Deformable Registration, Chart Rounds, and More: AutoContour and ClearCheck V2.2

The time has come. Over the past several months, we’ve worked hard to bring major new features to AutoContour and ClearCheck. With headliners such as the new chart rounds module, rigid and deformable registration, and improved editing and functionality, these updates provide new clinical tools to improve the contouring and plan review workflows.

AutoContour

The use of auto segmentation using deep learning has exploded recently, providing valuable time-savings and workflow improvements over traditional contouring methods. After releasing AutoContour in 2021, we’ve been focusing on providing more models and improving functionality with every release, and we’re excited to share what’s new with version 2.2. 

MR Models

To complement our expanding list of CT-based structure models, we are now debuting AI-based structure models trained using MR images. These models allow for greater accuracy for structures that generally exhibit poor contrast resolution on CT images. More MR models are on the roadmap, but to start, we are launching Brain MR models due to the considerable benefit of using MR for structures like the optic chiasm, brainstem, and hippocampus. 

Following guidelines established by the EPTN Consensus Neuro-Oncology Atlas, the models utilize T1 post-contrast data sets, which are most commonly used for contour generation for cranial SRS or hippocampal sparing treatments.Registration Functionality

The ability to register multiple image sets, including deformable registration,  is now available directly within AutoContour. In addition to viewing existing Eclipse and DICOM registrations, users can overlay CT and MR image sets using internal registration tools. 

Because the registration workspace is integrated directly into the main viewing window, it's now possible to execute any desired registration operations simultaneously while structure contouring results stream in from the cloud. Once a rigid or deformable registration has been made, AutoContour offers the ability to transfer structures made on one structure set directly to another. Contour on MR, transfer to CT, and get planning!

Additional New Features

• The Structure Comparison Tool allows for direct evaluation of contours between unique structure sets, including volume and Dice similarly coefficient (DSC) metrics. 
• New Volume of Interest (VOI) tools now allow for automatic processing based on a defined three-dimensional border, or manual fine-tuning for any existing registrations.
• A new Custom Bowel Loops threshold option allows for better segmentation of individual bowel loops found within an existing bowel bag contour. This tool searches multiple relevant HU ranges and automatically merges outputs into a single volume. 
• In collaboration with Videra Surgical, AutoContour now has a simplified workflow to identify VeraForm® markers quickly and generate target structures from these implanted fiducials. 
• Keep Every “N” Slices: export deep-learning structures omitting slices in a pattern as desired for a more straightforward physician review and interpolation workflow.
• Using a DICOM standalone import/export feature, automatically export completed structure sets directly to external endpoints like Eclipse.

ClearCheck
Radformation’s flagship automation solution, ClearCheck, has been delivering insightful information and intuitive plan review and reporting since 2016. With a new Chart Rounds module, the ability to assess deformed doses, and new ways to view and interact with plan information, ClearCheck delivers valuable new options to any department.

Chart Rounds

Finally: a better way to orchestrate interdisciplinary chart review. 

With the latest release, users can launch an instance of ClearCheck through a standalone ESAPI application instead of launching through Eclipse. This application has access to all the patients in the Eclipse database, so users can review ClearCheck results for multiple patients at any given time. 

Creating a patient worklist for chart rounds review is simple. Users can filter patients and plans by hospital, oncologist, plan approval status, fractions delivered, appointments, tasks, and more.

A new Chart Rounds section shows pertinent information needed for patient plan review. To record any actions taken during chart rounds, users can set the status, save a comment, and save the attendees list for the plan under review. This information is retained for each patient and can be included in the ClearCheck report. At the end of a Chart Rounds session, users can print the patient worklist to document the reviewed patient plans, along with their Chart Rounds status and the attendees who were present.

Deformed Dose

Leveraging the latest deformable registration capabilities from AutoContour, ClearCheck can now utilize an AutoContour registration to deform a dose distribution from one image to another. Visualizing this reshaped dose is helpful when accumulating dose between images where the anatomy is not consistent, e.g., for retreatments or off-line adaptive therapy. Users create a deformed dose plan sum in ClearCheck and then perform analysis as if it were a regular plan sum. As with other plan sums, it’s possible to calculate constraints, view the DVH and dose distribution, compare plans, or calculate BED or EQD2 dose—all with deformed datasets.

Three-Slice Viewer

ClearCheck V2.2 adds a three-slice viewer to the main interface window. This new feature allows users to view CT images, structures, dose, and BED/EQD2 Dose for plans, plan sums, and deformed dose plan sums. Users can automatically scroll through select structures for easier viewing. Seeing BED/EQD2 and deformed dose distributions helps aid the decision-making process for complicated cases that need this type of analysis.

Additional New Features

The latest from ClearCheck introduces many other new features:

• With ARIA Document Services configured, users can view all ARIA Documents within the ClearCheck main window.
  
  
• Evaluate new constraints and plan checks:
  • Generalized equivalent uniform dose (gEUD) constraint
  • Modulation Complexity Score plan check
• View more options in the ClearCheck report:
  • Chart Rounds section
  • Brachytherapy solid applicator properties
  • Plan Uncertainty properties
    
• Additional configuration options in the Administration Application include:
  • Active directory login
  • Assign Structure Check / Plan Check / Treat Prep Check / Report template to multiple constraint templates

Conclusion

The newest additions to AutoContour and ClearCheck amplify the potential impact on departments utilizing these tools for the pre-treatment workflow.  But if we’re being candid, we couldn’t improve these products to the extent we have without the outstanding ideas and feedback we receive from current and potential users. Thank you for allowing us to be partners in your clinical success.

With that said, we’d be remiss if we didn’t ask: what’s next?

Want to see more? Check out the webinar we hosted on October 5, 2022, where we showed off all the latest V2.2 features for AutoContour, ClearCheck, and ClearCalc.