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Abstract：
OBJECTIVE: Online Adaptive Radiation Therapy (oART) follows a different treatment paradigm than conventional radiotherapy, and because of this, the resources, implementation, and workflows needed are unique. The purpose of this report is to outline our institution\'s experience establishing, organizing, and implementing an oART program using the Ethos therapy system.
METHODS: We include resources used, operational models utilized, program creation timelines, and our institutional experiences with the implementation and operation of an oART program. Additionally, we provide a detailed summary of our first year\'s clinical experience where we delivered over 1000 daily adaptive fractions. For all treatments, the different stages of online adaption, primary patient set-up, initial kV-CBCT acquisition, contouring review and edit of influencer structures, target review and edits, plan evaluation and selection, Mobius3D 2nd check and adaptive QA, 2nd kV-CBCT for positional verification, treatment delivery, and patient leaving the room, were analyzed.
RESULTS: We retrospectively analyzed data from 97 patients treated from August 2021-August 2022. One thousand six hundred seventy seven individual fractions were treated and analyzed, 632(38%) were non-adaptive and 1045(62%) were adaptive. Seventy four of the 97 patients (76%) were treated with standard fractionation and 23 (24%) received stereotactic treatments. For the adaptive treatments, the generated adaptive plan was selected in 92% of treatments. On average(±std), adaptive sessions took 34.52 ± 11.42 min from start to finish. The entire adaptive process (from start of contour generation to verification CBCT), performed by the physicist (and physician on select days), was 19.84 ± 8.21 min.
CONCLUSIONS: We present our institution\'s experience commissioning an oART program using the Ethos therapy system. It took us 12 months from project inception to the treatment of our first patient and 12 months to treat 1000 adaptive fractions. Retrospective analysis of delivered fractions showed that the average overall treatment time was approximately 35 min and the average time for the adaptive component of treatment was approximately 20 min.
METHODS: We include resources used, operational models utilized, program creation timelines, and our institutional experiences with the implementation and operation of an oART program. Additionally, we provide a detailed summary of our first year\'s clinical experience where we delivered over 1000 daily adaptive fractions. For all treatments, the different stages of online adaption, primary patient set-up, initial kV-CBCT acquisition, contouring review and edit of influencer structures, target review and edits, plan evaluation and selection, Mobius3D 2nd check and adaptive QA, 2nd kV-CBCT for positional verification, treatment delivery, and patient leaving the room, were analyzed.
RESULTS: We retrospectively analyzed data from 97 patients treated from August 2021-August 2022. One thousand six hundred seventy seven individual fractions were treated and analyzed, 632(38%) were non-adaptive and 1045(62%) were adaptive. Seventy four of the 97 patients (76%) were treated with standard fractionation and 23 (24%) received stereotactic treatments. For the adaptive treatments, the generated adaptive plan was selected in 92% of treatments. On average(±std), adaptive sessions took 34.52 ± 11.42 min from start to finish. The entire adaptive process (from start of contour generation to verification CBCT), performed by the physicist (and physician on select days), was 19.84 ± 8.21 min.
CONCLUSIONS: We present our institution\'s experience commissioning an oART program using the Ethos therapy system. It took us 12 months from project inception to the treatment of our first patient and 12 months to treat 1000 adaptive fractions. Retrospective analysis of delivered fractions showed that the average overall treatment time was approximately 35 min and the average time for the adaptive component of treatment was approximately 20 min.
摘要：
目的：在线自适应放射治疗（oART）遵循与传统放射治疗不同的治疗模式，正因为如此,资源,实施，所需的工作流是独一无二的。本报告的目的是概述我们机构建立的经验，组织,并使用Ethos治疗系统实施oART计划。
方法：我们包括使用的资源，使用的操作模型，程序创建时间表，以及我们在实施和运营OART计划方面的机构经验。此外,我们提供了我们第一年的临床经验的详细总结，我们每天提供超过1000个自适应分数。对于所有的治疗,在线适应的不同阶段，主要患者设置，初始kV-CBCT采集，影响者结构的轮廓审查和编辑，目标审查和编辑，计划评估和选择，Mobius3D第二次检查和自适应QA，用于位置验证的第二kV-CBCT，治疗交付，和病人离开房间，进行了分析。
结果：我们回顾性分析了2021年8月至2022年8月治疗的97例患者的数据。对一千六百七十七个单独的馏分进行了处理和分析，632（38％）是非适应性的，1045（62％）是适应性的。97例患者中有74例（76％）接受了标准分割治疗，23例（24％）接受了立体定向治疗。对于适应性治疗，在92%的治疗中选择了生成的适应性计划.平均(±std)，自适应会话从开始到结束需要34.52±11.42分钟。整个自适应过程（从轮廓生成开始到验证CBCT），由物理学家(和医生在选定的日子)执行，为19.84±8.21分钟。
结论：我们介绍了我们机构使用Ethos治疗系统调试oART计划的经验。从项目开始到第一位患者的治疗花了我们12个月的时间，治疗1000个适应性部分花了12个月的时间。对递送部分的回顾性分析显示,平均总体治疗时间为约35分钟,而适应性治疗组分的平均时间为约20分钟。
方法：我们包括使用的资源，使用的操作模型，程序创建时间表，以及我们在实施和运营OART计划方面的机构经验。此外,我们提供了我们第一年的临床经验的详细总结，我们每天提供超过1000个自适应分数。对于所有的治疗,在线适应的不同阶段，主要患者设置，初始kV-CBCT采集，影响者结构的轮廓审查和编辑，目标审查和编辑，计划评估和选择，Mobius3D第二次检查和自适应QA，用于位置验证的第二kV-CBCT，治疗交付，和病人离开房间，进行了分析。
结果：我们回顾性分析了2021年8月至2022年8月治疗的97例患者的数据。对一千六百七十七个单独的馏分进行了处理和分析，632（38％）是非适应性的，1045（62％）是适应性的。97例患者中有74例（76％）接受了标准分割治疗，23例（24％）接受了立体定向治疗。对于适应性治疗，在92%的治疗中选择了生成的适应性计划.平均(±std)，自适应会话从开始到结束需要34.52±11.42分钟。整个自适应过程（从轮廓生成开始到验证CBCT），由物理学家(和医生在选定的日子)执行，为19.84±8.21分钟。
结论：我们介绍了我们机构使用Ethos治疗系统调试oART计划的经验。从项目开始到第一位患者的治疗花了我们12个月的时间，治疗1000个适应性部分花了12个月的时间。对递送部分的回顾性分析显示,平均总体治疗时间为约35分钟,而适应性治疗组分的平均时间为约20分钟。
