SU-G-JeP3-07: Real-Time Image Guided Radiation Therapy for Heterotopic Ossification in Patients After Hip Replacement.
PURPOSE
To demonstrate the feasibility of using CBCT in a real-time image guided radiation therapy (IGRT) for single fraction heterotopic ossification (HO) in patients after hip replacement. In this real-time procedure, all steps, from simulation, imaging, planning to treatment delivery, are performed at the treatment unit in one appointment time slot. This work promotes real-time treatment to create a paradigm shift in the single fraction radiation therapy.


METHODS
An integrated real-time IGRT for HO was developed and tested for radiation treatment of heterotopic ossification for patient after hip replacement. After CBCT images are acquired at the linac, and sent to the treatment planning system, the physician determines the field and/or draws a block. Subsequently, a simple 2D AP/PA plan with prescription of 700 cGy is created on-the-fly for physician to review. Once the physician approves the plan, the patient is treated on the same simulation position. This real-time treatment requires the team of attending physician, physicist, therapists, and dosimetrist to work in harmony to achieve all the steps in a timely manner.


RESULTS
Ten patients have been treated with this real-time treatment, having the same beams arrangement treatment plan and prescription as our clinically regular CT-based 2D plans. The average time for these procedures are 52.9 ±10.7 minutes from the time patient entered the treatment room until s/he exited, and 37.7 ±8.6 minutes from starting CBCT until last beam delivered.


CONCLUSION
The real-time IGRT for HO treatment has been tested and implemented to be a clinically accepted procedure. This one-time appointment greatly enhances the waiting time, especially when patients in high level of pain, and provides a convenient approach for the whole clinical staff. Other disease sites will be also tested with this new technology.