The Cancer Care Centers of Brevard (CCCB), Florida, have used VelocityAI™ software since 2008, when they acquired it primarily to help define clinical tumor volumes more precisely based on PET-CT standardized uptake values (SUVs). Now VelocityAI is also helping radiation oncologists with accurate multimodality fusion and radiation dose summation tools to support retreatment decisions.

Because of fusion discrepancies among the various imaging modalities, defining the tumor volume is a source of uncertainty and potential error. PET-CT scans showing the metabolic activity of cells around the tumor may be more useful than CT or MR imaging for delineating tumor volumes. Clinicians at CCCB wanted to contour target tumor volumes based on an SUV threshold so as to limit radiation morbidity to normal structures, but their treatment planning system could not provide SUV values along with the PET images. "We could see the uptake, but not the maximum, minimum, or average values," says chief medical physicist Daljit Saini, MS, DABR. So they went looking for a solution and found VelocityAI.

Contouring tumors based on glucose uptake values is the main reason that CCCB clinicians started using VelocityAI, but it is not the only reason they continue to use it today. "We have many other applications for Velocity," says Saini. For example MRIs that cannot be fused in CyberKnife Multiplan (because of strict imaging protocols) can be fused in VelocityAI, thus avoiding repeat MRIs. Radiation treatment response can be easily followed up by fusing the treated plan with new diagnostic images. Subtraction techniques and other tools show the changes between original and follow-up scans. Fusion techniques like deformable registration allow accurate fusion, despite different patient positions.

" VelocityAI has been a great tool
for achieving the precision required
in radiosurgery."

Ravi Shankar, MD, CCCB

Overall the application of VelocityAI software at CCCB has enhanced the treatment workflow, thus enabling good clinical outcomes.

The retreatment challenge
Retreatment is one of the biggest challenges in radiation therapy today. "Every radiation oncology department knows how to do a good job the first time, but when cancer recurs near the original site, the challenge begins," says Ravi Shankar, MD, radiation oncologist and medical director at CCCB.

Not every center is equipped for this challenge, but CCCB is. "We can retreat recurrent tumors at Cancer Care Centers of Brevard because the Velocity software enables us to combine data sets and the dose files from different treatments given at different times," says Shankar. "We are able to save many sick patients from traveling long distances to tertiary care centers to obtain such precise and technologically advanced treatments."