden 24 Patienten erfolgreich rekrutiert und überprüft. Für 15 Patienten (62,5 %) wurden eine oder mehrere Revisionen des kraniospinalen Bestrahlungsplans gefordert. Für 11 Patienten (45,8 %) wurden Änderungen für den Boost-Plan gefordert. Die rekrutierten Patienten wurden ausschließlich mit den zentral genehmigten RT-Plänen behandelt. In Italien wurde bislang kein einziger Patient wegen Nichteinhaltung des dosimetrischen Protokolls oder Überschreitung des für den Patienten erforderlichen Therapiestartdatums von der PNET5-Studie ausgeschlossen.

Schlussfolgerung

Die Cloud-Plattform unterstützt den Studienworkflow erfolgreich und ist darüber hinaus in der Lage, offizielle Überprüfungsdokumente zu erstellen. Diese effiziente QA war entscheidend, um sicherzustellen, dass alle Patienten, die in die PNET5-Studie aufgenommen wurden, eine optimale Behandlung erhielten, und dass die Protokolle eingehalten wurden.

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Acknowledgements

We deeply thank Associazione Bianca Garavaglia Onlus for making this whole project possible. We thank Piergiorgio Venuti from the company Secure Online Desktop for his valuable contribution.

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Authors and Affiliations

  1. Medical Physics Unit, Fondazone IRCCS Istituto Nazionale dei Tumori di Milano, Via Giacomo Venezian, 1, 20133, Milano, Italy

    Silvia Meroni, Claudia Cavatorta & Emanuele Pignoli

  2. U.O.S Radioterapia Infantile Policlinico SanMartino, Genova, Italy

    Salvina Barra

  3. Medical Physics Unit, Policlinico SanMartino, Genova, Italy

    Francesca Cavagnetto

  4. Radiation Therapy Department, Istituto Oncologico Veneto IOV—IRCCS, Padova, Italy

    Giovanni Scarzello

  5. Medical Physics Department, Istituto Oncologico Veneto IOV—IRCCS, Padova, Italy

    Alessandro Scaggion

  6. Pediatric Radiotherapy Unit, Fondazone IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy

    Emilia Pecori, Barbara Diletto, Ombretta Alessandro & Lorenza Gandola

  7. Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy

    Ombretta Alessandro

  8. Pediatric Oncology Unit, Fondazone IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy

    Maura Massimino

  9. Medical Software Solutions GmbH, Hagendorn, Switzerland

    Stefano Gianolini

Authors
  1. Silvia Meroni
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  2. Claudia Cavatorta
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  3. Salvina Barra
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  4. Francesca Cavagnetto
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  5. Giovanni Scarzello
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  6. Alessandro Scaggion
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  7. Emilia Pecori
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  8. Barbara Diletto
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  9. Ombretta Alessandro
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  10. Maura Massimino
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  11. Stefano Gianolini
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  12. Emanuele Pignoli
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  13. Lorenza Gandola
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Corresponding author

Correspondence to Claudia Cavatorta.

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Conflict of interest

S. Meroni, C. Cavatorta, S. Barra, F. Cavagnetto, G. Scarzello, A. Scaggion, E. Pecori, B. Diletto, O. Alessandro, M. Massimino, S. Gianolini, E. Pignoli, and L. Gandola declare that they have no competing interests.

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Meroni, S., Cavatorta, C., Barra, S. et al. A dedicated cloud system for real-time upfront quality assurance in pediatric radiation therapy. Strahlenther Onkol 195, 843–850 (2019). https://doi.org/10.1007/s00066-019-01469-y

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  • DOI: https://doi.org/10.1007/s00066-019-01469-y

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