Enhanced proton therapy planning with Monaco

Excellent plan quality and improved workflows at PTCC in Prague with new Monaco proton therapy planning tools

Elekta’s treatment planning system, Monaco^®, is well known for its powerful tools that bring increased automation, intelligent workflows, and high-quality treatment planning to a wide range of radiotherapy treatment delivery systems. Now, with Monaco proton planning (Monaco PT*), proton therapy centers can enjoy the ease of use and smart functionality of Monaco to obtain high-quality plans for both single field uniform dose (SFUD) and intensity modulated proton therapy (IMPT).

Monaco PT combines the market-leading Monte Carlo dose calculation accuracy and biological cost functions of Monaco with proton-specific features designed to achieve excellent dose control for proton therapy planning. These include smart spot placement, which removes the need for manual editing and enhances critical structure sparing. In addition, comprehensive robustness evaluation tools are integrated to ensure the suitability of plans over an entire course of proton therapy, even when uncertainties are present.

Alpha testing at a leading proton therapy center

The Proton Therapy Center Czech in Prague, Czech Republic is one of the world’s leading providers of proton therapy, having treated over 5,500 patients since they opened in 2012. The center currently has four treatment rooms, fully equipped with IBA technology, Elekta treatment planning and oncology information management software. The center operates at maximal capacity, so workflow efficiencies and productivity gains are key. They also have a strong research and development program, making them an ideal alpha testing site for Monaco PT.

“Compared to our existing planning software, the user interface for Monaco PT is clean, better constructed and more up to date – just what you would expect from a modern treatment planning system”

“Compared to our existing planning software, the user interface for Monaco PT is clean, better constructed and more up to date – just what you would expect from a modern treatment planning system,” comments Vladimir Vondráček, Head of Medical Physics at the Proton Therapy Center Czech in Prague, Czech Republic. “It is also much more integrated. There is no need to send plans back and forth between applications to make changes. Monaco PT is tab-based and we can easily switch between the different tools for contouring, plan creation, calculation and evaluation, making it easier to plan and make changes where necessary.”

“The speed of the Monte Carlo dose calculation algorithm ensures fast planning, and we obtain excellent quality plans,” Vondráček continues. “With XiO®, every time we performed patient QA, there was very good agreement between measured and calculated dose. This continues to be the case with Monaco PT.”

Intelligent dose placement

Often, with other planning systems, plan optimization—to meet clinical goals while minimizing doses to healthy tissues—can be a time-consuming process. Usually, multiple objectives must be used to spare these healthy tissues and even then, there is a significant amount of guesswork required to perfectly balance a plan. Monaco provides intuitive biological optimization cost functions that influence a structure’s entire DVH curve, depending on whether it is serial or parallel in nature, with a single objective able to perform what multiple may be used for usually. This removes the need for endless experimentation because, once parameters are set, the optimizer places dose intelligently—automatically sparing healthy tissue while maintaining optimal target dose.

“Monaco PT’s approach to optimization is quite different to other treatment planning systems I’ve seen,” Vondráček says. “Monaco uses biological optimization, which has the potential to create better plans. Since this is a new approach for us, it requires familiarization and a change in mindset, but this is quite possible with a well-trained and enthusiastic team.”

“We have a great relationship with IBA and Elekta,” Vondráček concludes. “Both companies are very responsive. Monaco PT has the potential to create excellent treatment plans and there is good integration with our oncology information system (OIS), MOSAIQ^®.”

“Monaco PT has the potential to create excellent treatment plans and there is good integration with our OIS, MOSAIQ.”

“We are proud to offer a fully integrated, end-to-end solution for proton therapy in partnership with IBA,” says Chris Fryer, SVP and Head of Product Management, Linac Solutions, Elekta. “The same intelligent workflows and automation found in MOSAIQ and Monaco for photon treatments are now available to proton therapy centers. With scripting and templates, these solutions help to transform and evolve treatment processes for efficient use of novel technologies at busy clinics.”

Find out more about Monaco and its new tools for proton therapy planning.

*Monaco PT is not available in all markets.