2233 - Enhanced Review of SRS Treatment Response on Follow-up MR Imaging by Incorporating Contouring DICOM Files in PACS
Presenter(s)
K. Steed1, Y. Kumar1, M. K. Melton1, H. Boggs2, R. A. Cardan2, R. A. Popple3, J. B. Fiveash3, and C. Cardenas2; 1University of Alabama at Birmingham, Birmingham, AL, 2Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 3University of Alabama at Birmingham Department of Radiation Oncology, Birmingham, AL
Purpose/Objective(s): In the clinical setting, patients with brain metastases who have undergone stereotactic radiosurgery (SRS) to these lesions are seen in one- to three-month intervals with MRI studies to assess treatment response and disease progression. This follow-up tends to be conducted by the physicians (radiation oncology and neurosurgery) who planned the SRS procedures. Reviewing treatment response or progression of disease on the follow-up MRI can be tedious and cumbersome, as most of these patients undergo the MRI study just prior to the follow-up appointment. When neurosurgeons see these patients in follow-up, they often reach out to the radiation oncology treating physician to review the prior treated lesions on the planning software. This requires coordination of both physician schedules, which can be challenging.
Materials/Methods: The medical physics team at our institution has developed a software tool that automatically propagates previously treated brain target contours onto follow-up MRIs, leveraging the DICOM standard to display these MRIs with outlines of the previously treated targets on PACS, in conjunction with the simulation planning CT with contours. In this study, we compare the average time to traditionally review previously treated brain lesions through PACS and Eclipse (10 cases) to utilizing the new software tool and having all treatment files incorporated into PACS (10 cases).
Results: The software tool reduced the time to review previously treated brain lesions, from 48.6 seconds/lesion to 24.6 seconds/lesion, on average, for the participating radiation oncologists for a total of 28 cases analyzed. Some areas for improvement include the overlay of contours on the MRI when there are very small brain metastases, as the MRI does not have the same pixel density as the CT scan. Also, overlaying the contours onto the MRI requires proper image registration, which can be challenging with two different imaging modalities and patient setup (e.g. head alignment and positioning), particularly when there are many lesions to review.
Conclusion: We hope as we continue to optimize this software tool that incorporates target outlines into post-treatment scans on PACS, it will improve clinic workflow for both the radiation oncology team and our neurosurgery colleagues. Particularly, we believe this tool will allow neurosurgery to review treated brain lesions without having to arrange time with the affiliated radiation oncologist.