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Mody P, Huiskes M, Chaves-de-Plaza NF, Onderwater A, Lamsma R, Hildebrandt K, Hoekstra N, Astreinidou E, Staring M, Dankers F. Large-scale dose evaluation of deep learning organ contours in head-and-neck radiotherapy by leveraging existing plans. Phys Imaging Radiat Oncol 2024; 30:100572. [PMID: 38633281 PMCID: PMC11021837 DOI: 10.1016/j.phro.2024.100572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
Background and purpose Retrospective dose evaluation for organ-at-risk auto-contours has previously used small cohorts due to additional manual effort required for treatment planning on auto-contours. We aimed to do this at large scale, by a) proposing and assessing an automated plan optimization workflow that used existing clinical plan parameters and b) using it for head-and-neck auto-contour dose evaluation. Materials and methods Our automated workflow emulated our clinic's treatment planning protocol and reused existing clinical plan optimization parameters. This workflow recreated the original clinical plan (P OG ) with manual contours (P MC ) and evaluated the dose effect (P OG - P MC ) on 70 photon and 30 proton plans of head-and-neck patients. As a use-case, the same workflow (and parameters) created a plan using auto-contours (P AC ) of eight head-and-neck organs-at-risk from a commercial tool and evaluated their dose effect (P MC - P AC ). Results For plan recreation (P OG - P MC ), our workflow had a median impact of 1.0% and 1.5% across dose metrics of auto-contours, for photon and proton respectively. Computer time of automated planning was 25% (photon) and 42% (proton) of manual planning time. For auto-contour evaluation (P MC - P AC ), we noticed an impact of 2.0% and 2.6% for photon and proton radiotherapy. All evaluations had a median Δ NTCP (Normal Tissue Complication Probability) less than 0.3%. Conclusions The plan replication capability of our automated program provides a blueprint for other clinics to perform auto-contour dose evaluation with large patient cohorts. Finally, despite geometric differences, auto-contours had a minimal median dose impact, hence inspiring confidence in their utility and facilitating their clinical adoption.
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Affiliation(s)
- Prerak Mody
- Division of Image Processing (LKEB), Department of Radiology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
- HollandPTC consortium – Erasmus Medical Center, Rotterdam, Holland Proton Therapy Centre, Delft, Leiden University Medical Center (LUMC), Leiden and Delft University of Technology, Delft, The Netherlands
| | - Merle Huiskes
- Department of Radiation Oncology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
| | - Nicolas F. Chaves-de-Plaza
- HollandPTC consortium – Erasmus Medical Center, Rotterdam, Holland Proton Therapy Centre, Delft, Leiden University Medical Center (LUMC), Leiden and Delft University of Technology, Delft, The Netherlands
- Computer Graphics and Visualization Group, EEMCS, TU Delft, Delft 2628 CD, The Netherlands
| | - Alice Onderwater
- Department of Radiation Oncology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
| | - Rense Lamsma
- Department of Radiation Oncology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
| | - Klaus Hildebrandt
- Computer Graphics and Visualization Group, EEMCS, TU Delft, Delft 2628 CD, The Netherlands
| | - Nienke Hoekstra
- Department of Radiation Oncology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
| | - Eleftheria Astreinidou
- Department of Radiation Oncology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
| | - Marius Staring
- Division of Image Processing (LKEB), Department of Radiology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
| | - Frank Dankers
- Department of Radiation Oncology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
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Hirotaki K, Tomizawa K, Moriya S, Oyoshi H, Raturi V, Ito M, Sakae T. Fully automated volumetric modulated arc therapy planning for locally advanced rectal cancer: feasibility and efficiency. Radiat Oncol 2023; 18:147. [PMID: 37670390 PMCID: PMC10481560 DOI: 10.1186/s13014-023-02334-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/21/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Volumetric modulated arc therapy (VMAT) for locally advanced rectal cancer (LARC) has emerged as a promising technique, but the planning process can be time-consuming and dependent on planner expertise. We aimed to develop a fully automated VMAT planning program for LARC and evaluate its feasibility and efficiency. METHODS A total of 26 LARC patients who received VMAT treatment and the computed tomography (CT) scans were included in this study. Clinical target volumes and organs at risk were contoured by radiation oncologists. The automatic planning program, developed within the Raystation treatment planning system, used scripting capabilities and a Python environment to automate the entire planning process. The automated VMAT plan (auto-VMAT) was created by our automated planning program with the 26 CT scans used in the manual VMAT plan (manual-VMAT) and their regions of interests. Dosimetric parameters and time efficiency were compared between the auto-VMAT and the manual-VMAT created by experienced planners. All results were analyzed using the Wilcoxon signed-rank sum test. RESULTS The auto-VMAT achieved comparable coverage of the target volume while demonstrating improved dose conformity and uniformity compared with the manual-VMAT. V30 and V40 in the small bowel were significantly lower in the auto-VMAT compared with those in the manual-VMAT (p < 0.001 and < 0.001, respectively); the mean dose of the bladder was also significantly reduced in the auto-VMAT (p < 0.001). Furthermore, auto-VMAT plans were consistently generated with less variability in quality. In terms of efficiency, the auto-VMAT markedly reduced the time required for planning and expedited plan approval, with 93% of cases approved within one day. CONCLUSION We developed a fully automatic feasible VMAT plan creation program for LARC. The auto-VMAT maintained target coverage while providing organs at risk dose reduction. The developed program dramatically reduced the time to approval.
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Affiliation(s)
- Kouta Hirotaki
- Doctoral Program in Medical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
- Department of Radiological Technology, National Cancer Center Hospital East, Chiba, Japan
| | - Kento Tomizawa
- Department of Radiation Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, 277-8577, Kashiwa, Chiba, Japan.
| | | | - Hajime Oyoshi
- Department of Radiological Technology, National Cancer Center Hospital East, Chiba, Japan
| | - Vijay Raturi
- Department of Radiation Oncology, Apollomedics Hospital, Lucknow, India
| | - Masashi Ito
- Department of Radiological Technology, National Cancer Center Hospital East, Chiba, Japan
| | - Takeji Sakae
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Automation of pencil beam scanning proton treatment planning for intracranial tumours. Phys Med 2023; 105:102503. [PMID: 36529006 DOI: 10.1016/j.ejmp.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/04/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate the feasibility of comprehensive automation of an intra-cranial proton treatment planning. MATERIALS AND METHODS Class solution (CS) beam configuration selection allows the user to identify predefined beam configuration based on target localization; automatic CS (aCS) will then explore all the possible CS beam geometries. Ten patients, already used for the evaluation of the automatic selection of the beam configuration, have been also employed to training an algorithm based on the computation of a benchmark dose exploit automatic general planning solution (GPS) optimization with a wish list approach for the planning optimization. An independent cohort of ten patients has been then used for the evaluation step between the clinical and the GPS plan in terms of dosimetric quality of plans and the time needed to generate a plan. RESULTS The definition of a beam configuration requires on average 22 min (range 9-29 min). The average time for GPS plan generation is 18 min (range 7-26 min). Median dose differences (GPS-Manual) for each OAR constraints are: brainstem -1.60 Gy, left cochlea -1.22 Gy, right cochlea -1.42 Gy, left eye 0.55 Gy, right eye -2.33 Gy, optic chiasm -1.87 Gy, left optic nerve -4.45 Gy, right optic nerve -2.48 Gy and optic tract -0.31 Gy. Dosimetric CS and aCS plan evaluation shows a slightly worsening of the OARs values except for the optic tract and optic chiasm for both CS and aCS, where better results have been observed. CONCLUSION This study has shown the feasibility and implementation of the automatic planning system for intracranial tumors. The method developed in this work is ready to be implemented in a clinical workflow.
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Li X, Ge Y, Wu Q, Wang C, Sheng Y, Wang W, Stephens H, Yin FF, Wu QJ. Input feature design and its impact on the performance of deep learning models for predicting fluence maps in intensity-modulated radiation therapy. Phys Med Biol 2022; 67:215009. [PMID: 36206747 DOI: 10.1088/1361-6560/ac9882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
Objective. Deep learning (DL) models for fluence map prediction (FMP) have great potential to reduce treatment planning time in intensity-modulated radiation therapy (IMRT) by avoiding the lengthy inverse optimization process. This study aims to improve the rigor of input feature design in a DL-FMP model by examining how different designs of input features influence model prediction performance.Approach. This study included 231 head-and-neck intensity-modulated radiation therapy patients. Three input feature designs were investigated. The first design (D1) assumed that information of all critical structures from all beam angles should be combined to predict fluence maps. The second design (D2) assumed that local anatomical information was sufficient for predicting radiation intensity of a beamlet at a respective beam angle. The third design (D3) assumed the need for both local anatomical information and inter-beam modulation to predict radiation intensity values of the beamlets that intersect at a voxel. For each input design, we tailored the DL model accordingly. All models were trained using the same set of ground truth plans (GT plans). The plans generated by DL models (DL plans) were analyzed using key dose-volume metrics. One-way ANOVA with multiple comparisons correction (Bonferroni method) was performed (significance level = 0.05).Main results. For PTV-related metrics, all DL plans had significantly higher maximum dose (p < 0.001), conformity index (p < 0.001), and heterogeneity index (p < 0.001) compared to GT plans, with D2 being the worst performer. Meanwhile, except for cord+5 mm (p < 0.001), DL plans of all designs resulted in OAR dose metrics that are comparable to those of GT plans.Significance. Local anatomical information contains most of the information that DL models need to predict fluence maps for clinically acceptable OAR sparing. Input features from beam angles are needed to achieve the best PTV coverage. These results provide valuable insights for further improvement of DL-FMP models and DL models in general.
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Affiliation(s)
- Xinyi Li
- Duke University Medical Center, United States of America
| | - Yaorong Ge
- University of North Carolina at Charlotte, United States of America
| | - Qiuwen Wu
- Duke University Medical Center, United States of America
| | - Chunhao Wang
- Duke University Medical Center, United States of America
| | - Yang Sheng
- Duke University Medical Center, United States of America
| | - Wentao Wang
- Duke University Medical Center, United States of America
| | | | - Fang-Fang Yin
- Duke University Medical Center, United States of America
| | - Q Jackie Wu
- Duke University Medical Center, United States of America
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Development and evaluation of a three-step automatic planning technique for lung Stereotactic Body Radiation Therapy based on performance examination of advanced settings in Pinnacle's auto-planning module. Appl Radiat Isot 2022; 189:110434. [DOI: 10.1016/j.apradiso.2022.110434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 11/22/2022]
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Fu Y, Zhang H, Morris ED, Glide-Hurst CK, Pai S, Traverso A, Wee L, Hadzic I, Lønne PI, Shen C, Liu T, Yang X. Artificial Intelligence in Radiation Therapy. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2022; 6:158-181. [PMID: 35992632 PMCID: PMC9385128 DOI: 10.1109/trpms.2021.3107454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Artificial intelligence (AI) has great potential to transform the clinical workflow of radiotherapy. Since the introduction of deep neural networks, many AI-based methods have been proposed to address challenges in different aspects of radiotherapy. Commercial vendors have started to release AI-based tools that can be readily integrated to the established clinical workflow. To show the recent progress in AI-aided radiotherapy, we have reviewed AI-based studies in five major aspects of radiotherapy including image reconstruction, image registration, image segmentation, image synthesis, and automatic treatment planning. In each section, we summarized and categorized the recently published methods, followed by a discussion of the challenges, concerns, and future development. Given the rapid development of AI-aided radiotherapy, the efficiency and effectiveness of radiotherapy in the future could be substantially improved through intelligent automation of various aspects of radiotherapy.
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Affiliation(s)
- Yabo Fu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Hao Zhang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Eric D. Morris
- Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, CA 90095, USA
| | - Carri K. Glide-Hurst
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Suraj Pai
- Maastricht University Medical Centre, Netherlands
| | | | - Leonard Wee
- Maastricht University Medical Centre, Netherlands
| | | | - Per-Ivar Lønne
- Department of Medical Physics, Oslo University Hospital, PO Box 4953 Nydalen, 0424 Oslo, Norway
| | - Chenyang Shen
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75002, USA
| | - Tian Liu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
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Momin S, Fu Y, Lei Y, Roper J, Bradley JD, Curran WJ, Liu T, Yang X. Knowledge-based radiation treatment planning: A data-driven method survey. J Appl Clin Med Phys 2021; 22:16-44. [PMID: 34231970 PMCID: PMC8364264 DOI: 10.1002/acm2.13337] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/26/2021] [Accepted: 06/02/2021] [Indexed: 12/18/2022] Open
Abstract
This paper surveys the data-driven dose prediction methods investigated for knowledge-based planning (KBP) in the last decade. These methods were classified into two major categories-traditional KBP methods and deep-learning (DL) methods-according to their techniques of utilizing previous knowledge. Traditional KBP methods include studies that require geometric or anatomical features to either find the best-matched case(s) from a repository of prior treatment plans or to build dose prediction models. DL methods include studies that train neural networks to make dose predictions. A comprehensive review of each category is presented, highlighting key features, methods, and their advancements over the years. We separated the cited works according to the framework and cancer site in each category. Finally, we briefly discuss the performance of both traditional KBP methods and DL methods, then discuss future trends of both data-driven KBP methods to dose prediction.
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Affiliation(s)
- Shadab Momin
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGAUSA
| | - Yabo Fu
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGAUSA
| | - Yang Lei
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGAUSA
| | - Justin Roper
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGAUSA
| | - Jeffrey D. Bradley
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGAUSA
| | - Walter J. Curran
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGAUSA
| | - Tian Liu
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGAUSA
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGAUSA
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Characterization of automatic treatment planning approaches in radiotherapy. Phys Imaging Radiat Oncol 2021; 19:60-65. [PMID: 34307920 PMCID: PMC8295841 DOI: 10.1016/j.phro.2021.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/09/2021] [Accepted: 07/01/2021] [Indexed: 12/05/2022] Open
Abstract
Auto-Planning is widely used, yet creation of high quality treatment plans remains challenging. Systematic investigation of behavior and optimal use of Auto-Planning. Widely applicable solutions to create optimal plans. Auto-Planning outperforms manual plans in DVH metrics and blind comparisons.
Background and purpose Automatic approaches are widely implemented to automate dose optimization in radiotherapy treatment planning. This study systematically investigates how to configure automatic planning in order to create the best possible plans. Materials and methods Automatic plans were generated using protocol based automatic iterative optimization. Starting from a simple automation protocol which consisted of the constraints for targets and organs at risk (OAR), the performance of the automatic approach was evaluated in terms of target coverage, OAR sparing, conformity, beam complexity, and plan quality. More complex protocols were systematically explored to improve the quality of the automatic plans. The protocols could be improved by adding a dose goal on the outer 2 mm of the PTV, by setting goals on strategically chosen subparts of OARs, by adding goals for conformity, and by limiting the leaf motion. For prostate plans, development of an automated post-optimization procedure was required to achieve precise control over the dose distribution. Automatic and manually optimized plans were compared for 20 head and neck (H&N), 20 prostate, and 20 rectum cancer patients. Results Based on simple automation protocols, the automatic optimizer was not always able to generate adequate treatment plans. For the improved final configurations for the three sites, the dose was lower in automatic plans compared to the manual plans in 12 out of 13 considered OARs. In blind tests, the automatic plans were preferred in 80% of cases. Conclusions With adequate, advanced, protocols the automatic planning approach is able to create high-quality treatment plans.
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Biston MC, Costea M, Gassa F, Serre AA, Voet P, Larson R, Grégoire V. Evaluation of fully automated a priori MCO treatment planning in VMAT for head-and-neck cancer. Phys Med 2021; 87:31-38. [PMID: 34116315 DOI: 10.1016/j.ejmp.2021.05.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/19/2021] [Accepted: 05/29/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Automated planning techniques aim to reduce manual planning time and inter-operator variability without compromising the plan quality which is particularly challenging for head-and-neck (HN) cancer radiotherapy. The objective of this study was to evaluate the performance of an a priori-multicriteria plan optimization algorithm on a cohort of HN patients. METHODS A total of 14 nasopharyngeal carcinoma (upper-HN) and 14 "middle-lower indications" (lower-HN) previously treated in our institution were enrolled in this study. Automatically generated plans (autoVMAT) were compared to manual VMAT or Helical Tomotherapy planning (manVMAT-HT) by assessing differences in dose delivered to targets and organs at risk (OARs), calculating plan quality indexes (PQIs) and performing blinded comparisons by clinicians. Quality control of the plans and measurements of the delivery times were also performed. RESULTS For the 14 lower-HN patients, with equivalent planning target volume (PTV) dosimetric criteria and dose homogeneity, significant decrease in the mean doses to the oral cavity, esophagus, trachea and larynx were observed for autoVMAT compared to manVMAT-HT. Regarding the 14 upper-HN cases, the PTV coverage was generally significantly superior for autoVMAT which was also confirmed with higher calculated PQIs on PTVs for 13 out of 14 patients, whereas PQIs calculated on OARs were generally equivalent. Number of MUs and total delivery time were significantly higher for autoVMAT compared to manVMAT. All plans were considered clinically acceptable by clinicians. CONCLUSIONS Overall superiority of autoVMAT compared to manVMAT-HT plans was demonstrated for HN cancer. The obtained plans were operator-independent and required no post-optimization or manual intervention.
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Affiliation(s)
- Marie-Claude Biston
- Centre Léon Bérard, 28 rue Laennec 69373, LYON Cedex 08, France; CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Lyon 1, Villeurbanne, France.
| | - Madalina Costea
- Centre Léon Bérard, 28 rue Laennec 69373, LYON Cedex 08, France; CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Lyon 1, Villeurbanne, France
| | - Frédéric Gassa
- Centre Léon Bérard, 28 rue Laennec 69373, LYON Cedex 08, France
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Hu J, Liu B, Xie W, Zhu J, Yu X, Gu H, Wang M, Wang Y, Qi Z. Quantitative Comparison of Knowledge-Based and Manual Intensity Modulated Radiation Therapy Planning for Nasopharyngeal Carcinoma. Front Oncol 2021; 10:551763. [PMID: 33489869 PMCID: PMC7817947 DOI: 10.3389/fonc.2020.551763] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/26/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE To validate the feasibility and efficiency of a fully automatic knowledge-based planning (KBP) method for nasopharyngeal carcinoma (NPC) cases, with special attention to the possible way that the success rate of auto-planning can be improved. METHODS AND MATERIALS A knowledge-based dose volume histogram (DVH) prediction model was developed based on 99 formerly treated NPC patients, by means of which the optimization objectives and the corresponding priorities for intensity modulation radiation therapy (IMRT) planning were automatically generated for each head and neck organ at risk (OAR). The automatic KBP method was thus evaluated in 17 new NPC cases with comparison to manual plans (MP) and expert plans (EXP) in terms of target dose coverage, conformity index (CI), homogeneity index (HI), and normal tissue protection. To quantify the plan quality, a metric was applied for plan evaluation. The variation in the plan quality and time consumption among planners was also investigated. RESULTS With comparable target dose distributions, the KBP method achieved a significant dose reduction in critical organs such as the optic chiasm (p<0.001), optic nerve (p=0.021), and temporal lobe (p<0.001), but failed to spare the spinal cord (p<0.001) compared with MPs and EXPs. The overall plan quality evaluation gave mean scores of 144.59±11.48, 142.71±15.18, and 144.82±15.17, respectively, for KBPs, MPs, and EXPs (p=0.259). A total of 15 out of 17 KBPs (i.e., 88.24%) were approved by our physician as clinically acceptable. CONCLUSION The automatic KBP method using the DVH prediction model provided a possible way to generate clinically acceptable plans in a short time for NPC patients.
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Affiliation(s)
- Jiang Hu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Boji Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Weihao Xie
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Jinhan Zhu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xiaoli Yu
- Sun Yat-sen Memory Hospital, Guangzhou, China
| | - Huikuan Gu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Mingli Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yixuan Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - ZhenYu Qi
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
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Bai P, Weng X, Quan K, Chen J, Dai Y, Xu Y, Lin F, Zhong J, Wu T, Chen C. A knowledge-based intensity-modulated radiation therapy treatment planning technique for locally advanced nasopharyngeal carcinoma radiotherapy. Radiat Oncol 2020; 15:188. [PMID: 32746873 PMCID: PMC7397573 DOI: 10.1186/s13014-020-01626-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/21/2020] [Indexed: 01/18/2023] Open
Abstract
Background To investigate the feasibility of a knowledge-based automated intensity-modulated radiation therapy (IMRT) planning technique for locally advanced nasopharyngeal carcinoma (NPC) radiotherapy. Methods One hundred forty NPC patients treated with definitive radiation therapy with the step-and-shoot IMRT techniques were retrospectively selected and separated into a knowledge library (n = 115) and a test library (n = 25). For each patient in the knowledge library, the overlap volume histogram (OVH), target volume histogram (TVH) and dose objectives were extracted from the manually generated plan. 5-fold cross validation was performed to divide the patients in the knowledge library into 5 groups before validating one group by using the other 4 groups to train each neural network (NN) machine learning models. For patients in the test library, their OVH and TVH were then used by the trained models to predict a corresponding set of mean dose objectives, which were subsequently used to generate automated plans (APs) in Pinnacle planning system via an in-house developed automated scripting system. All APs were obtained after a single step of optimization. Manual plans (MPs) for the test patients were generated by an experienced medical physicist strictly following the established clinical protocols. The qualities of the APs and MPs were evaluated by an attending radiation oncologist. The dosimetric parameters for planning target volume (PTV) coverage and the organs-at-risk (OAR) sparing were also quantitatively measured and compared using Mann-Whitney U test and Bonferroni correction. Results APs and MPs had the same rating for more than 80% of the patients (19 out of 25) in the test group. Both AP and MP achieved PTV coverage criteria for no less than 80% of the patients. For each OAR, the number of APs achieving its criterion was similar to that in the MPs. The AP approach improved planning efficiency by greatly reducing the planning duration to about 17% of the MP (9.85 ± 1.13 min vs. 57.10 ± 6.35 min). Conclusion A robust and effective knowledge-based IMRT treatment planning technique for locally advanced NPC is developed. Patient specific dose objectives can be predicted by trained NN models based on the individual’s OVH and clinical TVH goals. The automated planning scripts can use these dose objectives to efficiently generate APs with largely shortened planning time. These APs had comparable dosimetric qualities when compared to our clinic’s manual plans.
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Affiliation(s)
- Penggang Bai
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Xing Weng
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Kerun Quan
- School of Nuclear Science and Technology, University of South China, Hengyang, China
| | - Jihong Chen
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Yitao Dai
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Yuanji Xu
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Fasheng Lin
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Jing Zhong
- Department of Radiology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Tianming Wu
- Department of Radiation and Cellular Oncology, The University of Chicago Medicine, Chicago, USA
| | - Chuanben Chen
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China.
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12
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Zhang Q, Ou L, Peng Y, Yu H, Wang L, Zhang S. Evaluation of automatic VMAT plans in locally advanced nasopharyngeal carcinoma. Strahlenther Onkol 2020; 197:177-187. [PMID: 32488293 DOI: 10.1007/s00066-020-01631-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/04/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to evaluate the quality of locally advanced nasopharyngeal carcinoma (NPC) radiotherapy plans generated by the automated planning module of a commercial treatment planning system (TPS). METHODS Data of 30 patients with locally advanced NPC were retrospectively investigated. For each patient, volumetric modulated arc therapy (VMAT) plans with double arcs were generated manually by experienced physicists and automatically in the Pinnacle3 Auto-Planning module (Philips Medical Systems, Fitchburg, WI, USA). The anatomic distance between the second clinical target volume (CTV2) and the pons of the brainstem, and the T category of disease were factored into the evaluation. Dosimetric verification was evaluated in terms of gamma pass rate. Target coverage, sparing of organs at risk (OARs), and monitor units were evaluated and compared between the manual and automatic VMAT plans. RESULTS Not all treatment plans fully met the dose objectives for planning target volumes (PTVs) and OARs, particularly in T4 patients. Overall, automatic VMAT provides a comparable or superior plan quality to manual VMAT in most cases. In stratified analysis, plan quality is mainly independent on T category but is also affected by anatomic distance. If the anatomic distance is less than 5 mm, the automatic VMAT plan quality is equal or even inferior to manual VMAT performed by experienced physicists. Conversely, if the anatomic distance is greater than 5 mm, the automatic VMAT plan quality is superior to manual VMAT. Gamma pass rates for quality assurance are similar between manual and automatic VMAT plans for the former case, but significantly higher in automatic VMAT for the latter. CONCLUSION The selection of manual versus automatic VMAT planning in locally advanced NPC should be made individually based on the anatomic distance, rather than blindly and habitually, since automatic VMAT is not good enough to completely replace manual VMAT.
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Affiliation(s)
- Quanbin Zhang
- Radiotherapy center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Liya Ou
- Guangzhou Medical University, Guangzhou, China.
| | - Yingying Peng
- Radiotherapy center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Hui Yu
- Radiotherapy center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Linjing Wang
- Radiotherapy center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Shuxu Zhang
- Radiotherapy center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China.
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13
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Chamunyonga C, Edwards C, Caldwell P, Rutledge P, Burbery J. The Impact of Artificial Intelligence and Machine Learning in Radiation Therapy: Considerations for Future Curriculum Enhancement. J Med Imaging Radiat Sci 2020; 51:214-220. [PMID: 32115386 DOI: 10.1016/j.jmir.2020.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/31/2020] [Accepted: 01/31/2020] [Indexed: 12/14/2022]
Abstract
Artificial intelligence (AI) and machine learning (ML) approaches have caught the attention of many in health care. Current literature suggests there are many potential benefits that could transform future clinical workflows and decision making. Embedding AI and ML concepts in radiation therapy education could be a fundamental step in equipping radiation therapists (RTs) to engage in competent and safe practice as they utilise clinical technologies. In this discussion paper, the authors provide a brief review of some applications of AI and ML in radiation therapy and discuss pertinent considerations for radiation therapy curriculum enhancement. As the current literature suggests, AI and ML approaches will impose changes to routine clinical radiation therapy tasks. The emphasis in RT education could be on critical evaluation of AI and ML application in routine clinical workflows and gaining an understanding of the impact on quality assurance, provision of quality of care and safety in radiation therapy as well as research. It is also imperative RTs have a broader understanding of AI/ML impact on health care, including ethical and legal considerations. The paper concludes with recommendations and suggestions to deliberately embed AI and ML aspects in RT education to empower future RT practitioners.
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Affiliation(s)
- Crispen Chamunyonga
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Christopher Edwards
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter Caldwell
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peta Rutledge
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Julie Burbery
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
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14
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Wang C, Zhu X, Hong JC, Zheng D. Artificial Intelligence in Radiotherapy Treatment Planning: Present and Future. Technol Cancer Res Treat 2020; 18:1533033819873922. [PMID: 31495281 PMCID: PMC6732844 DOI: 10.1177/1533033819873922] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Treatment planning is an essential step of the radiotherapy workflow. It has become more sophisticated over the past couple of decades with the help of computer science, enabling planners to design highly complex radiotherapy plans to minimize the normal tissue damage while persevering sufficient tumor control. As a result, treatment planning has become more labor intensive, requiring hours or even days of planner effort to optimize an individual patient case in a trial-and-error fashion. More recently, artificial intelligence has been utilized to automate and improve various aspects of medical science. For radiotherapy treatment planning, many algorithms have been developed to better support planners. These algorithms focus on automating the planning process and/or optimizing dosimetric trade-offs, and they have already made great impact on improving treatment planning efficiency and plan quality consistency. In this review, the smart planning tools in current clinical use are summarized in 3 main categories: automated rule implementation and reasoning, modeling of prior knowledge in clinical practice, and multicriteria optimization. Novel artificial intelligence-based treatment planning applications, such as deep learning-based algorithms and emerging research directions, are also reviewed. Finally, the challenges of artificial intelligence-based treatment planning are discussed for future works.
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Affiliation(s)
- Chunhao Wang
- 1 Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Xiaofeng Zhu
- 2 Department of Radiation Oncology, Georgetown University Hospital, Rockville, MD, USA
| | - Julian C Hong
- 1 Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA.,3 Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Dandan Zheng
- 4 Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
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15
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Haderlein M, Speer S, Ott O, Lettmaier S, Hecht M, Semrau S, Frey B, Scherl C, Iro H, Kesting M, Fietkau R. Dose Reduction to the Swallowing Apparatus and the Salivary Glands by De-Intensification of Postoperative Radiotherapy in Patients with Head and Neck Cancer: First (Treatment Planning) Results of the Prospective Multicenter DIREKHT Trial. Cancers (Basel) 2020; 12:cancers12030538. [PMID: 32110958 PMCID: PMC7139715 DOI: 10.3390/cancers12030538] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/07/2020] [Accepted: 02/20/2020] [Indexed: 02/06/2023] Open
Abstract
Aim: Evaluating radiotherapy treatment plans of the prospective DIREKHT trial (ClinicalTrials.gov, NCT02528955) investigating de-intensification of radiotherapy in patients with head and neck cancer. Patients and Methods: The first 30 patients from the DIREKHT trial of the leading study centre were included in this analysis. Standard treatment plans and study treatment plans derived from the protocol were calculated for each patient. Sizes of planning target volumes (PTVs) and mean doses to organs at risk were compared using the Student’s t-test with paired samples. Results: Mean PTV3 including primary tumor region and ipsilateral elective neck up to a dose of 50 Gy in the study treatment plans was 662 mL (+/− 165 mL standard deviation (SD)) and therefore significantly smaller than those of the standard treatment plans (1166 mL (+/− 266 mL SD). In the medial and inferior constrictor muscles, cricopharyngeal muscle, glottic and supraglottic laryngeal areas, arytenoid cartilages, contralateral major salivary glands highly significant dose reductions (p < 0.0001) of more than 10 Gy were achieved in study treatment plan compared to standard treatment plan. Conclusion: De-intensification of radiotherapy led to smaller planning target volumes and clinical relevant dose reductions in the swallowing apparatus and in the contralateral salivary glands.
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Affiliation(s)
- Marlen Haderlein
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
- Correspondence: ; Tel.: +49-9131-8543-025; Fax: +49-9131-8535-969
| | - Stefan Speer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
| | - Oliver Ott
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
| | - Sebastian Lettmaier
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
| | - Markus Hecht
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
| | - Sabine Semrau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
| | - Benjamin Frey
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
| | - Claudia Scherl
- Department of Otorhinolaryngology, Universitätsklinikum Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany;
- Department of Otorhinolaryngology, Universitätsklinikum, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Heinrich Iro
- Department of Otorhinolaryngology, Universitätsklinikum, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Marco Kesting
- Department of Oral and Maxillofacial Surgery, Universitätsklinikum, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
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16
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Delaby N, Martin S, Barateau A, Henry O, Perichon N, De Crevoisier R, Chajon E, Castelli J, Lafond C. Implementation of an optimization method for parotid gland sparing during inverse planning for head and neck cancer radiotherapy. Cancer Radiother 2020; 24:28-37. [PMID: 32007370 DOI: 10.1016/j.canrad.2019.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To guide parotid gland (PG) sparing at the dose planning step, a specific model based on overlap between PTV and organ at risk (Moore et al.) was developed and evaluated for VMAT in head-and-neck (H&N) cancer radiotherapy. MATERIALS AND METHODS One hundred and sixty patients treated for locally advanced H&N cancer were included. A model optimization was first performed (20 patients) before a model evaluation (110 patients). Thirty cases were planned with and without the model to quantify the PG dose sparing. The inter-operator variability was evaluated on one case, planned by 12 operators with and without the model. The endpoints were PG mean dose (Dmean), PTV homogeneity and number of monitor units (MU). RESULTS The PG Dmean predicted by the model was reached in 89% of cases. Using the model significantly reduced the PG Dmean: -6.1±4.3Gy. Plans with the model showed lower PTV dose homogeneity and more MUs (+10.5% on average). For the inter-operator variability, PG dose volume histograms without the optimized model were significantly different compared to those with the model; the Dmean standard deviation for the ipsilateral PG decreased from 2.2Gy to 1.2Gy. For the contralateral PG, this value decreased from 2.9Gy to 0.8Gy. CONCLUSION During the H&N inverse planning, the optimized model guides to the lowest PG achievable mean dose, allowing a significant PG mean dose reduction of -6.1Gy. Integrating this method at the treatment-planning step significantly reduced the inter-patient and inter-operator variabilities.
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Affiliation(s)
- N Delaby
- Centre Eugène Marquis, Unité de Physique Médicale, rue de La Bataille Flandres Dunkerque, CS 44229, 35042 Rennes Cedex, France.
| | - S Martin
- Centre Eugène Marquis, Département de Radiothérapie, rue de La Bataille Flandres Dunkerque, CS 44229, 35042 Rennes Cedex, France
| | - A Barateau
- Université Rennes, CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, 35000 Rennes, France
| | - O Henry
- Centre Eugène Marquis, Unité de Physique Médicale, rue de La Bataille Flandres Dunkerque, CS 44229, 35042 Rennes Cedex, France
| | - N Perichon
- Centre Eugène Marquis, Unité de Physique Médicale, rue de La Bataille Flandres Dunkerque, CS 44229, 35042 Rennes Cedex, France
| | - R De Crevoisier
- Université Rennes, CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, 35000 Rennes, France
| | - E Chajon
- Centre Eugène Marquis, Département de Radiothérapie, rue de La Bataille Flandres Dunkerque, CS 44229, 35042 Rennes Cedex, France
| | - J Castelli
- Université Rennes, CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, 35000 Rennes, France
| | - C Lafond
- Université Rennes, CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, 35000 Rennes, France
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Yang Y, Shao K, Zhang J, Chen M, Chen Y, Shan G. Automatic Planning for Nasopharyngeal Carcinoma Based on Progressive Optimization in RayStation Treatment Planning System. Technol Cancer Res Treat 2020; 19:1533033820915710. [PMID: 32552600 PMCID: PMC7307279 DOI: 10.1177/1533033820915710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 02/08/2020] [Accepted: 02/26/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To evaluate and quantify the planning performance of automatic planning (AP) with manual planning (MP) for nasopharyngeal carcinoma in the RayStation treatment planning system (TPS). METHODS A progressive and effective design method for AP of nasopharyngeal carcinoma was realized through automated scripts in this study. A total of 30 patients with nasopharyngeal carcinoma with initial treatment was enrolled. The target coverage, conformity index (CI), homogeneity index (HI), organs at risk sparing, and the efficiency of design and execution were compared between automatic and manual volumetric modulated arc therapy (VMAT) plans. RESULTS The results of the 2 design methods met the clinical dose requirement. The differences in D95 between the 2 groups in PTV1 and PTV2 showed statistical significance, and the MPs are higher than APs, but the difference in absolute dose was only 0.21% and 0.16%. The results showed that the conformity index of planning target volumes (PTV1, PTV2, PTVnd and PGTVnx+rpn [PGTVnx and PGTVrpn]), homogeneity index of PGTVnx+rpn, and HI of PTVnd in APs are better than that in MPs. For organs at risk, the APs are lower than the MPs, and the difference was statistically significant (P < .05). The manual operation time in APs was 83.21% less than that in MPs, and the computer processing time was 34.22% more. CONCLUSION IronPython language designed by RayStation TPS has clinical application value in the design of automatic radiotherapy plan for nasopharyngeal carcinoma. The dose distribution of tumor target and organs at risk in the APs was similar or better than those in the MPs. The time of manual operation in the plan design showed a sharp reduction, thus significantly improving the work efficiency in clinical application.
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Affiliation(s)
- Yiwei Yang
- Institute of Cancer and Basic Medical (ICBM), Chinese Academy of
Sciences, Hangzhou, China
- Department of Radiation Physics, Cancer Hospital of University of
Chinese Academy of Sciences, Hangzhou, China
- Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou,
China
| | - Kainan Shao
- Institute of Cancer and Basic Medical (ICBM), Chinese Academy of
Sciences, Hangzhou, China
- Department of Radiation Physics, Cancer Hospital of University of
Chinese Academy of Sciences, Hangzhou, China
- Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou,
China
| | - Jie Zhang
- Institute of Cancer and Basic Medical (ICBM), Chinese Academy of
Sciences, Hangzhou, China
- Department of Radiation Physics, Cancer Hospital of University of
Chinese Academy of Sciences, Hangzhou, China
- Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou,
China
| | - Ming Chen
- Institute of Cancer and Basic Medical (ICBM), Chinese Academy of
Sciences, Hangzhou, China
- Department of Radiation Oncology, Cancer Hospital of University of
Chinese Academy of Sciences, Hangzhou, China
- Department of Radiation Oncology, Zhejiang Cancer Hospital,
Hangzhou, China
| | - Yuanyuan Chen
- Institute of Cancer and Basic Medical (ICBM), Chinese Academy of
Sciences, Hangzhou, China
- Department of Radiation Oncology, Cancer Hospital of University of
Chinese Academy of Sciences, Hangzhou, China
- Department of Radiation Oncology, Zhejiang Cancer Hospital,
Hangzhou, China
| | - Guoping Shan
- Institute of Cancer and Basic Medical (ICBM), Chinese Academy of
Sciences, Hangzhou, China
- Department of Radiation Physics, Cancer Hospital of University of
Chinese Academy of Sciences, Hangzhou, China
- Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou,
China
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18
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Smith A, Granatowicz A, Stoltenberg C, Wang S, Liang X, Enke CA, Wahl AO, Zhou S, Zheng D. Can the Student Outperform the Master? A Plan Comparison Between Pinnacle Auto-Planning and Eclipse knowledge-Based RapidPlan Following a Prostate-Bed Plan Competition. Technol Cancer Res Treat 2019; 18:1533033819851763. [PMID: 31177922 PMCID: PMC6558545 DOI: 10.1177/1533033819851763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose: Pinnacle Auto-Planning and Eclipse RapidPlan are 2 major commercial automated planning
engines that are fundamentally different: Auto-Planning mimics real planners in the
iterative optimization, while RapidPlan generates static dose objectives from
estimations predicted based on a prior knowledge base. This study objectively compared
their performances on intensity-modulated radiotherapy planning for prostate fossa and
lymphatics adopting the plan quality metric used in the 2011 American Association of
Medical Dosimetrists Plan Challenge. Methods: All plans used an identical intensity-modulated radiotherapy beam setup and a
simultaneous integrated boost prescription (68 Gy/56 Gy to prostate fossa/lymphatics).
Auto-Planning was used to retrospectively plan on 20 patients, which were subsequently
employed as the library to build an RapidPlan model. To compare the 2 engines’
performances, a test set including 10 patients and the Plan Challenge patient was
planned by both Auto-Planning (master) and RapidPlan (student) without manual
intervention except for a common dose normalization and evaluated using the plan quality
metric that included 14 quantitative submetrics ranging over target coverage, spillage,
and organ at risk doses. Plan quality metric scores were compared between the
Auto-Planning and RapidPlan plans using the Mann-Whitney U test. Results: There was no significant difference between the overall performance of the 2 engines on
the 11 test cases (P = .509). Among the 14 submetrics, Auto-Planning
and RapidPlan showed no significant difference on most submetrics except for 2. On the
Plan Challenge case, Auto-Planning scored 129.9 and RapidPlan scored 130.3 out of 150,
as compared with the average score of 116.9 ± 16.4 (range: 58.2-142.5) among the 125
Plan Challenge participants. Conclusion: Using an innovative study design, an objective comparison has been conducted between 2
major commercial automated inverse planning engines. The 2 engines performed comparably
with each other and both yielded plans at par with average human planners. Using a
constant-performing planner (Auto-Planning) to train and to compare, RapidPlan was found
to yield plans no better than but as good as its library plans.
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Affiliation(s)
- April Smith
- 1 Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Andrew Granatowicz
- 1 Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Cole Stoltenberg
- 1 Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shuo Wang
- 1 Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Xiaoying Liang
- 2 University of Florida Proton Therapy Institute, Jacksonville, FL, USA
| | - Charles A Enke
- 1 Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Andrew O Wahl
- 1 Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sumin Zhou
- 1 Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dandan Zheng
- 1 Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
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Richter A, Exner F, Bratengeier K, Polat B, Flentje M, Weick S. Impact of beam configuration on VMAT plan quality for Pinnacle 3Auto-Planning for head and neck cases. Radiat Oncol 2019; 14:12. [PMID: 30658661 PMCID: PMC6339276 DOI: 10.1186/s13014-019-1211-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/02/2019] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to compare automatically generated VMAT plans to find the superior beam configurations for Pinnacle3 Auto-Planning and share “best practices”. Methods VMAT plans for 20 patients with head and neck cancer were generated using Pinnacle3 Auto-Planning Module (Pinnacle3 Version 9.10) with different beam setup parameters. VMAT plans for single (V1) or double arc (V2) and partial or full gantry rotation were optimized. Beam configurations with different collimator positions were defined. Target coverage and sparing of organs at risk were evaluated based on scoring of an evaluation parameter set. Furthermore, dosimetric evaluation was performed based on the composite objective value (COV) and a new cross comparison method was applied using the COVs. Results The evaluation showed a superior plan quality for double arcs compared to one single arc or two single arcs for all cases. Plan quality was superior if a full gantry rotation was allowed during optimization for unilateral target volumes. A double arc technique with collimator setting of 15° was superior to a double arc with collimator 60° and a two single arcs with collimator setting of 15° and 345°. Conclusion The evaluation showed that double and full arcs are superior to single and partial arcs in terms of organs at risk sparing even for unilateral target volumes. The collimator position was found as an additional setup parameter, which can further improve the target coverage and sparing of organs at risk.
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Affiliation(s)
- Anne Richter
- Department of Radiation Oncology, University of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
| | - Florian Exner
- Department of Radiation Oncology, University of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Klaus Bratengeier
- Department of Radiation Oncology, University of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Bülent Polat
- Department of Radiation Oncology, University of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Michael Flentje
- Department of Radiation Oncology, University of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Stefan Weick
- Department of Radiation Oncology, University of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
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20
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Hussein M, Heijmen BJM, Verellen D, Nisbet A. Automation in intensity modulated radiotherapy treatment planning-a review of recent innovations. Br J Radiol 2018; 91:20180270. [PMID: 30074813 DOI: 10.1259/bjr.20180270] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Radiotherapy treatment planning of complex radiotherapy techniques, such as intensity modulated radiotherapy and volumetric modulated arc therapy, is a resource-intensive process requiring a high level of treatment planner intervention to ensure high plan quality. This can lead to variability in the quality of treatment plans and the efficiency in which plans are produced, depending on the skills and experience of the operator and available planning time. Within the last few years, there has been significant progress in the research and development of intensity modulated radiotherapy treatment planning approaches with automation support, with most commercial manufacturers now offering some form of solution. There is a rapidly growing number of research articles published in the scientific literature on the topic. This paper critically reviews the body of publications up to April 2018. The review describes the different types of automation algorithms, including the advantages and current limitations. Also included is a discussion on the potential issues with routine clinical implementation of such software, and highlights areas for future research.
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Affiliation(s)
- Mohammad Hussein
- 1 Metrology for Medical Physics Centre, National Physical Laboratory , Teddington , UK
| | - Ben J M Heijmen
- 2 Division of Medical Physics, Erasmus MC Cancer Institute , Rotterdam , The Netherlands
| | - Dirk Verellen
- 3 Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB) , Brussels , Belgium.,4 Radiotherapy Department, Iridium Kankernetwerk , Antwerp , Belgium
| | - Andrew Nisbet
- 5 Department of Medical Physics, Royal Surrey County Hospital NHS Foundation Trust , Guildford , UK.,6 Department of Physics, University of Surrey , Guildford , UK
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21
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Exploring the Role and Application of the Deliberate Practice Concept in Radiation Therapy. J Med Imaging Radiat Sci 2018; 49:237-242. [PMID: 32074048 DOI: 10.1016/j.jmir.2018.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/04/2018] [Accepted: 04/06/2018] [Indexed: 11/21/2022]
Abstract
The concept of deliberate practice (DP) has been extensively applied to the development of skill and expert performance in many domains of professional practice. Although it has been widely reviewed in other health professions, there is a lack of evidence on its application in radiation therapy practice. This article aims to explore the concept of DP and how it can be applied to radiation therapy practice. The authors define DP, why it is essential, and how it can be implemented in radiation therapy. Evidence from the DP literature in the health professions was used to clarify the guiding principles for successful DP implementation within both the clinical and educational contexts. While the authors encourage radiation therapy practitioners to engage in DP approaches, every profession utilizing DP will develop strategies unique to the individual discipline. Hence, rather than imitating other professions, it is essential that radiation therapists engage evidence-based approaches that will generate empirical evidence to model radiation therapy-specific DP approaches.
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Künzel LA, Dohm OS, Alber M, Zips D, Thorwarth D. Automatic replanning of VMAT plans for different treatment machines: A template-based approach using constrained optimization. Strahlenther Onkol 2018; 194:921-928. [PMID: 29846751 DOI: 10.1007/s00066-018-1319-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/12/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate a new automatic template-based replanning approach combined with constrained optimization, which may be highly useful for a rapid plan transfer for planned or unplanned machine breakdowns. This approach was tested for prostate cancer (PC) and head-and-neck cancer (HNC) cases. METHODS The constraints of a previously optimized volumetric modulated arc therapy (VMAT) plan were used as a template for automatic plan reoptimization for different accelerator head models. All plans were generated using the treatment planning system (TPS) Hyperion. Automatic replanning was performed for 16 PC cases, initially planned for MLC1 (4 mm MLC) and reoptimized for MLC2 (5 mm) and MLC3 (10 mm) and for 19 HNC cases, replanned from MLC2 to MLC3. EUD, Dmean, D2%, and D98% were evaluated for targets; for OARs EUD and D2% were analyzed. Replanning was considered successful if both plans fulfilled equal constraints. RESULTS All prostate cases were successfully replanned. The mean relative target EUD deviation was -0.15% and -0.57% for replanning to MLC2 and MLC3, respectively. OAR sparing was successful in all cases. Replanning of HNC cases from MLC2 to MLC3 was successful in 16/19 patients with a mean decrease of -0.64% in PTV60 EUD. In three cases target doses were substantially decreased by up to -2.58% (PTV60) and -3.44% (PTV54), respectively. Nevertheless, OAR sparing was always achieved as planned. CONCLUSIONS Automatic replanning of VMAT plans for a different treatment machine by using pre-existing constraints as a template for a reoptimization is feasible and successful in terms of equal constraints.
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Affiliation(s)
- Luise A Künzel
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Oliver S Dohm
- Department of Radiation Oncology, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Markus Alber
- Radiation Oncology, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Tübingen, 72076, Tübingen, Germany
- German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, 72076, Tübingen, Germany.
- German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany.
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