Table 2.
Timing data
| Time point | Mean time per fraction (range) | Description |
|---|---|---|
| Influencer creation | 0.83 (0.50-1.12) | TPS deforms simulation heart and lung contours onto the patient's anatomy of the day |
| Influencer verification | 0.35 (0.25-0.83) | Physician and physicist verify the deformed influencers |
| Target generation | 1.07 (0.25-0.83) | TPS deforms GTV onto the patient's anatomy of the day |
| Target verification | 1.82 (0.42-5.23) | Physicist rigidly copies the GTV over the deformed GTV and verifies its alignment |
| OAR and GTV contouring | 13.60 (4.62-31.82) | Treating physician amends and/or recontours all OARs within the 3-cm contour ring as well as edits the GTV if needed |
| Plan generation | 9.47 (6.97-11.88) | TPS generates the PA while the PI is simultaneously projected on the patient's anatomy of the day |
| Plan evaluation | 1.19 (0.58-3.45) | The PI and PA are compared, and the superior plan is delivered. The PA is selected if it resolves ≥1 OAR hard constraint violation and/or improves target coverage by ≥5% |
| Total | 28.21 (18.02-50.97) | Total ETHOS adaptive workflow time |
Abbreviations: GTV = gross total volume; N/A = not applicable; OAR = organ at risk; PA = adapted plan; PI = patient's initial anatomy at CT simulation; PTV = planning target volume; TPS = treatment planning system.
Average timing data per fraction are presented in minutes for each step of the workflow as well as the total workflow time. Included are descriptions of each step of the ETHOS adaptive workflow. Notably, the in silico workflow does not capture timing data while the patient is on the treatment table as well as timing data for intrafraction motion management via breath-hold. Timing data are presented in minutes.