2547 - A Free and Open-Source Solution to Standardize and Automate the Creation of Setup Fields in Radiation Therapy Planning

Purpose/Objective(s): In today’s landscape of image guided radiation therapy, the optimal set of imaging setup fields depends on a range of variables including site, laterality, treatment technique, and patient position. Not having the needed setup fields available at the machine can delay treatment. Manual creation of these fields is inherently error prone. Historically, these challenges were addressed by the use of plan templates containing all possible setup fields. This increased physician plan review complexity due to the extensive number of fields. Attempts to reduce the number of fields through the use of a standardized set of templates were not sustainable, resulting in increased variability in setup field usage and issues such as missed fields during review and undelivered fields. These challenges demonstrate the need for a standardized, automated approach for setup field creation to mitigate patient safety risks. The objective of this project is to develop and implement a streamlined, automated method for creating setup fields within the Eclipse Treatment Planning System.

Materials/Methods: The Eclipse database was queried to provide tabulated data of the setup fields used for various treatment sites and patient orientations. This was then adjusted and refined using input from therapists, dosimetrists, physicists, and physicians to generate a comprehensive configuration file that indicates which setup fields go with which patient orientations for which treatment sites. Orientation-specific default options were created for uncommon treatment sites that might not have entries. The configuration file relies on keyed mappings, this allows updates to treatment site names or new entries to be handled in the configuration file rather than needing a revised script. The Eclipse Scripting API was used to generate a C# script that reads the patient’s orientation and treatment site and adds the appropriate setup fields according to the aforementioned configuration file. Using the script is streamlined by the assignment of a hot key combination within the Eclipse environment, enabling planners to rapidly deploy the script. The script was approved for clinical use after an internal code review and end-to-end validation performed on a mirrored research system.

Results: The script executes without issues on the clinical system in under five seconds. The configuration file enables easy modification of the scripts functionality to adapt for updating clinical standards and a trivial installation process for specific clinics’ preferences. The script is actively being used clinically.

Conclusion: This simple script facilitates a cleaner workspace with standardized naming and a reduction in unnecessary setup fields. Automating the creation of setup fields promises an improvement to the workload for dosimetrists. The script developed in this work will be made free and open-source after publication, further encouraging the distribution of this helpful tool.