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[jadyn_pretty]

Is there a way to send a Free Breathing DICOM for DIBH patients so that it can be used for initial set-up?  We currently have our DIBH patients hold their breath day 1 and set up to Breath Hold DICOM because our planning department does not know how to send a Free Breathing DICOM. There is no planning done on the Free Breathing scan...so they say nothing can be sent to VisionRT.  Is there a way?

[jacqui_dorney]

Hi Jadyn,

Yes absolutely as long as you complete a planning scan in FB and then in BH so you can generate both data sets.  Using the FB surface for set up is standard practice in most sites.

Physics/dosimetry just need to send both surfaces over labelled FB and BH so you can clearly differentiate between the two.  One of VisionRT's clin apps specialists will be able to talk your team through how to set this up, then you can use FB for set up, switch over in the linac to the BH surface, coach your pt into BH, and adjust any minor lat and long deltas in BH prior to trt.

Hope that helps

Jacqui

[mark_wyatt]

We acquire a FB and DIBH CT at simulation in the same CT series without moving the patient or re-zeroing the couch, so the two CT's  have the same DICOM origin. In Eclipse we then take advantage of that image registration to copy the FB BODY structure/contour onto the DIBH structure set. Since both body contours are now in the same DIBH plan, they can be sent to OSMS and imported.

[michael_tallhamer_msc_dabr]

We would have to know what your planning system is before we could give you specific instructions but it is possible. We use Eclipse at my institution and as in anything within RO there are multiple ways to skin that cat.

If you scan the patient FB then immediately in BH during CT sim you have a couple options. The best one is in the TPS the two scans are co-registered based on sharing the same DICOM coordinates so all you have to do is contour and copy the FB body structure into the BH plan. We name the Free Breathing Body "FB BODY" and the Breath Hold body "BH BODY" so the therapists importing can easily identify the structures when importing into the correct setup fields in AlignRT. This process is easy in Eclipse and allows the dosimetrist to only have to export 1 plan to AlignRT.

A second option is to copy the whole plan to the FB CT scan recontour the body structure to represent the FB body and push both the FB plan and the BH plan but this can cause confusion at the machine when importing if the therapists aren't careful.

If you have another TPS like Pinnacle or RayStation there may be a similar process but I don't know what that would be right off the top of my head at the moment. If there isn't a similar process and you have something like MIM or Velocity the process described above for Eclipse is very easy and very similar in both of those systems but does require and extra step of pushing it back to the TPS.

[dcameron]

Jadyn,

Does your facility perform both a free breathing and breath hold scan at the day of CT simulation for your DIBH patients?  If so, then send the free breathing scan to the treatment planning system and create a body contour  (usually done automatically). After the body contour has been created you can send this free breathing structure set to your AlignRT software.  Create a free breathing field based on the breath hold isocenter, and import the free breathing body via the "IMPORT RTSTRUCT" in record.   If you do not perform a free breathing scan, then you can use the camera feature in record to capture a free breathing surface.  I will save this process to avoid confusion.  Hope that helps.

[james_murray]

From Eclipse, there is most definitely a way to do this.  I can send you my instructions if you have Eclipse.  james.murray@21co.com

[kristen_beck]

VisionRT has a written workflow for how to set this up in the software in their "Treatment Planning Workflows" document.