Clinicians have long wanted the ability to adapt radiotherapy treatments to changes in patient anatomy over time. Adaptive treatment up to now has required time-consuming re-planning between treatment sessions, or, more recently, monopolizing a delivery system for an extended period of time while the patient waits on the table for new plans to be generated. Neither of these alternatives is practical and affordable at scale. The process is long and complex. Clinics often don’t have the resources even if they have the tools. However, the barrier to adaptive therapy is about to be leveled.
At ASTRO last year, Varian introduced Ethos™ therapy, a Varian Adaptive Intelligence™ solution that uses artificial intelligence and machine learning to create contours and generate adapted plans for physician review within minutes, while a patient is on the treatment couch. Ethos therapy, which has CE Mark approval and is pending US Food & Drug Administration (FDA) 510(k) clearance, allows a physician to choose which plan to deliver and to complete a treatment within a typical 15-minute treatment time slot.
Removing the barriers to adaptive therapy
Ethos therapy offers radiation oncologists a set of powerful yet simple tools that enable them to achieve their intention for each patient, each and every day. They can see changes in patient anatomy with diagnostic clarity and adapt the treatment plan within minutes. Online adaptive therapy is no longer an elusive aspiration—too complex and time-consuming to be practical and too exclusive for most clinics and patients. True to the Ethos name, this revolutionary therapy is within reach now for cancer patients everywhere. Ethos therapy is so intuitive to use that it can be adopted in virtually any clinic or hospital. No additional specialized staff or intensive new training are required. Information for making decisions is presented in structured, contextually logical and easy-to-understand manner.
New levels of visibility
Ethos therapy integrates multi-modal diagnostic quality images at the point of treatment on the treatment console. By providing a current and detailed view of patient anatomy, Ethos therapy gives clinicians confidence that adapted plans are based on quality imaging. At each treatment, Ethos therapy shows:
- That day’s anatomy with iCBCT images
- Diagnostic-quality CT, PET, MR, and CBCT images
- The expected 3D radiation dose to the target and organs at risk
- Preview of tradeoffs between target and critical structures
Simplified decision-making guided by AI
Ethos therapy takes the complexity out of adaptive planning and enables decisions in minutes.
During initial planning, Ethos therapy quickly produces several customized plans, showing the possible radiation dose distributions. Each day, the clinician selects the plan—original or adapted—that meets his or her intent. The process is guided by the technology, as follows:
- An intuitive decision tree guides the entire adaptive therapy process
- Treatment management and treatment planning applications are tightly coupled and context-aware
- Clinician approvals move the process from one step to the next
- Every step of the workflow is optimized for speed and safety
Automated dose accumulation
Each day, the Ethos therapy system reconstructs delivered dose in relation to today’s anatomy. This capability:
- Demonstrates that the patient is receiving the intended dose
- Improves understanding of the treatment progress
- Reduces the need for dose calculations by technical personnel
- Helps identify when re-simulation may be required
- Simplifies off-line adaption
Familiar, efficient QA
QA for Ethos therapy follows a familiar workflow, saving time and resources, and enhancing confidence in results.
- No additional staff or training is required for Ethos therapy commissioning or QA
- Initial planning and adaptive planning at the console use the same algorithms for consistency
- Independent adaptive plan QA can be performed on-demand, without impeding treatment workflow
To advance the worldwide adoption of Ethos therapy, Varian supports the work of an Adaptive Intelligence™ Consortium, a community of clinicians and scientists from leading cancer clinics across the globe. The consortium will lead clinical trials to develop evidence-based clinical protocols for Varian’s Ethos therapy solution in order to minimize the need for individual clinics to develop their own methods and practices.
For more information on Ethos and adaptive therapy, visit Varian’s website. (Link to: https://www.varian.com/products/adaptive-therapy/ethos).