title: Technical Note: scuda: A software platform for cumulative dose assessment.
abstract: OBJECTIVE
  Accurate tracking of anatomical changes and computation of actually delivered dose to the patient are critical for successful adaptive radiation therapy (ART). Additionally, efficient data management and fast processing are practically important for the adoption in clinic as ART involves a large amount of image and treatment data. The purpose of this study was to develop an accurate and efficient Software platform for CUmulative Dose Assessment (scuda) that can be seamlessly integrated into the clinical workflow.
  
  
  METHODS
  scuda consists of deformable image registration (DIR), segmentation, dose computation modules, and a graphical user interface. It is connected to our image PACS and radiotherapy informatics databases from which it automatically queries/retrieves patient images, radiotherapy plan, beam data, and daily treatment information, thus providing an efficient and unified workflow. For accurate registration of the planning CT and daily CBCTs, the authors iteratively correct CBCT intensities by matching local intensity histograms during the DIR process. Contours of the target tumor and critical structures are then propagated from the planning CT to daily CBCTs using the computed deformations. The actual delivered daily dose is computed using the registered CT and patient setup information by a superposition/convolution algorithm, and accumulated using the computed deformation fields. Both DIR and dose computation modules are accelerated by a graphics processing unit.
  
  
  RESULTS
  The cumulative dose computation process has been validated on 30 head and neck (HN) cancer cases, showing 3.5 ± 5.0 Gy (mean±STD) absolute mean dose differences between the planned and the actually delivered doses in the parotid glands. On average, DIR, dose computation, and segmentation take 20 s/fraction and 17 min for a 35-fraction treatment including additional computation for dose accumulation.
  
  
  CONCLUSIONS
  The authors developed a unified software platform that provides accurate and efficient monitoring of anatomical changes and computation of actually delivered dose to the patient, thus realizing an efficient cumulative dose computation workflow. Evaluation on HN cases demonstrated the utility of our platform for monitoring the treatment quality and detecting significant dosimetric variations that are keys to successful ART.
authors: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland 21231.
authors: Seyoun
authors: S
authors: Park
authors: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland 21231.
authors: Todd
authors: T
authors: McNutt
authors: IGI Technologies, Inc., College Park, Maryland 20742.
authors: William
authors: W
authors: Plishker
authors: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland 21231.
authors: Harry
authors: H
authors: Quon
authors: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland 21231.
authors: John
authors: J
authors: Wong
authors: IGI Technologies, Inc., College Park, Maryland 20742 and Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC 20010.
authors: Raj
authors: R
authors: Shekhar
authors: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland 21231.
authors: Junghoon
authors: J
authors: Lee
mesh_terms: D054893:Cone-Beam Computed Tomography; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy; D006801:Humans; D007091:Image Processing, Computer-Assisted; D011829:Radiation Dosage; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D012984:Software