Kali MC: an open-source toolkit for intraoperative electron radiation therapy treatment planning
Clinical Snapshot
PICO Framework
| P — Population | Patients receiving intraoperative electron radiation therapy (IOERT) with Liac HWL mobile accelerator |
| I — Intervention | Kali MC open-source software toolkit for treatment planning |
| C — Comparator | Traditional spreadsheet-based calculations and static look-up tables |
| O — Outcomes | Absorbed dose visualization, monitor unit calculation accuracy, treatment report generation, and workflow efficiency |
Bottom Line
Kali MC represents a significant advancement in IOERT treatment planning by providing an integrated, open-source solution that addresses current limitations of spreadsheet-based calculations. The software combines Monte Carlo dose calculations with practical workflow features including 3D visualization, automated MU calculations, and DICOM integration. While the technical approach appears sound, the abstract lacks detailed validation data and comparative analysis with existing methods. The requirement for local commissioning is appropriate and aligns with radiation therapy quality assurance standards. For Australian practice, this tool could enhance IOERT delivery consistency and efficiency, particularly in centres seeking to move beyond manual calculation methods. However, implementation would require thorough local validation, TGA compliance assessment, and integration with existing record-and-verify systems before clinical deployment.
Key Findings
P Value: Not applicable for technical development study
Effect Size: Not quantified in abstract
Primary Outcome: Successful development of integrated IOERT planning software
Nnt Or Sensitivity: Software functionality validated with experimentally determined output factors
Confidence Interval: Not provided
Clinical Application
High feasibility given open-source nature and Python-based implementation Relevant for Australian radiation oncology centres using IOERT; would require TGA software validation and local commissioning per ACPSEM guidelines Radiation oncology departments performing IOERT with compatible mobile accelerators
Abstract
Intraoperative electron radiation therapy (IOERT) is commonly delivered without intraoperative imaging, limiting patient-specific planning and requiring fast, reliable treatment calculations in the operating room. As a result, monitor unit (MU) calculations are often performed using spreadsheets and static look-up tables derived from measurements in water. We present Kali MC, an open source, Python-based software developed to streamline IOERT absorbed dose visualization, MU calculation and report generation for treatments delivered with the Liac HWL mobile accelerator. The software provides a graphical interface to visualize precomputed Monte Carlo absorbed dose distributions in water and performs MU calculations using experimentally determined output factors. Optional atmospheric pressure correction and predefined rescaling factors are supported to improve consistency of dose delivery and target coverage with the prescription isodose. Kali MC also generates customizable PDF treatment reports and exports DICOM RT Plan objects to facilitate integration with record-and-verify systems. By integrating validated dosimetric data, correction methods, and 3D dose visualization into a transparent platform, Kali MC supports efficient intraoperative decision-making; however, its use should be locally commissioned and evaluated according to institution-specific procedures and equipment characteristics.
References
- 1.Ayala, R., García, R., Ruiz, G., Gómez, S., Santos, M., Álvarez, A., García, M. J., Soza, Á., Udías, J. M., & Ibáñez, P. (2026). Kali MC: an open-source toolkit for intraoperative electron radiation therapy treatment planning. Biomedical Physics & Engineering Express. https://doi.org/10.1088/2057-1976/ae5f9d
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