MONACO (treatment planning)

MONACO (treatment planning)
Name	MONACO
Developer	Elekta
Released	2000s
Latest release	5.x–6.x
Operating system	Microsoft Windows
Genre	Radiotherapy treatment planning system
License	Commercial

MONACO (treatment planning) is a commercial radiotherapy treatment planning system developed by Elekta for dose calculation and inverse planning in external beam radiotherapy, intensity-modulated radiotherapy, and volumetric-modulated arc therapy. The system integrates advanced algorithms for photon and electron beam modeling with clinical workflows used in oncology centers such as Memorial Sloan Kettering Cancer Center, MD Anderson Cancer Center, and national networks like NHS England and Institut Curie. MONACO is positioned alongside other planning systems from vendors including Varian Medical Systems, Philips Healthcare, and Siemens Healthineers in multidisciplinary tumor boards at institutions such as Mayo Clinic and Johns Hopkins Hospital.

Overview

MONACO provides a planning environment that combines three-dimensional imaging datasets from modalities like Philips Brilliance CT, Siemens SOMATOM, and GE Healthcare scanners with contouring inputs from systems such as MIM Software, Elekta Monaco Contouring, and RayStation. The platform supports beam models for linear accelerators manufactured by Varian Medical Systems, Elekta, and manufacturers such as Accuray for stereotactic applications used in centers like UCSF Medical Center and The Royal Marsden Hospital. MONACO’s user interface and plan library are used by clinical teams at institutions including Cleveland Clinic and Karolinska University Hospital.

History and Development

MONACO originated within Elekta research groups during a period of rapid innovation in radiotherapy that included developments at laboratories associated with Massachusetts General Hospital, Hauptman-Woodward Medical Research Institute, and university departments such as University of Cambridge and Stanford University. Early releases incorporated Monte Carlo concepts influenced by research from groups like National Research Council (Canada) and investigators at University of Wisconsin–Madison. Subsequent versions adapted lessons from clinical trials run by cooperative groups such as RTOG and EORTC and regulatory interactions with bodies including the European Medicines Agency and U.S. Food and Drug Administration.

Technical Features and Algorithms

MONACO’s dose engine implements a variant of Monte Carlo and convolution–superposition algorithms for photon and electron transport, building on mathematical techniques developed at institutions such as CERN, Imperial College London, and Massachusetts Institute of Technology. The optimizer uses constrained inverse planning and biological cost functions informed by research from Memorial Sloan Kettering Cancer Center and MD Anderson Cancer Center, and supports segment sequencing compatible with multileaf collimators from Elekta and Varian Medical Systems. The system incorporates image registration routines leveraging methods advanced at University College London and Karolinska Institutet for rigid and deformable alignments of CT, MRI, and PET datasets, including imports from Siemens Healthineers PET/CT and GE Healthcare PET/CT.

Clinical Applications and Workflows

MONACO is applied across disease sites treated at centers like Royal Adelaide Hospital, Princess Margaret Cancer Centre, and Christie NHS Foundation Trust, including head and neck, lung, prostate, and central nervous system plans discussed at tumor boards with specialists from Dana-Farber Cancer Institute and Oxford University Hospitals. Workflows integrate with oncology information systems such as MOSAIQ and Aria and support techniques from stereotactic radiosurgery practiced at Cleveland Clinic Foundation and brachytherapy programs linked to Gustave Roussy. Clinical protocols referencing MONACO have been used in trials coordinated by ICON and regional consortia like Southeast Cancer Control Program.

Validation, Accuracy, and Quality Assurance

Rigorous validation of MONACO’s dose calculations follows standards promulgated by organizations including International Atomic Energy Agency, American Association of Physicists in Medicine, and European Society for Radiotherapy and Oncology. Dose verification studies have been performed using measurement equipment from PTW and IBA and phantoms developed at National Physical Laboratory (UK) and NIST. Quality assurance workflows incorporate tools from Sun Nuclear Corporation and task groups such as AAPM Task Group 119 and TG-142 recommendations, with clinical audits undertaken by networks like QUARTET and accreditation bodies such as The Joint Commission.

Integration and Interoperability

MONACO supports DICOM RT interoperability with imaging modalities from Philips Healthcare, GE Healthcare, and Siemens Healthineers and integrates with treatment delivery systems from Elekta and Varian Medical Systems. Connectivity with hospital systems leverages interfaces compatible with Epic Systems and Cerner Corporation electronic health records used at Massachusetts General Hospital and Cedars-Sinai Medical Center. Vendor-neutral archiving and exchange utilize standards promoted by IHE and consortia including RSNA for multi-institutional collaborations among centers such as MD Anderson Cancer Center and Princess Margaret Cancer Centre.

Regulatory Approval and Commercial Use

MONACO’s commercialization and regulatory clearances have proceeded through pathways overseen by the U.S. Food and Drug Administration and the European Medicines Agency, with deployments in public and private hospitals across regions regulated by agencies like Health Canada and Therapeutic Goods Administration. Commercial adoption has been documented in clinical practice at institutions including Addenbrooke's Hospital, St. James's Hospital, and private networks such as Ramsay Health Care, with procurement processes involving hospital groups like NHS Scotland and national tenders managed by organizations such as Crown Commercial Service.

Category:Radiation therapy software