Virtual SBRT and SRS Remote Training Session 6: SBRT/SRS Planning Demo

Department of Radiation Oncology at Baylor College of Medicine is organizing virtual SRBT /SRS training sessions for radiation oncologists, medical physicists, dosimetrists and therapists in low- and middle-income countries.

Summary
This training session focused on advanced techniques and practical demonstrations for planning stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS), specifically for various disease sites such as liver, lung, and brain. The session began with a recap of previous lectures covering the clinical and technical aspects of different tumor sites and then transitioned into live planning demonstrations by experts. The trainers emphasized the importance of contouring, creating optimization structures (rings), and using dose constraints to achieve highly conformal dose distributions with sharp dose fall-offs—a critical requirement in SBRT/SRS.

For liver and lung cases, multiple ring structures were created to guide dose optimization, aiming for rapid dose fall-off outside the planning target volume (PTV) and internal target volume (ITV). The planners demonstrated how to set dose objectives and priorities for target volumes and organs at risk (OARs), using partial arcs and appropriate beam angles to maximize conformality while minimizing dose to surrounding normal tissue. The session also discussed technical considerations such as using flattening filter-free (FFF) beams to reduce treatment time, and the limitations or non-necessity of couch kicks for body sites due to collision and dosimetric concerns.

For brain radiosurgery, a more complex planning approach was presented involving multiple ring structures at different margins (5 mm, 1 cm, 2 cm) to control dose gradients. Here, couch kicks were recommended due to better geometric clearance and improved dose conformity. The brain planning also included manual and automated (HyperArc) methodologies, highlighting the ease and efficiency of automation with advanced planning software. The importance of avoiding collisions and using appropriate arc geometry was stressed.

Throughout the session, the trainers engaged with participants’ questions, addressed common challenges such as calculation speed and software limitations, and emphasized the clinical goal of achieving conformal plans with acceptable hotspots inside the target. The session concluded with encouragement to complete all training modules for certification and an invitation for further questions post-training.

Highlights
🏥 Comprehensive training on SBRT and SRS planning for liver, lung, and brain tumor sites.
🎯 Emphasis on creating multiple ring structures to achieve rapid dose fall-off and high conformality.
⚙️ Use of flattening filter-free beams and partial arcs to reduce treatment time and optimize dose distribution.
🧠 Brain radiosurgery planning includes couch kicks and advanced arc geometries for better dose conformity.
💻 Demonstration of manual planning and automated HyperArc planning for brain SRS.
⏳ Challenges with calculation speed despite GPU acceleration highlighted.
🏅 Completion of multiple sessions leads to certification, encouraging participant engagement.
Key Insights
📐 Ring Structures as Key Optimization Tools

🎯 Conformality and Sharp Dose Gradient Are Paramount

⚡ Partial Arcs and Beam Geometry Optimization

🧑‍⚕️ Differences Between Brain and Body SBRT Planning

🤖 Automation Enhances Efficiency and Consistency

⏳ Computation Speed Is a Practical Limitation

📊 Plan Evaluation Metrics Are Essential for Quality Assurance

Видео Virtual SBRT and SRS Remote Training Session 6: SBRT/SRS Planning Demo канала Baozhou Sun