Personalized Therapy Planning - Microsoft
Radiation OncologyPersonalizedtherapy planningPhilips Pinnacle EvolutionPinnacle Evolution is the next generation of treatment planning technology fromPhilips improving the quality, consistency and efficiency of the radiation therapyplanning process.With personalized, patient-specific goals integrated from the start, more advancedautomated planning tools and a new way of working, Pinnacle Evolution is readyto take on your planning challenges.QualityPersonalized planningKnow what goals are feasiblefor each organ.AIConsistencyEfficiencyAutomated planningAdvanced planningalgorithms help users fromnovice to expert deliverconsistent results.Newly optimized performanceFast optimizations and anefficient user interface helpyou quickly achieve clinicallydeliverable, personalizedtherapy plans.
QualityPersonalized planningImprove the quality of the treatment planning process with personalized,patient-specific goals integrated into the therapy plan from the start. Determine feasible goals at the start Create patient-specific, personalized therapy plans Improve planning workflow by reducing trial and error2Robust algorithm1Determine feasible, idealized goalsfor each individual OAR by comparingdose fall-off from the target.1Informed decisionsCompare and adjust initial OARgoals with feasible patient-specific,personalized goals.Robust, model-based approach adaptsto each unique patient.Make informed clinical decisions ontarget coverage or OAR sparing, oradditional optimization goals to furtherenhance plan quality.Complete, clinically deliverable planReview and approve plans morecollaboratively and more efficientlyby knowing the patient’s personalizedgoals at the start.2
Automation withintelligent algorithmsAIConsistencyDemonstrated leadership3 delivering consistent results from noviceto expert with advanced automated planning algorithms.These next-generation intelligent algorithms provide consistency to all users. Increased consistency of plan quality, regardless of the planner’s experience level Automated planning results are preferred by physicians Significant reductions in dose for many OARsFeasabilityPersonalizationand goal settingAIOptimizationProprietary,IMRT and VMATtechnologyAutomated workflowReduce manually and iterativelycreated dosimetric dose controlstructures such as rings, hot/coldspots and overlap regions.Create robust treatment techniquesdetailing the patient’s target,prescription and OAR goals, as wellas other optimization parameters.Enhanced controlDefine variable dose levels and voxelweights, dose fall-off rates for betterOAR sparing.3IntelligentautomationAutomatedplanning algorithmsIntegrated performanceIntelligently drive OAR sparing, asneeded, beyond what was initiallyrequired, while minimizing anycompromise on target coverage.Set dose fall-off rate and marginsfor greater control of integral dose.Start, stop, adjust and resumethe automated planning algorithmsto achieve desired results.3
Optimized performanceQuickly achieve clinically deliverable, personalized therapy planswith fast optimizations and an efficient user interface.EfficiencyThe speed of optimization is valuable, yet the benefit is only realized if the useris able to achieve consistent, personalized plan quality. Pinnacle Evolutionfeatures proprietary optimization to improve speed performance, as wellas integration in IntelliSpace Radiation Oncology to enhance workflow.FeasabilityPersonalizationand goal settingAIOptimizationProprietary,IMRT and VMATtechnologyProprietary optimized solutionsState-of-the-art numerical methods,solvers and algorithms reducecomplexity and optimization time,while maintaining exceptional quality.Integration of automated algorithmsFast speed performance by embeddingautomated planning algorithms insidethe optimization process itself.PatientchangedImport newimages alized planningA complete, clinically deliverableplan in less than: 15 minutes for IMRT* 30 minutes for VMAT*LeverageDynamic Planningto adapt patient plansKnowing when to adapt a patient’s plan based on changein anatomy – and having the confidence to know in advanceif the plan changes will have the desired clinical impact –can be an uncertain and time-consuming task. DynamicPlanning in Pinnacle allows for greater confidence. Quickly adapt therapy plans with assessmentand automated re-planning toolsEvaluatedosimetricimpactCopy planparametersDeformableImageRegistration4Improved performanceConventional planningA single optimization step in less than: 1 minute for IMRT** 2 minutes for VMAT**Fast speed performance for all userswith CPU horsepower, multi-threaded,multi-core parallel processing.Createnew plan(if required)IntelligentautomationAutomatedplanning algorithms Easily monitor treatment efficacy Efficiently create new plans with limiteduser intervention* As measured by PlanIQ quality score. Prostate, 40 iterations, 3 mm dose grid, 7-beam IMRT, 1-arc VMAT. X6 server hardware.Optimization times may vary depending on specific planning needs.** As measured by PlanIQ quality score. Prostate, 3 mm dose grid, 7-beam IMRT, 1-arc VMAT.
Case studies†Adding feasibility to the therapyplanning processAutomated planningto improve qualityUniversity Hospital ClevelandCleveland Clinic FoundationThe clinical team studied the impact of feasibility in casesof complex re-irradiation.A major challenge in therapy planning is large variationsin plan quality among treatment planners, in part due tovaried planning skills and limited planning time.Feasibility provides clear feedback at the onset of treatmentplanning. The quality of the feasibility plans was equalto, or greater than, manual planning.Eliminating possible trial and error associated with somemanual planning reduced “planning time” an averageof approximately 10 hours.4*“The time from completing thecontouring to a physician-approvedplan was shortened as a resultof eliminating optimizationuncertainties tied to the refinementof dose objectives previously enteredmanually by the dosimetrist.The clinical team assessed whether Pinnacle automatedplanning algorithms improve the quality of head and neck(HN) radiotherapy plans, and also the viability of planquality predictions of this commercial feasibility tool.Automated planning improves dose coverage of thelow-dose planning target volume while dose coverage ofthe high dose PTV was maintained, reducing dose to criticalorgans compared to manual plans.Automated Planning IMRT plans had similar homogeneityindices (HI) and conformality indices (CI); VMAT planshad comparable HI and improved CI to manual plans.Feasibility is a practical solution to improving workflowand plan quality.2”Seth Duffy, MS, CMD, BSPHUniversity Hospitals: Cleveland Medical Center SCC** Planning times were verified via MOSAIQ timestamps from contour completion to final plan review.† Results are specific to the institution where they were obtained and may not reflect the results achievable at other institutions.5
Everything starts with the patientPinnacle Evolution is a foundational element in the Philips vision of connectinginformation in oncology.Scan and planwith TumorLOCand PinnacleIntegrated workflowwith IntelliSpaceRadiation OncologyTumorLOC allows for workflow integration betweenthe Philips Big Bore RT system and Pinnacle Evolution.Philips IntelliSpace Radiation Oncology is an intelligentpatient management system, accelerating time from referralof the patient to start of treatment. Pinnacle Evolution,integrated into the foundation of IntelliSpace RadiationOncology, offers efficient context-sensitive launching intothe exact contouring or planning step of the workflow.TumorLOCBig Bore RTPinnacleTumorLOC is powered by Pinnacle Evolution. Ease of use with a single integrated environmentfor imaging and simulation Create consistent, reproducible set-up from simulationto treatment Go directly to treatment with palliative “Sim to Treat” tools Eliminate data transfer and repetition of actions byrecording planning functions in Pinnacle at the console Simulate anywhere and create MIPs, remotely approve,4D review, create additional IPs and contour ITVsManage complexityCreate a harmonized way of working and transparentcommunications.Improve efficiencyDeeply integrate applications, maintaining data integrity andautomated workflows.Enable operational excellenceMitigate risk, document results and discover actionable insights.6
Integrated oncology pathwaysThe Philips vision of connected oncology is to deliver a fully integrated,vendor-agnostic ecosystem to clinicians, enabling them to improve the qualityand robustness of oncology care while decreasing inefficiencies and costs.As a result of this integration and use of patient data from diagnostics tofollow-up, clinicians are offered information and tools supporting informedchoices and precise decisions.Integrated solution approaches along clinical pathwaysPrecision diagnosisTherapy erapy executionChemotherapy/immunotherapyFast diagnosesto improveoutcomesIntelligent erapiesto reducecostsRadiotherapyIntegrated clinicalpath decisions toimprove theexperienceMinimally invasiveintervention/surgeryEarly assessmentsto improvepopulation healthLocal and globaloutcome dataHistopathologyFollow-upTargeted therapyLearning from outcomes7
PINNACLE EVOLUTIONPinnacle EvolutionThe Pinnacle Base License enables an efficient workflow fromsimulation to 3D treatment planning, including the followingcapabilities: Image review, manual and automatic rigid fusion registration Target and OAR contouring and segmentation Simulation and beam placement Stereotactic planning 3D conformal dose computation Dynamic planning DICOM support for send, receive, and storage of:– CT, NM, MR, and PET images, RT plan, structure,and dose objectsPlease refer to the DICOM Conformance Statement for more detail.Personalized planningThe Pinnacle Evolution personalized planning workflow definesfeasible, personalized patient goals at the start of the planningprocess and then creates a treatment plan with automatedplanning algorithms and optimization in one integrated,easy-to-use interface. Integration with functionality found in the PinnacleBase License Select a predefined or user-defined treatment techniquefor each patient with standard OAR goals Review feasibility assessment for determination of a patient’spersonalized optimization goals based on the patient’s uniqueanatomy and relationship of the target volume to OARs Drive proprietary automated planning algorithms with feasiblegoals to create VMAT or IMRT therapy plans– Undo/redo for manually added goal parameters– Normal tissue dose control– Target dose transitions to either other targets or proximal OARs– Progressive algorithms that utilize integrated goal tuning Adjust manually, individual goals if needed, in a completedpersonalized plan to further refine plan quality (warm start) Review results with a scorecard of predefined, customizedbenchmarks or with sample scorecards based on select radiationtherapy oncology group (RTOG) protocols Includes conventional planning workflow for VMATor IMRT delivery– Manual setting or user defined protocols– Selectable prescription to be optimized, dose fromadditional prescriptions are considered as background dose– Iterative review and manual changes to dose plan aftereach optimization– Undo/redo for manually added objective parameters– Manual creation of ring, hot/cold spot and othertuning structures Investigate plan quality with advanced evaluation toolsintegrated within the same planning interface– DVH zoom tools– Point and click to return DVH statistics– Side-by-side isodose distribution and DVH comparison– Navigate with one click to maximum or minimum pointof target or OAR– Cine display of control pointsIMRT and VMAT treatment optimization Philips proprietary IMRT optimization– Beam and segment weight-based optimization algorithms– General equivalent uniform dose (gEUD)-basedbiological optimization– Dose or dose volume-based treatment objectives– Direct optimization of MLC leaf position– Combine forward and inverse plans to form a compositeplan of the entire patient treatment– Define minimum MU, minimum segment area, lengthand width of control point and number of control points– Compute dose at specified depth for QA check ofoptimized plan– Electronic portal imaging device (EPID) QA plancreation capabilities User-defined parameters for IMRT or VMAT planning– Use either relative or absolute patient set-up information– Link individual CT scanner to specific CT density tablesMinimum specificationsPinnacle Evolution requires the following hardware: X5 or X6 Professional or Pinnacle SmartEnterprise server, or HealthSuite on Premises (HSOP)A server or PC is also required for the feasibility calculations, withthe following minimum specifications: Operating systems: Windows 7 (32- or 64-bit), Windows 8.1(32- or 64-bit), Windows 10, and Windows Server 2008, 2008R2 and 2012, or newer CPU: 2.4 GHz, multi-core processor (4 cores, 8 threads) Hard drive space: software components fully installed requireonly 20 MB, but storage requirements for voluminous patientdata and archives are much larger and will vary from one clinicto another; a minimum 900 GB hard drive is suggested withlarger drives for DICOM archives Memory (RAM): 2 GB x number of cores (for example,8 GB for 4 cores) Display resolution of 1920 x 1080 screen resolution,24- or 32-bit color depthReferences1234Ahmed, et al. Medical Physics 2017.Ouyang, et al. J Applied Clin Med Phys. 2019.Pinnacle Auto-Planning clinical proof statements. Data on file.Duffy, et al. AAMD 2019. Poster. 2020 Koninklijke Philips N.V. All rights reserved.Specifications are subject to change without notice.Trademarks are the property of Koninklijke Philips N.V.or their respective owners.Please visit www.philips.com/pinnaclePrinted in the Netherlands.4522 991 62821 * SEP 2020
planning process. With personalized, patient-specific goals integrated from the start, more advanced automated planning tools and a new way of working, Pinnacle Evolution is ready to take on your planning challenges. Quality Personalized planning Know what goals are feasible for each organ. Efficiency Newly optimized performance
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