ORBIT-RT: A Real-Time, Open Platform for Knowledge-Based Quality Control of Radiotherapy Treatment Planning.

PURPOSE: Access to knowledge-based treatment plan quality control has been hindered by the complexity of developing models and integration with different treatment planning systems (TPS). Online Real-time Benchmarking Information Technology for RadioTherapy (ORBIT-RT) provides a free, web-based platform for knowledge-based dose estimation that can be used by clinicians worldwide to benchmark the quality of their radiotherapy plans. MATERIALS AND METHODS: The ORBIT-RT platform was developed to satisfy four primary design criteria: web-based access, TPS independence, Health Insurance Portability and Accountability Act compliance, and autonomous operation. ORBIT-RT uses a cloud-based server to automatically anonymize a user's Digital Imaging and Communications in Medicine for RadioTherapy (DICOM-RT) file before upload and processing of the case. From there, ORBIT-RT uses established knowledge-based dose-volume histogram (DVH) estimation methods to autonomously create DVH estimations for the uploaded DICOM-RT. ORBIT-RT performance was evaluated with an independent validation set of 45 volumetric modulated arc therapy prostate plans with two key metrics: (i) accuracy of the DVH estimations, as quantified by their error, DVHclinical - DVHprediction and (ii) time to process and display the DVH estimations on the ORBIT-RT platform. RESULTS: ORBIT-RT organ DVH predictions show < 1% bias and 3% error uncertainty at doses > 80% of prescription for the prostate validation set. The ORBIT-RT extensions require 3.0 seconds per organ to analyze. The DICOM upload, data transfer, and DVH output display extend the entire system workflow to 2.5-3 minutes. CONCLUSION: ORBIT-RT demonstrated fast and fully autonomous knowledge-based feedback on a web-based platform that takes only anonymized DICOM-RT as input. The ORBIT-RT system can be used for real-time quality control feedback that provides users with objective comparisons for final plan DVHs.

Development and Usage of eContour, a Novel, Three-Dimensional, Image-Based Web Site to Facilitate Access to Contouring Guidelines at the Point of Care.

PURPOSE: Variation in contouring quality by radiation oncologists is common and can have significant clinical consequences. Image-based guidelines can improve contour accuracy but are underused. We sought to develop a free, online, easily accessible contouring resource that allows users to scroll through cases with 3-dimensional images and access relevant evidence-based contouring information. MATERIALS AND METHODS: eContour (http://econtour.org) was developed using modern Web technologies, primarily HTML5, Python, and JavaScript, to display JPEGs generated from DICOM files from real patient cases. The viewer has standard tools for image manipulation as well as toggling of contours and overlayed images and radiation dose distributions. Brief written content references published guidelines for contour delineation. Mixpanel software was used to collect Web page usage statistics. RESULTS: In the first 3 years of operation (March 8, 2016 to March 7, 2019), a total of 13,391 users from 128 countries registered on the Web site, including 2,358 physicians from the United States. High-frequency users were more likely to be physicians (P < .001) and from the United States (P < .001). In one 6-month period, there were 68,642 individual case page views, with head-and-neck the most commonly viewed disease site (32%). Users who accessed a head-and-neck case were more likely to be high-frequency users, and 67% of repeat users accessed the same case more than once. CONCLUSION: The large, diverse user base and steady growth in Web site traffic over the first 3 years of eContour demonstrate its strong potential to address the unmet need for dissemination and use of evidence-based contouring information at the point of care.