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Gonzalez Y, Visak J, Overman L, Liao C, Yen A, Zhuang T, Cai B, Godley A, Zhang Y, Timmerman R, Iyengar P, Westover K, Parsons D, Lin M. Beyond conventional bounds: Surpassing system limits for stereotactic ablative (SAbR) lung radiotherapy using CBCT-based adaptive planning system. J Appl Clin Med Phys 2024; 25:e14375. [PMID: 38712917 PMCID: PMC11302803 DOI: 10.1002/acm2.14375] [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: 10/18/2023] [Revised: 03/27/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE Online adaptive radiotherapy relies on a high degree of automation to enable rapid planning procedures. The Varian Ethos intelligent optimization engine (IOE) was originally designed for conventional treatments so it is crucial to provide clear guidance for lung SAbR plans. This study investigates using the Ethos IOE together with adaptive-specific optimization tuning structures we designed and templated within Ethos to mitigate inter-planner variability in meeting RTOG metrics for both online-adaptive and offline SAbR plans. METHODS We developed a planning strategy to automate the generation of tuning structures and optimization. This was validated by retrospective analysis of 35 lung SAbR cases (total 105 fractions) treated on Ethos. The effectiveness of our planning strategy was evaluated by comparing plan quality with-and-without auto-generated tuning structures. Internal target volume (ITV) contour was compared between that drawn from CT simulation and from cone-beam CT (CBCT) at time of treatment to verify CBCT image quality and treatment effectiveness. Planning strategy robustness for lung SAbR was quantified by frequency of plans meeting reference plan RTOG constraints. RESULTS Our planning strategy creates a gradient within the ITV with maximum dose in the core and improves intermediate dose conformality on average by 2%. ITV size showed no significant difference between those contoured from CT simulation and first fraction, and also trended towards decreasing over course of treatment. Compared to non-adaptive plans, adaptive plans better meet reference plan goals (37% vs. 100% PTV coverage compliance, for scheduled and adapted plans) while improving plan quality (improved GI (gradient index) by 3.8%, CI (conformity index) by 1.7%). CONCLUSION We developed a robust and readily shareable planning strategy for the treatment of adaptive lung SAbR on the Ethos system. We validated that automatic online plan re-optimization along with the formulated adaptive tuning structures can ensure consistent plan quality. With the proposed planning strategy, highly ablative treatments are feasible on Ethos.
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Affiliation(s)
- Yesenia Gonzalez
- Department of Radiation OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Justin Visak
- Department of Radiation OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Luke Overman
- Department of Radiation OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Chien‐Yi Liao
- Department of Radiation OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Allen Yen
- Department of Radiation OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Tingliang Zhuang
- Department of Radiation OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Bin Cai
- Department of Radiation OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Andrew Godley
- Department of Radiation OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Yuanyuan Zhang
- Department of Radiation OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew York CityNew YorkUSA
| | - Robert Timmerman
- Department of Radiation OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Puneeth Iyengar
- Department of Radiation OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew York CityNew YorkUSA
| | - Kenneth Westover
- Department of Radiation OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew York CityNew YorkUSA
| | - David Parsons
- Department of Radiation OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Mu‐Han Lin
- Department of Radiation OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Medical Artificial Intelligence and Automation LaboratoryDepartment of Radiation OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
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Douglas R, Olanrewaju A, Mumme R, Zhang L, Beadle BM, Court LE. Evaluating automatically generated normal tissue contours for safe use in head and neck and cervical cancer treatment planning. J Appl Clin Med Phys 2024; 25:e14338. [PMID: 38610118 PMCID: PMC11244666 DOI: 10.1002/acm2.14338] [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: 05/24/2023] [Revised: 03/05/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024] Open
Abstract
PURPOSE Volumetric-modulated arc therapy (VMAT) is a widely accepted treatment method for head and neck (HN) and cervical cancers; however, creating contours and plan optimization for VMAT plans is a time-consuming process. Our group has created an automated treatment planning tool, the Radiation Planning Assistant (RPA), that uses deep learning models to generate organs at risk (OARs), planning structures and automates plan optimization. This study quantitatively evaluates the quality of contours generated by the RPA tool. METHODS For patients with HN (54) and cervical (39) cancers, we retrospectively generated autoplans using the RPA. Autoplans were generated using deep-learning and RapidPlan models developed in-house. The autoplans were, then, applied to the original, physician-drawn contours, which were used as a ground truth (GT) to compare with the autocontours (RPA). Using a "two one-sided tests" (TOST) procedure, we evaluated whether the autocontour normal tissue dose was equivalent to that of the ground truth by a margin, δ, that we determined based on clinical judgement. We also calculated the number of plans that met established clinically accepted dosimetric criteria. RESULTS For HN plans, 91.8% and 91.7% of structures met dosimetric criteria for automatic and manual contours, respectively; for cervical plans, 95.6% and 95.7% of structures met dosimetric criteria for automatic and manual contours, respectively. Autocontours were equivalent to the ground truth for 71% and 75% of common DVH metrics for the HN and cervix, respectively. CONCLUSIONS This study shows that dosimetrically equivalent normal tissue contours can be created for HN and cervical cancers using deep learning techniques. In general, differences between the contours did not affect the passing or failing of clinical dose tolerances.
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Affiliation(s)
- Raphael Douglas
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Adenike Olanrewaju
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Raymond Mumme
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Lifei Zhang
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Beth M. Beadle
- Department of Radiation OncologyStanford UniversityStanfordCaliforniaUSA
| | - Laurence Edward Court
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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Scaggion A, Cavinato S, Dusi F, El Khouzai B, Guida F, Paronetto C, Rossato MA, Sapignoli S, Scott ASA, Sepulcri M, Paiusco M. On the necessity of specialized knowledge-based models for SBRT prostate treatments plans. Phys Med 2024; 121:103364. [PMID: 38701626 DOI: 10.1016/j.ejmp.2024.103364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/21/2024] [Accepted: 04/19/2024] [Indexed: 05/05/2024] Open
Abstract
PURPOSE Test whether a well-grounded KBP model trained on moderately hypo-fractionated prostate treatments can be used to satisfactorily drive the optimization of SBRT prostate treatments. MATERIALS AND METHODS A KBP model (SBRT-model) was developed, trained and validated using the first forty-seven clinically treated VMAT SBRT prostate plans (42.7 Gy/7fx or 36.25 Gy/5fx). The performance and robustness of this model were compared against a high-quality KBP-model (ST-model) that was already clinically adopted for hypo-fractionated (70 Gy/28fx and 60 Gy/20fx) prostate treatments. The two models were compared in terms of their predictions robustness, and the quality of their outcomes were evaluated against a set of reference clinical SBRT plans. Plan quality was assessed using DVH metrics, blinded clinical ranking, and a dedicated Plan Quality Metric algorithm. RESULTS The plan libraries of the two models were found to share a high degree of anatomical similarity. The overall quality (APQM%) of the plans obtained both with the ST- and SBRT-models was compatible with that of the original clinical plans, namely (93.7 ± 4.1)% and (91.6 ± 3.9)% vs (92.8.9 ± 3.6)%. Plans obtained with the ST-model showed significantly higher target coverage (PTV V95%): (97.9 ± 0.8)% vs (97.1 ± 0.9)% (p < 0.05). Conversely, plans optimized following the SBRT-model showed a small but not-clinically relevant increase in OAR sparing. ST-model generally provided more reliable predictions than SBRT-model. Two radiation oncologists judged as equivalent the plans based on the KBP prediction, which was also judged better that reference clinical plans. CONCLUSION A KBP model trained on moderately fractionated prostate treatment plans provided optimal SBRT prostate plans, with similar or larger plan quality than an embryonic SBRT-model based on a limited number of cases.
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Affiliation(s)
- Alessandro Scaggion
- S.C. Fisica Sanitaria, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy.
| | - Samuele Cavinato
- S.C. Fisica Sanitaria, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Francesca Dusi
- S.C. Fisica Sanitaria, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Badr El Khouzai
- S.C. Radioterapia, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Federica Guida
- S.C. Fisica Sanitaria, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Chiara Paronetto
- S.C. Radioterapia, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | | | - Sonia Sapignoli
- S.C. Fisica Sanitaria, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | | | - Matteo Sepulcri
- S.C. Radioterapia, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Marta Paiusco
- S.C. Fisica Sanitaria, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
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Liu S, Chapman KL, Berry SL, Bertini J, Ma R, Fu Y, Yang D, Moran JM, Della-Biancia C. Implementation of a knowledge-based decision support system for treatment plan auditing through automation. Med Phys 2023; 50:6978-6989. [PMID: 37211898 DOI: 10.1002/mp.16472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Independent auditing is a necessary component of a comprehensive quality assurance (QA) program and can also be utilized for continuous quality improvement (QI) in various radiotherapy processes. Two senior physicists at our institution have been performing a time intensive manual audit of cross-campus treatment plans annually, with the aim of further standardizing our planning procedures, updating policies and guidelines, and providing training opportunities of all staff members. PURPOSE A knowledge-based automated anomaly-detection algorithm to provide decision support and strengthen our manual retrospective plan auditing process was developed. This standardized and improved the efficiency of the assessment of our external beam radiotherapy (EBRT) treatment planning across all eight campuses of our institution. METHODS A total of 843 external beam radiotherapy plans for 721 lung patients from January 2020 to March 2021 were automatically acquired from our clinical treatment planning and management systems. From each plan, 44 parameters were automatically extracted and pre-processed. A knowledge-based anomaly detection algorithm, namely, "isolation forest" (iForest), was then applied to the plan dataset. An anomaly score was determined for each plan using recursive partitioning mechanism. Top 20 plans ranked with the highest anomaly scores for each treatment technique (2D/3D/IMRT/VMAT/SBRT) including auto-populated parameters were used to guide the manual auditing process and validated by two plan auditors. RESULTS The two auditors verified that 75.6% plans with the highest iForest anomaly scores have similar concerning qualities that may lead to actionable recommendations for our planning procedures and staff training materials. The time to audit a chart was approximately 20.8 min on average when done manually and 14.0 min when done with the iForest guidance. Approximately 6.8 min were saved per chart with the iForest method. For our typical internal audit review of 250 charts annually, the total time savings are approximately 30 hr per year. CONCLUSION iForest effectively detects anomalous plans and strengthens our cross-campus manual plan auditing procedure by adding decision support and further improve standardization. Due to the use of automation, this method was efficient and will be used to establish a standard plan auditing procedure, which could occur more frequently.
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Affiliation(s)
- Shi Liu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Katherine L Chapman
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sean L Berry
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Julian Bertini
- Committee on Medical Physics, Biological Science Division, University of Chicago, Chicago, Illinois, USA
| | - Rongtao Ma
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yabo Fu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Deshan Yang
- Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina, USA
| | - Jean M Moran
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cesar Della-Biancia
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Zeverino M, Piccolo C, Wuethrich D, Jeanneret-Sozzi W, Marguet M, Bourhis J, Bochud F, Moeckli R. Clinical implementation of deep learning-based automated left breast simultaneous integrated boost radiotherapy treatment planning. Phys Imaging Radiat Oncol 2023; 28:100492. [PMID: 37780177 PMCID: PMC10534254 DOI: 10.1016/j.phro.2023.100492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023] Open
Abstract
Background and purpose Automation in radiotherapy treatment planning aims to improve both the quality and the efficiency of the process. The aim of this study was to report on a clinical implementation of a Deep Learning (DL) auto-planning model for left-sided breast cancer. Materials and methods The DL model was developed for left-sided breast simultaneous integrated boost treatments under deep-inspiration breath-hold. Eighty manual dose distributions were revised and used for training. Ten patients were used for model validation. The model was then used to design 17 clinical auto-plans. Manual and auto-plans were scored on a list of clinical goals for both targets and organs-at-risk (OARs). For validation, predicted and mimicked dose (PD and MD, respectively) percent error (PE) was calculated with respect to manual dose. Clinical and validation cohorts were compared in terms of MD only. Results Median values of both PD and MD validation plans fulfilled the evaluation criteria. PE was < 1% for targets for both PD and MD. PD was well aligned to manual dose while MD left lung mean dose was significantly less (median:5.1 Gy vs 6.1 Gy). The left-anterior-descending artery maximum dose was found out of requirements (median values:+5.9 Gy and + 2.9 Gy, for PD and MD respectively) in three validation cases, while it was reduced for clinical cases (median:-1.9 Gy). No other clinically significant differences were observed between clinical and validation cohorts. Conclusion Small OAR differences observed during the model validation were not found clinically relevant. The clinical implementation outcomes confirmed the robustness of the model.
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Affiliation(s)
- Michele Zeverino
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Consiglia Piccolo
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Diana Wuethrich
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Wendy Jeanneret-Sozzi
- Radiation Oncology Department, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Maud Marguet
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Jean Bourhis
- Radiation Oncology Department, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Francois Bochud
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Raphael Moeckli
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
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Ueda Y, Fukunaga JI, Kamima T, Shimizu Y, Kubo K, Doi H, Monzen H. Standardization of knowledge-based volumetric modulated arc therapy planning with a multi-institution model (broad model) to improve prostate cancer treatment quality. Phys Eng Sci Med 2023; 46:1091-1100. [PMID: 37247102 DOI: 10.1007/s13246-023-01278-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/08/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE To evaluate whether knowledge-based volumetric modulated arc therapy plans for prostate cancer with a multi-institution model (broad model) are clinically useful and effective as a standardization method. METHODS A knowledge-based planning (KBP) model was trained with 561 prostate VMAT plans from five institutions with different contouring and planning policies. Five clinical plans at each institution were reoptimized with the broad and single institution model, and the dosimetric parameters and relationship between Dmean and the overlapping volume (rectum or bladder and target) were compared. RESULTS The differences between the broad and single institution models in the dosimetric parameters for V50, V80, V90, and Dmean were: rectum; 9.5% ± 10.3%, 3.3% ± 1.5%, 1.7% ± 1.6%, and 3.6% ± 3.6%, (p < 0.001), bladder; 8.7% ± 12.8%, 1.5% ± 2.6%, 0.7% ± 2.4%, and 2.7% ± 4.6% (p < 0.02), respectively. The differences between the broad model and clinical plans were: rectum; 2.4% ± 4.6%, 1.7% ± 1.7%, 0.7% ± 2.4%, and 1.5% ± 2.0%, (p = 0.004, 0.015, 0.112, and 0.009) bladder; 2.9% ± 5.8%, 1.6% ± 1.9%, 0.9% ± 1.7%, and 1.1% ± 4.8%, (p < 0.018), respectively. Positive values indicate that the broad model has a lower value. Strong correlations were observed (p < 0.001) in the relationship between Dmean and the rectal and bladder volume overlapping with the target in the broad model (R = 0.815 and 0.891, respectively). The broad model had the smallest R2 of the three plans. CONCLUSIONS KBP with the broad model is clinically effective and applicable as a standardization method at multiple institutions.
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Affiliation(s)
- Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 537-8567, Japan.
| | - Jun-Ichi Fukunaga
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1, Maidashi, Higashi- ku, Fukuoka, 812-8582, Japan
| | - Tatsuya Kamima
- Radiation Oncology Department, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yumiko Shimizu
- Department of Radiology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka Ward, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Kazuki Kubo
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Hiroshi Doi
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
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Bufacchi A, Arcangeli G, Pasciuti K. Performance of auto-planning for VMAT hypofractionated left whole-breast irradiation with simultaneous integrated boost. Med Dosim 2023:S0958-3947(23)00025-0. [PMID: 37087355 DOI: 10.1016/j.meddos.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/08/2023] [Accepted: 03/14/2023] [Indexed: 04/24/2023]
Abstract
Retrospective analysis of volumetric modulated arc therapy plans for hypofractionated left whole-breast irradiation with simultaneous integrated boost to assess the performance of the auto-planning (AP) engine. Fifteen treatment plans, produced using manual optimization planning approach (MP) were replanned using (AP) approach. Dose-volume parameters were defined to quantify the quality of concurrent treatment plans assessing target coverage and sparing organs at risk (OARs). The Wilcoxon Signed Rank test was used for statistical comparison of all results obtained from the use of the 2 approaches. Dose coverage for both PTVs, PTVbreast, and PTVboost, were similar with AP showing slightly significantly better results for the homogeneity index for both PTVs, for D98% of PTVbreast and D2% of PTVboost. AP plans provided a significant reduction of dose for ipsilateral lung and contralateral lung. No significant differences were observed for heart and contralateral breast. A percentage difference of -14.0% was found for the mean dose of left coronary artery between AP plans and MP plans. Despite increase of total MU by 4.3% for AP plans, planning time resulted about half of that of the MP approach. Although PTVs doses were similar between MP and AP plans, AP plans generally spared OARs significantly better than MP plans. Furthermore, the shortest AP treatment plan time approach was attractive with respect to the workload.
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Ahmed S, Liu C, LaHurd D, Murray E, Kolar M, Joshi N, Woody N, Koyfman S, Xia P. Using feasibility dose-volume histograms to reduce intercampus plan quality variability for head-and-neck cancer. J Appl Clin Med Phys 2022; 24:e13749. [PMID: 35962566 PMCID: PMC9859985 DOI: 10.1002/acm2.13749] [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: 12/12/2021] [Revised: 04/12/2022] [Accepted: 07/21/2022] [Indexed: 01/26/2023] Open
Abstract
The purpose of this work is to objectively assess variability of intercampus plan quality for head-and-neck (HN) cancer and to test utility of a priori feasibility dose-volume histograms (FDVHs) as planning dose goals. In this study, 109 plans treated from 2017 to 2019 were selected, with 52 from the main campus and 57 from various regional centers. For each patient, the planning computed tomography images and contours were imported into a commercial program to generate FDVHs with a feasibility value (f-value) ranging from 0.0 to 0.5. For 10 selected organs-at-risk (OARs), we used the Dice similarity coefficient (DSC) to quantify the overlaps between FDVH and clinically achieved DVH of each OAR and determined the f-value associated with the maximum DSC (labeled as f-max). Subsequently, 10 HN plans from the regional centers were replanned with planning dose goals guided by FDVHs. The clinical and feasibility-guided auto-planning (FgAP) plans were evaluated using our institutional criteria. Among plans from the main campus and regional centers, the median f-max values were statistically significantly different (p < 0.05) for all OARs except for the left parotid (p = 0.622), oral cavity (p = 0.057), and mandible (p = 0.237). For the 10 FgAP plans, the median values of f-max were 0.21, compared to 0.37 from the clinical plans. With comparable dose coverage to the tumor volumes, the significant differences (p < 0.05) in the median f-max and corresponding dose reduction (shown in parenthesis) for the spinal cord, larynx, supraglottis, trachea, and esophagus were 0.27 (8.5 Gy), 0.3 (7.6 Gy), 0.19 (5.9 Gy), 0.19 (8.9 Gy), and 0.12 (4.0 Gy), respectively. In conclusion, the FDVH prediction is an objective quality assurance tool to evaluate the intercampus plan variability. This tool can also provide guideline in planning dose goals to further improve plan quality.
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Affiliation(s)
- Saeed Ahmed
- Department of Radiation Oncology, Taussig Cancer CenterCleveland Clinic FoundationClevelandOhioUSA
| | - Chieh‐Wen Liu
- Department of Radiation Oncology, Taussig Cancer CenterCleveland Clinic FoundationClevelandOhioUSA
| | - Danielle LaHurd
- Department of Radiation Oncology, Taussig Cancer CenterCleveland Clinic FoundationClevelandOhioUSA
| | - Eric Murray
- Department of Radiation Oncology, Taussig Cancer CenterCleveland Clinic FoundationClevelandOhioUSA
| | - Matthew Kolar
- Department of Radiation Oncology, Taussig Cancer CenterCleveland Clinic FoundationClevelandOhioUSA
| | - Nikhil Joshi
- Department of Radiation OncologyRush University Medical CenterChicagoIllinoisUSA
| | - Neil Woody
- Department of Radiation Oncology, Taussig Cancer CenterCleveland Clinic FoundationClevelandOhioUSA
| | - Shlomo Koyfman
- Department of Radiation Oncology, Taussig Cancer CenterCleveland Clinic FoundationClevelandOhioUSA
| | - Ping Xia
- Department of Radiation Oncology, Taussig Cancer CenterCleveland Clinic FoundationClevelandOhioUSA
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Tudda A, Castriconi R, Benecchi G, Cagni E, Cicchetti A, Dusi F, Esposito PG, Guernieri M, Ianiro A, Landoni V, Mazzilli A, Moretti E, Oliviero C, Placidi L, Rambaldi Guidasci G, Rancati T, Scaggion A, Trojani V, Fiorino C. Knowledge-based multi-institution plan prediction of whole breast irradiation with tangential fields. Radiother Oncol 2022; 175:10-16. [PMID: 35868603 DOI: 10.1016/j.radonc.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To quantify inter-institute variability of Knowledge-Based (KB) models for right breast cancer patients treated with tangential fields whole breast irradiation (WBI). MATERIALS AND METHODS Ten institutions set KB models by using RapidPlan (Varian Inc.), following previously shared methodologies. Models were tested on 20 new patients from the same institutes, exporting DVH predictions of heart, ipsilateral lung, contralateral lung, and contralateral breast. Inter-institute variability was quantified by the inter-institute SDint of predicted DVHs/Dmean. Association between lung sparing vs PTV coverage strategy was also investigated. The transferability of models was evaluated by the overlap of each model's geometric Principal Component (PC1) when applied to the test patients of the other 9 institutes. RESULTS The overall inter-institute variability of DVH/Dmean ipsilateral lung dose prediction, was less than 2% (20%-80% dose range) and 0.55 Gy respectively (1SD) for a 40 Gy in 15 fraction schedule; it was < 0.2 Gy for other OARs. Institute 6 showed the lowest mean dose prediction value and no overlap between PTV and ipsilateral lung. Once excluded, the predicted ipsilateral lung Dmean was correlated with median PTV D99% (R2 = 0.78). PC1 values were always within the range of applicability (90th percentile) for 7 models: for 2 models they were outside in 1/18 cases. For the model of institute 6, it failed in 7/18 cases. The impact of inter-institute variability of dose calculation was tested and found to be almost negligible. CONCLUSIONS Results show limited inter-institute variability of plan prediction models translating in high inter-institute interchangeability, except for one of ten institutes. These results encourage future investigations in generating benchmarks for plan prediction incorporating inter-institute variability.
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Affiliation(s)
- Alessia Tudda
- Medical Physics Dept, San Raffaele Scientific Institute, Milano, Italy; Università Statale di Milano, Milano, Italy
| | | | | | - Elisabetta Cagni
- Medical Physics Unit, Department of Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Francesca Dusi
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Marika Guernieri
- Department of Medical Physics, University Hospital, Udine, Italy
| | - Anna Ianiro
- Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | | | - Aldo Mazzilli
- Medical Physics Dept, University Hospital of Parma AOUP, Italy
| | - Eugenia Moretti
- Department of Medical Physics, University Hospital, Udine, Italy
| | | | - Lorenzo Placidi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giulia Rambaldi Guidasci
- Amethyst Radioterapia Italia, Medical Physics Department, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Scaggion
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Valeria Trojani
- Medical Physics Unit, Department of Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Claudio Fiorino
- Medical Physics Dept, San Raffaele Scientific Institute, Milano, Italy
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10
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Douglas RJ, Olanrewaju A, Zhang L, Beadle BM, Court LE. Assessing the practicality of using a single knowledge‐based planning model for multiple linac vendors. J Appl Clin Med Phys 2022; 23:e13704. [PMID: 35791594 PMCID: PMC9359004 DOI: 10.1002/acm2.13704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 05/18/2022] [Accepted: 05/31/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose Knowledge‐based planning (KBP) has been shown to be an effective tool in quality control for intensity‐modulated radiation therapy treatment planning and generating high‐quality plans. Previous studies have evaluated its ability to create consistent plans across institutions and between planners within the same institution as well as its use as teaching tool for inexperienced planners. This study evaluates whether planning quality is consistent when using a KBP model to plan across different treatment machines. Materials and methods This study used a RapidPlan model (Varian Medical Systems) provided by the vendor, to which we added additional planning objectives, maximum dose limits, and planning structures, such that a clinically acceptable plan is achieved in a single optimization. This model was used to generate and optimize volumetric‐modulated arc therapy plans for a cohort of 50 patients treated for head‐neck cancer. Plans were generated using the following treatment machines: Varian 2100, Elekta Versa HD, and Varian Halcyon. A noninferiority testing methodology was used to evaluate the hypothesis that normal and target metrics in our autoplans were no worse than a set of clinically‐acceptable baseline plans by a margin of 1.8 Gy or 3% dose‐volume. The quality of these plans were also compared through the use of common clinical dose‐volume histogram criteria. Results The Versa HD met our noninferiority criteria for 23 of 34 normal and target metrics; while the Halcyon and Varian 2100 machines met our criteria for 24 of 34 and 26 of 34 metrics, respectively. The experimental plans tended to have less volume coverage for prescription dose planning target volume and larger hotspot volumes. However, comparable plans were generated across different treatment machines. Conclusions These results support the use of a head‐neck RapidPlan models in centralized planning workflows that support clinics with different linac models/vendors, although some fine‐tuning for targets may be necessary.
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Affiliation(s)
- Raphael J. Douglas
- Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Adenike Olanrewaju
- Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Lifei Zhang
- Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Beth M. Beadle
- Department of Radiation Oncology Stanford University Palo Alto California USA
| | - Laurence E. Court
- Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston Texas USA
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11
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Hoffmann L, Mortensen H, Shamshad M, Berbee M, Bizzocchi N, Bütof R, Canters R, Defraene G, Lykkegaard Ehmsen M, Fiorini F, Haustermans K, Hulley R, Korevaar EW, Clarke M, Makocki S, Muijs CT, Murray L, Nicholas O, Nordsmark M, Radhakrishna G, Thomas M, Troost EGC, Vilches-Freixas G, Visser S, Weber DC, Sloth Møller D. Treatment planning comparison in the PROTECT-trial randomising proton versus photon beam therapy in oesophageal cancer: results from eight european centres. Radiother Oncol 2022; 172:32-41. [PMID: 35513132 DOI: 10.1016/j.radonc.2022.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/06/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare dose distributions and robustness in treatment plans from eight European centres in preparation for the European randomized phase-III PROTECT-trial investigating the effect of proton therapy (PT) versus photon therapy (XT) for oesophageal cancer. MATERIALS AND METHODS All centres optimized one PT and one XT nominal plan using delineated 4DCT scans for four patients receiving 50.4Gy(RBE) in 28 fractions. Target volume receiving 95% of prescribed dose (V95%iCTVtotal) should be >99%. Robustness towards setup, range, and respiration was evaluated. The plans were recalculated on a surveillance 4DCT (sCT) acquired at fraction ten and robustness evaluation was performed to evaluate the effect of respiration and inter-fractional anatomical changes. RESULTS All PT and XT plans complied with V95%iCTVtotal>99% for the nominal plan and V95%iCTVtotal>97% for all respiratory and robustness scenarios. Lung and heart dose varied considerably between centres for both modalities. The difference in mean lung dose and mean heart dose between each pair of XT and PT plans was in median [range] 4.8Gy [1.1;7.6] and 8.4Gy [1.9;24.5], respectively. Patients B and C showed large inter-fractional anatomical changes on sCT. For patient B, the minimum V95%iCTVtotal in the worst-case robustness scenario was 45% and 94% for XT and PT, respectively. For patient C, the minimum V95%iCTVtotal was 57% and 72% for XT and PT, respectively. Patient A and D showed minor inter-fractional changes and the minimum V95%iCTVtotal was >85%. CONCLUSION Large variability in dose to the lungs and heart was observed for both modalities. Inter-fractional anatomical changes led to larger target dose deterioration for XT than PT plans.
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Affiliation(s)
- Lone Hoffmann
- Department of Medical Physics, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark.
| | - Hanna Mortensen
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | - Muhammad Shamshad
- Department of Medical Physics, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | - Maaike Berbee
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, The Netherlands
| | - Nicola Bizzocchi
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
| | - Rebecca Bütof
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Richard Canters
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, The Netherlands
| | - Gilles Defraene
- KU Leuven - University of Leuven - Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium
| | | | | | - Karin Haustermans
- KU Leuven - University of Leuven - Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium; University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Ryan Hulley
- South West Wales Cancer Centre, Swansea University Board, UL AND Swansea University Medical School, United Kingdom
| | - Erik W Korevaar
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Matthew Clarke
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sebastian Makocki
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Christina T Muijs
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Luke Murray
- Rutherford Cancer Centre, Shinfield, Reading, United Kingdom
| | - Owen Nicholas
- South West Wales Cancer Centre, Swansea University Board, UL AND Swansea University Medical School, United Kingdom
| | | | | | - Melissa Thomas
- KU Leuven - University of Leuven - Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium; University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Esther G C Troost
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany; Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Rossendorf, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Gloria Vilches-Freixas
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, The Netherlands
| | - Sabine Visser
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland; Radiation Oncology Department, University Hospital Zurich, Zurich, Switzerland
| | - Ditte Sloth Møller
- Department of Medical Physics, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
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12
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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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Visak J, Webster A, Bernard ME, Kudrimoti M, Randall ME, McGarry RC, Pokhrel D. Fast generation of lung SBRT plans with a knowledge-based planning model on ring-mounted Halcyon Linac. J Appl Clin Med Phys 2021; 22:54-63. [PMID: 34562308 PMCID: PMC8598154 DOI: 10.1002/acm2.13427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/23/2021] [Accepted: 09/07/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose To demonstrate fast treatment planning feasibility of stereotactic body radiation therapy (SBRT) for centrally located lung tumors on Halcyon Linac via a previously validated knowledge‐based planning (KBP) model to support offline adaptive radiotherapy. Materials/methods Twenty previously treated non‐coplanar volumetric‐modulated arc therapy (VMAT) lung SBRT plans (c‐Truebeam) on SBRT‐dedicated C‐arm Truebeam Linac were selected. Patients received 50 Gy in five fractions. c‐Truebeam plans were re‐optimized for Halcyon manually (m‐Halcyon) and with KBP model (k‐Halcyon). Both m‐Halcyon and k‐Halcyon plans were normalized for identical or better target coverage than clinical c‐Truebeam plans and compared for target conformity, dose heterogeneity, dose fall‐off, and dose tolerances to the organs‐at‐risk (OAR). Treatment delivery parameters and planning times were evaluated. Results k‐Halcyon plans were dosimetrically similar or better than m‐Halcyon and c‐Truebeam plans. k‐Halcyon and m‐Halcyon plan comparisons are presented with respect to c‐Truebeam. Differences in conformity index were statistically insignificant in k‐Halcyon and on average 0.02 higher (p = 0.04) in m‐Halcyon plans. Gradient index was on average 0.43 (p = 0.006) lower and 0.27 (p = 0.02) higher for k‐Halcyon and m‐Halcyon, respectively. Maximal dose 2 cm away in any direction from target was statistically insignificant. k‐Halcyon increased maximal target dose on average by 2.9 Gy (p < 0.001). Mean lung dose was on average reduced by 0.10 Gy (p = 0.004) in k‐Halcyon and increased by 0.14 Gy (p < 0.001) in m‐Halcyon plans. k‐Halcyon plans lowered bronchial tree dose on average by 1.2 Gy. Beam‐on‐time (BOT) was increased by 2.85 and 1.67 min, on average for k‐Halcyon and m‐Halcyon, respectively. k‐Halcyon plans were generated in under 30 min compared to estimated dedicated 180 ± 30 min for m‐Halcyon or c‐Truebeam plan. Conclusion k‐Halcyon plans were generated in under 30 min with excellent plan quality. This adaptable KBP model supports high‐volume clinics in the expansion or transfer of lung SBRT patients to Halcyon.
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Affiliation(s)
- Justin Visak
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Aaron Webster
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Mark E Bernard
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Mahesh Kudrimoti
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Marcus E Randall
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Ronald C McGarry
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Damodar Pokhrel
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
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14
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Piliero MA, Pupillo F, Leva S, Casiraghi M, Paulicelli E, Bellesi L, Presilla S. Plan quality and consistency in spine radiosurgery treatment planning: comparison between automatic treatment planning with Elements Spine SRS and manual inverse planning with Varian Eclipse. Med Dosim 2021; 47:43-47. [PMID: 34538692 DOI: 10.1016/j.meddos.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/02/2021] [Accepted: 08/08/2021] [Indexed: 11/27/2022]
Abstract
Spine radiosurgery treatment planning can be a challenging task since a high radiation dose is delivered to target volumes close to the spinal cord, therefore a steep dose gradient is required. Plan quality is greatly influenced by the planner skills, so automatic treatment planning has been proposed to overcome this issue and assure high-quality plans. The Brainlab Elements Spine SRS treatment planning system is specially designed for spine radiosurgery treatments. It is an automatic treatment planning system that works through predefined protocols, with minimal planner interaction required. In this work, we evaluated the plan quality and consistency among the planners within the same institution when using the Elements Spine SRS compared to manual inverse planning with the Varian Eclipse system. Six planners produced a plan for 3 sample target volumes representing different spine metastases in the thoracic region using both treatment planning systems. Dose prescription was 16 Gy in a single fraction, at more than 80% of the target volume. The most important organ at risk was the spinal canal. The dose constraint was V10 Gy < 0.35 cm3. High dose spillage outside the target volume, the homogeneity index, the Paddick conformity index and the number of monitor units were also evaluated. The mean dose to the target volumes in the Elements Spine SRS plans were consistently higher by 0.8 Gy to 1.5 Gy and the maximum dose to the target volumes were consistently higher by 1.8 Gy to 3.1 Gy. Spinal cord sparing was comparable to the Eclipse plans. However, the number of monitor units was greatly reduced, up to 2270 monitor units less. No difference was found in plan quality variability among the planners.
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Affiliation(s)
- Maria A Piliero
- Medical Physics Division, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Via Gallino 12, 6500 Bellinzona, Switzerland..
| | - Francesco Pupillo
- Medical Physics Division, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Via Gallino 12, 6500 Bellinzona, Switzerland
| | - Stefano Leva
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland, 6500 Bellinzona, Via Gallino 12, 6500 Bellinzona, Switzerland
| | - Margherita Casiraghi
- Medical Physics Division, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Via Gallino 12, 6500 Bellinzona, Switzerland
| | - Eleonora Paulicelli
- Medical Physics Division, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Via Gallino 12, 6500 Bellinzona, Switzerland
| | - Luca Bellesi
- Medical Physics Division, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Via Gallino 12, 6500 Bellinzona, Switzerland
| | - Stefano Presilla
- Medical Physics Division, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Via Gallino 12, 6500 Bellinzona, Switzerland
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15
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Geng H, Giaddui T, Cheng C, Zhong H, Ryu S, Liao Z, Yin FF, Gillin M, Mohan R, Xiao Y. A comparison of two methodologies for radiotherapy treatment plan optimization and QA for clinical trials. J Appl Clin Med Phys 2021; 22:329-337. [PMID: 34432946 PMCID: PMC8504592 DOI: 10.1002/acm2.13401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 06/28/2021] [Accepted: 08/04/2021] [Indexed: 12/25/2022] Open
Abstract
Background and purpose The efficacy of clinical trials and the outcome of patient treatment are dependent on the quality assurance (QA) of radiation therapy (RT) plans. There are two widely utilized approaches that include plan optimization guidance created based on patient‐specific anatomy. This study examined these two techniques for dose‐volume histogram predictions, RT plan optimizations, and prospective QA processes, namely the knowledge‐based planning (KBP) technique and another first principle (FP) technique. Methods This analysis included 60, 44, and 10 RT plans from three Radiation Therapy Oncology Group (RTOG) multi‐institutional trials: RTOG 0631 (Spine SRS), RTOG 1308 (NSCLC), and RTOG 0522 (H&N), respectively. Both approaches were compared in terms of dose prediction and plan optimization. The dose predictions were also compared to the original plan submitted to the trials for the QA procedure. Results For the RTOG 0631 (Spine SRS) and RTOG 0522 (H&N) plans, the dose predictions from both techniques have correlation coefficients of >0.9. The RT plans that were re‐optimized based on the predictions from both techniques showed similar quality, with no statistically significant differences in target coverage or organ‐at‐risk sparing. The predictions of mean lung and heart doses from both methods for RTOG1308 patients, on the other hand, have a discrepancy of up to 14 Gy. Conclusions Both methods are valuable tools for optimization guidance of RT plans for Spine SRS and Head and Neck cases, as well as for QA purposes. On the other hand, the findings suggest that KBP may be more feasible in the case of inoperable lung cancer patients who are treated with IMRT plans that have spatially unevenly distributed beam angles.
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Affiliation(s)
- Huaizhi Geng
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tawfik Giaddui
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chingyun Cheng
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Haoyu Zhong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Samuel Ryu
- Stony Brook University Medical Center, Stony Brook, New York, USA
| | | | - Fang-Fang Yin
- Duke University Medical Center, Durham, North Carolina, USA
| | | | - Radhe Mohan
- MD Anderson Cancer Center, Houston, Texas, USA
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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16
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Hardcastle N, Cook O, Ray X, Moore A, Moore KL, Pryor D, Rossi A, Foroudi F, Kron T, Siva S. Personalising treatment plan quality review with knowledge-based planning in the TROG 15.03 trial for stereotactic ablative body radiotherapy in primary kidney cancer. Radiat Oncol 2021; 16:142. [PMID: 34344402 PMCID: PMC8330099 DOI: 10.1186/s13014-021-01820-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/12/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Quality assurance (QA) of treatment plans in clinical trials improves protocol compliance and patient outcomes. Retrospective use of knowledge-based-planning (KBP) in clinical trials has demonstrated improved treatment plan quality and consistency. We report the results of prospective use of KBP for real-time QA of treatment plan quality in the TROG 15.03 FASTRACK II trial, which evaluates efficacy of stereotactic ablative body radiotherapy (SABR) for kidney cancer. METHODS A KBP model was generated based on single institution data. For each patient in the KBP phase (open to the last 31 patients in the trial), the treating centre submitted treatment plans 7 days prior to treatment. A treatment plan was created by using the KBP model, which was compared with the submitted plan for each organ-at-risk (OAR) dose constraint. A report comparing each plan for each OAR constraint was provided to the submitting centre within 24 h of receiving the plan. The centre could then modify the plan based on the KBP report, or continue with the existing plan. RESULTS Real-time feedback using KBP was provided in 24/31 cases. Consistent plan quality was in general achieved between KBP and the submitted plan. KBP review resulted in replan and improvement of OAR dosimetry in two patients. All centres indicated that the feedback was a useful QA check of their treatment plan. CONCLUSION KBP for real-time treatment plan review was feasible for 24/31 cases, and demonstrated ability to improve treatment plan quality in two cases. Challenges include integration of KBP feedback into clinical timelines, interpretation of KBP results with respect to clinical trade-offs, and determination of appropriate plan quality improvement criteria.
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Affiliation(s)
- Nicholas Hardcastle
- Physical Sciences, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC, 3000, Australia. .,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia. .,Department of Oncology, Sir Peter MacCallum, University of Melbourne, Parkville, Australia.
| | - Olivia Cook
- Trans Tasman Radiation Oncology Group, Newcastle, Australia
| | - Xenia Ray
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, USA
| | - Alisha Moore
- Trans Tasman Radiation Oncology Group, Newcastle, Australia
| | - Kevin L Moore
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, USA
| | - David Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - Alana Rossi
- Trans Tasman Radiation Oncology Group, Newcastle, Australia
| | - Farshad Foroudi
- Olivia Newton, John Cancer Centre at Austin Health, Heidelberg, Australia
| | - Tomas Kron
- Physical Sciences, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC, 3000, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia.,Department of Oncology, Sir Peter MacCallum, University of Melbourne, Parkville, Australia
| | - Shankar Siva
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Parkville, Australia.,Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Nakamura K, Okuhata K, Tamura M, Otsuka M, Kubo K, Ueda Y, Nakamura Y, Nakamatsu K, Tanooka M, Monzen H, Nishimura Y. An updating approach for knowledge-based planning models to improve plan quality and variability in volumetric-modulated arc therapy for prostate cancer. J Appl Clin Med Phys 2021; 22:113-122. [PMID: 34338435 PMCID: PMC8425874 DOI: 10.1002/acm2.13353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this study was to compare the dose-volume parameters and regression scatter plots of the iteratively improved RapidPlan (RP) models, specific knowledge-based planning (KBP) models, in volumetric-modulated arc therapy (VMAT) for prostate cancer over three periods. METHODS A RP1 model was created from 47 clinical intensity-modulated radiation therapy (IMRT)/VMAT plans. A RP2 model was created to exceed dosimetric goals which set as the mean values +1SD of the dose-volume parameters of RP1 (50 consecutive new clinical VMAT plans). A RP3 model was created with more strict dose constraints for organs at risks (OARs) than RP1 and RP2 models (50 consecutive anew clinical VMAT plans). Each RP model was validated against 30 validation plans (RP1, RP2, and RP3) that were not used for model configuration, and the dose-volume parameters were compared. The Cook's distances of regression scatterplots of each model were also evaluated. RESULTS Significant differences (p < 0.05) between RP1 and RP2 were found in Dmean (101.5% vs. 101.9%), homogeneity index (3.90 vs. 4.44), 95% isodose conformity index (1.22 vs. 1.20) for the target, V40Gy (47.3% vs. 45.7%), V60Gy (27.9% vs. 27.1%), V70Gy (16.4% vs. 15.2%), and V78Gy (0.4% vs. 0.2%) for the rectal wall, and V40Gy (43.8% vs. 41.8%) and V70Gy (21.3% vs. 20.5%) for the bladder wall, whereas only V70Gy (15.2% vs. 15.8%) of the rectal wall differed significantly between RP2 and RP3. The proportions of cases with a Cook's distance of <1.0 (RP1, RP2, and RP3 models) were 55%, 78%, and 84% for the rectal wall, and 77%, 68%, and 76% for the bladder wall, respectively. CONCLUSIONS The iteratively improved RP models, reflecting the clear dosimetric goals based on the RP feedback (dose-volume parameters) and more strict dose constraints for the OARs, generated superior dose-volume parameters and the regression scatterplots in the model converged. This approach could be used to standardize the inverse planning strategies.
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Affiliation(s)
- Kenji Nakamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osakasayama, Japan.,Department of Radiotherapy, Takarazuka City Hospital, Kohama, Takarazuka, Japan
| | - Katsuya Okuhata
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osakasayama, Japan
| | - Mikoto Tamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osakasayama, Japan
| | - Masakazu Otsuka
- Department of Radiology, Kindai University Hospital, Osakasayama, Japan
| | - Kazuki Kubo
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osakasayama, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, Chuo-ku, Japan
| | - Yasunori Nakamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osakasayama, Japan
| | - Kiyoshi Nakamatsu
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Masao Tanooka
- Department of Radiotherapy, Takarazuka City Hospital, Kohama, Takarazuka, Japan
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osakasayama, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Japan
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Costa E, Richir T, Robilliard M, Bragard C, Logerot C, Kirova Y, Fourquet A, De Marzi L. Assessment of a conventional volumetric-modulated arc therapy knowledge-based planning model applied to the new Halcyon© O-ring linac in locoregional breast cancer radiotherapy. Phys Med 2021; 86:32-43. [PMID: 34051551 DOI: 10.1016/j.ejmp.2021.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/31/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the performance of a knowledge-based planning (KBP) model for breast cancer trained on plans performed on a conventional linac with 6 MV FF (flattening filter) beams and volumetric-modulated arc therapy (VMAT) for plans performed on the new jawless Halcyon© system with 6 MV FFF (flattening filter-free) beams. MATERIALS AND METHODS Based on the RapidPlan© (RP) KBP optimization engine, a DVH Estimation Model was first trained using 56 VMAT left-sided breast cancer treatment plans performed on a conventional linac, and validated on another 20 similar cases (without manual intervention). To determine the capacity of the model for Halcyon©, an additional cohort of 20 left-sided breast cancer plans was generated with RP and analyzed for both TrueBeam© and Halcyon© machines. Plan qualities between manual vs RP (followed by manual intervention) Halcyon© plans set were compared qualitatively by blinded review by radiation oncologists for 10 new independent plans. RESULTS Halcyon© plans generated with the VMAT model trained with conventional linac plans showed comparable target dose distribution compared to TrueBeam© plans. Organ sparingwas comparable between the 2 devices with a slight decrease in heart dose for Halcyon© plans. Nine out of ten automatically generated Halcyon© plans were preferentially chosen by the radiation oncologists over the manually generated Halcyon© plans. CONCLUSION A VMAT KBP model driven by plans performed on a conventional linac with 6 MV FF beams provides high quality plans performed with 6 MV FFF beams on the new Halcyon© linac.
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Affiliation(s)
- Emilie Costa
- Institut Curie, Radiation Oncology Department, 26 rue d'Ulm, Paris 75005, France.
| | - Thomas Richir
- Institut Curie, Radiation Oncology Department, 26 rue d'Ulm, Paris 75005, France
| | - Magalie Robilliard
- Institut Curie, Radiation Oncology Department, 26 rue d'Ulm, Paris 75005, France
| | - Christel Bragard
- Institut Curie, Radiation Oncology Department, 26 rue d'Ulm, Paris 75005, France
| | - Christelle Logerot
- Institut Curie, Radiation Oncology Department, 26 rue d'Ulm, Paris 75005, France
| | - Youlia Kirova
- Institut Curie, Radiation Oncology Department, 26 rue d'Ulm, Paris 75005, France
| | - Alain Fourquet
- Institut Curie, Radiation Oncology Department, 26 rue d'Ulm, Paris 75005, France
| | - Ludovic De Marzi
- Institut Curie, Radiation Oncology Department, 26 rue d'Ulm, Paris 75005, France; Institut Curie, University Paris Saclay, PSL Research University, Inserm LITO, Orsay, France
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Evaluation of treatment plan quality for head and neck IMRT: a multicenter study. Med Dosim 2021; 46:310-317. [PMID: 33838998 DOI: 10.1016/j.meddos.2021.03.003] [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: 08/19/2020] [Revised: 01/06/2021] [Accepted: 03/05/2021] [Indexed: 11/23/2022]
Abstract
Intensity-modulated radiotherapy (IMRT) treatment planning for head and neck cancer is challenging and complex due to many organs at risk (OAR) in this region. The experience and skills of planners may result in substantial variability of treatment plan quality. This study assessed the performance of IMRT planning in Malaysia and observed plan quality variation among participating centers. The computed tomography dataset containing contoured target volumes and OAR was provided to participating centers. This is to control variations in contouring the target volumes and OARs by oncologists. The planner at each center was instructed to complete the treatment plan based on clinical practice with a given prescription, and the plan was analyzed against the planning goals provided. The quality of completed treatment plans was analyzed using the plan quality index (PQI), in which a score of 0 indicated that all dose objectives and constraints were achieved. A total of 23 plans were received from all participating centers comprising 14 VMAT, 7 IMRT, and 2 tomotherapy plans. The PQI indexes of these plans ranged from 0 to 0.65, indicating a wide variation of plan quality nationwide. Results also reported 5 out of 21 plans achieved all dose objectives and constraints showing more professional training is needed for planners in Malaysia. Understanding of treatment planning system and computational physics could also help in improving the quality of treatment plans for IMRT delivery.
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Roy A, Widjaja R, Wang M, Cutright D, Gopalakrishnan M, Mittal BB. Treatment plan quality control using multivariate control charts. Med Phys 2021; 48:2118-2126. [PMID: 33621381 DOI: 10.1002/mp.14795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/19/2021] [Accepted: 02/15/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Statistical process control tools such as control charts were recommended by the American Association of Physicists in Medicine (AAPM) Task Group 218 for radiotherapy quality assurance. However, the tools needed to analyze multivariate, correlated data that are often encountered in treatment plan quality measures, are lacking. In this study, we develop quality control tools that can model multivariate plan quality measures with correlations and account for patient-specific risk factors, without adding a significant burden to clinical workflow. METHODS AND MATERIALS A multivariate, quality control chart is developed that includes a risk-adjustment model, Hotelling's T2 statistic, and principal component analysis (PCA). Principal component analysis accounts for correlations among a set of organ-at-risk (OAR) dose-volume histogram (DVH) points that serves as proxies for plan quality. Risk-adjustment models estimate the principal components from PCA using a set of patient- and treatment-specific risk factors. The resulting residuals from the risk-adjustment models are used to compute the Hotelling's T2 statistic; the corresponding multivariate control chart is then plotted based on the beta distribution followed by the statistic. Further, the box-cox transformation is used to account for non-normality in DVH points. We investigate the application of the proposed methodology via three multivariate control charts - a conventional chart that ignores risk-adjustment and PCA, a risk-adjusted chart ignoring PCA, and a PCA-based, risk-adjusted chart. These control charts are evaluated on 69 head-and-neck cases. RESULTS The conventional multivariate control chart fails to account for important patient-specific risk factors, including volumes and cross-sectional areas of the tumor and OARs and distances in-between. This failure leads to a larger number of false alarms. While the multivariate risk-adjusted control chart is able to reduce false alarms, it fails to account for correlations in DVH points. The multivariate PCA-based, risk-adjusted control chart can detect unusual plans after accounting for the correlations. By replanning, improvements are shown on an unusual plan identified by both risk-adjusted methods. CONCLUSIONS The multivariate risk-adjusted control chart developed here enables quality control of plans prior to delivery. This methodology is generic and can be readily applied for other radiotherapy quality assurance protocols, such as gamma analysis pass rates.
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Affiliation(s)
- Arkajyoti Roy
- Department of Management Science and Statistics, University of Texas at San Antonio, San Antonio, TX, 78249, USA
| | - Reisa Widjaja
- Department of Management Science and Statistics, University of Texas at San Antonio, San Antonio, TX, 78249, USA
| | - Min Wang
- Department of Management Science and Statistics, University of Texas at San Antonio, San Antonio, TX, 78249, USA
| | - Dan Cutright
- Department of Radiation Oncology, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Mahesh Gopalakrishnan
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Bharat B Mittal
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
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Hoffmann L, Knap MM, Alber M, Møller DS. Optimal beam angle selection and knowledge-based planning significantly reduces radiotherapy dose to organs at risk for lung cancer patients. Acta Oncol 2021; 60:293-299. [PMID: 33306422 DOI: 10.1080/0284186x.2020.1856409] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Lung cancer patients struggle with high toxicity rates. This study investigates if IMRT plans with individually set beam angles or uni-lateral VMAT plans results in dose reduction to OARs. We investigate if introduction of a RapidPlan model leads to reduced dose to OARs. Finally, the model is validated prospectively. MATERIAL AND METHODS Seventy-four consecutive lung cancer patients treated with IMRT were included. For all patients, new IMRT plans were made by an experienced dose planner re-tuning beam angles aiming for minimized dose to the lungs and heart. Additionally, VMAT plans were made. The IMRT plans were selected as input for a RapidPlan model, which was used to generate 74 new IMRT plans. The new IMRT plans were used as input for a second RapidPlan model. This model was clinically implemented and used for generation of clinical treatment plans. Dosimetric parameters were compared using a Wilcoxon signed rank test or a 1-sided student's t-test. p < .05 was considered significant. RESULTS IMRT plans significantly reduced mean doses to lungs (MLD) and heart (MHD) by 1.6 Gy and 1.7 Gy in mean compared to VMAT plans. MLD was significantly (p < .001) reduced from 10.8 Gy to 9.4 Gy by using the second RapidPlan model. MHD was significantly (p < .001) reduced from 4.9 Gy to 3.9 Gy. The model was validated in prospectively collected treatment plans showing significantly lower MLD after the implementation of the second RapidPlan model. CONCLUSION Introduction of RapidPlan and beam angles selected based on the target and OARs position reduces dose to OARs.
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Affiliation(s)
- L. Hoffmann
- Department of Oncology, Section for Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - M. M. Knap
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - M. Alber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - D. S. Møller
- Department of Oncology, Section for Medical Physics, Aarhus University Hospital, Aarhus, Denmark
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Rago M, Placidi L, Polsoni M, Rambaldi G, Cusumano D, Greco F, Indovina L, Menna S, Placidi E, Stimato G, Teodoli S, Mattiucci GC, Chiesa S, Marazzi F, Masiello V, Valentini V, De Spirito M, Azario L. Evaluation of a generalized knowledge-based planning performance for VMAT irradiation of breast and locoregional lymph nodes-Internal mammary and/or supraclavicular regions. PLoS One 2021; 16:e0245305. [PMID: 33449952 PMCID: PMC7810311 DOI: 10.1371/journal.pone.0245305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/24/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the performance of eleven Knowledge-Based (KB) models for planning optimization (RapidPlantm (RP), Varian) of Volumetric Modulated Arc Therapy (VMAT) applied to whole breast comprehensive of nodal stations, internal mammary and/or supraclavicular regions. METHODS AND MATERIALS Six RP models have been generated and trained based on 120 VMAT plans data set with different criteria. Two extra-structures were delineated: a PTV for the optimization and a ring structure. Five more models, twins of the previous models, have been created without the need of these structures. RESULTS All models were successfully validated on an independent cohort of 40 patients, 30 from the same institute that provided the training patients and 10 from an additional institute, with the resulting plans being of equal or better quality compared with the clinical plans. The internal validation shows that the models reduce the heart maximum dose of about 2 Gy, the mean dose of about 1 Gy and the V20Gy of 1.5 Gy on average. Model R and L together with model B without optimization structures ensured the best outcomes in the 20% of the values compared to other models. The external validation observed an average improvement of at least 16% for the V5Gy of lungs in RP plans. The mean heart dose and for the V20Gy for lung IPSI were almost halved. The models reduce the maximum dose for the spinal canal of more than 2 Gy on average. CONCLUSIONS All KB models allow a homogeneous plan quality and some dosimetric gains, as we saw in both internal and external validation. Sub-KB models, developed by splitting right and left breast cases or including only whole breast with locoregional lymph nodes, have shown good performances, comparable but slightly worse than the general model. Finally, models generated without the optimization structures, performed better than the original ones.
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Affiliation(s)
- Maria Rago
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenzo Placidi
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mattia Polsoni
- Fatebenefratelli Isola Tiberina, Ospedale San Giovanni Calibita, Rome, Italy
- Amethyst Radioterapia Italia, Isola Tiberina, Rome, Italy
| | - Giulia Rambaldi
- Fatebenefratelli Isola Tiberina, Ospedale San Giovanni Calibita, Rome, Italy
- Amethyst Radioterapia Italia, Isola Tiberina, Rome, Italy
| | - Davide Cusumano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Greco
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Indovina
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sebastiano Menna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elisa Placidi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Stefania Teodoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Silvia Chiesa
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabio Marazzi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valeria Masiello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vincenzo Valentini
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco De Spirito
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luigi Azario
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Visak J, McGarry RC, Randall ME, Pokhrel D. Development and clinical validation of a robust knowledge-based planning model for stereotactic body radiotherapy treatment of centrally located lung tumors. J Appl Clin Med Phys 2020; 22:146-155. [PMID: 33285034 PMCID: PMC7856508 DOI: 10.1002/acm2.13120] [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: 07/09/2020] [Revised: 09/18/2020] [Accepted: 11/20/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To develop a robust and adaptable knowledge-based planning (KBP) model with commercially available RapidPlanTM for early stage, centrally located non-small-cell lung tumors (NSCLC) treated with stereotactic body radiotherapy (SBRT) and improve a patient's"simulation to treatment" time. METHODS The KBP model was trained using 86 clinically treated high-quality non-coplanar volumetric modulated arc therapy (n-VMAT) lung SBRT plans with delivered prescriptions of 50 or 55 Gy in 5 fractions. Another 20 independent clinical n-VMAT plans were used for validation of the model. KBP and n-VMAT plans were compared via Radiation Therapy Oncology Group (RTOG)-0813 protocol compliance criteria for conformity (CI), gradient index (GI), maximal dose 2 cm away from the target in any direction (D2cm), dose to organs-at-risk (OAR), treatment delivery efficiency, and accuracy. KBP plans were re-optimized with larger calculation grid size (CGS) of 2.5 mm to assess feasibility of rapid adaptive re-planning. RESULTS Knowledge-based plans were similar or better than n-VMAT plans based on a range of target coverage and OAR metrics. Planning target volume (PTV) for validation cases was 30.5 ± 19.1 cc (range 7.0-71.7 cc). KBPs provided an average CI of 1.04 ± 0.04 (0.97-1.11) vs. n-VMAT plan'saverage CI of 1.01 ± 0.04 (0.97-1.17) (P < 0.05) with slightly improved GI with KBPs (P < 0.05). D2cm was similar between the KBPs and n-VMAT plans. KBPs provided lower lung V10Gy (P = 0.003), V20Gy (P = 0.007), and mean lung dose (P < 0.001). KBPs had overall better sparing of OAR at the minimal increased of average total monitor units and beam-on time by 460 (P < 0.05) and 19.2 s, respectively. Quality assurance phantom measurement showed similar treatment delivery accuracy. Utilizing a CGS of 2.5 mm in the final optimization improved planning time (mean, 5 min) with minimal or no cost to the plan quality. CONCLUSION The RTOG-compliant adaptable RapidPlan model for early stage SBRT treatment of centrally located lung tumors was developed. All plans met RTOG dosimetric requirements in less than 30 min of planning time, potentially offering shorter "simulation to treatment" times. OAR sparing via KBPs may permit tumorcidal dose escalation with minimal penalties. Same day adaptive re-planning is plausible with a 2.5-mm CGS optimizer setting.
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Affiliation(s)
- Justin Visak
- Medical Physics Graduate Program, Department of Radiation Medicine, University Kentucky, Lexington, KY, USA
| | - Ronald C McGarry
- Medical Physics Graduate Program, Department of Radiation Medicine, University Kentucky, Lexington, KY, USA
| | - Marcus E Randall
- Medical Physics Graduate Program, Department of Radiation Medicine, University Kentucky, Lexington, KY, USA
| | - Damodar Pokhrel
- Medical Physics Graduate Program, Department of Radiation Medicine, University Kentucky, Lexington, KY, USA
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Visak J, Ge GY, McGarry RC, Randall M, Pokhrel D. An Automated knowledge-based planning routine for stereotactic body radiotherapy of peripheral lung tumors via DCA-based volumetric modulated arc therapy. J Appl Clin Med Phys 2020; 22:109-116. [PMID: 33270975 PMCID: PMC7856484 DOI: 10.1002/acm2.13114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/20/2020] [Accepted: 11/09/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To develop a knowledge‐based planning (KBP) routine for stereotactic body radiotherapy (SBRT) of peripherally located early‐stage non‐small‐cell lung cancer (NSCLC) tumors via dynamic conformal arc (DCA)‐based volumetric modulated arc therapy (VMAT) using the commercially available RapidPlanTM software. This proposed technique potentially improves plan quality, reduces complexity, and minimizes interplay effect and small‐field dosimetry errors associated with treatment delivery. Methods KBP model was developed and validated using 70 clinically treated high quality non‐coplanar VMAT lung SBRT plans for training and 20 independent plans for validation. All patients were treated with 54 Gy in three treatments. Additionally, a novel k‐DCA planning routine was deployed to create plans incorporating historical three‐dimensional‐conformal SBRT planning practices via DCA‐based approach prior to VMAT optimization in an automated planning engine. Conventional KBPs and k‐DCA plans were compared with clinically treated plans per RTOG‐0618 requirements for target conformity, tumor dose heterogeneity, intermediate dose fall‐off and organs‐at‐risk (OAR) sparing. Treatment planning time, treatment delivery efficiency, and accuracy were recorded. Results KBPs and k‐DCA plans were similar or better than clinical plans. Average planning target volume for validation was 22.4 ± 14.1 cc (7.1–62.3 cc). KBPs and k‐DCA plans provided similar conformity to clinical plans with average absolute differences of 0.01 and 0.01, respectively. Maximal doses to OAR were lowered in both KBPs and k‐DCA plans. KBPs increased monitor units (MU) on average 1316 (P < 0.001) while k‐DCA reduced total MU on average by 1114 (P < 0.001). This routine can create k‐DCA plan in less than 30 min. Independent Monte Carlo calculation demonstrated that k‐DCA plans showed better agreement with planned dose distribution. Conclusion A k‐DCA planning routine was developed in concurrence with a knowledge‐based approach for the treatment of peripherally located lung tumors. This method minimizes plan complexity associated with model‐based KBP techniques and improve plan quality and treatment planning efficiency.
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Affiliation(s)
- Justin Visak
- Medical Physics Graduate Program, Department of Radiation Medicine, University Kentucky, Lexington, KY, USA
| | - Gary Y Ge
- Medical Physics Graduate Program, Department of Radiation Medicine, University Kentucky, Lexington, KY, USA
| | - Ronald C McGarry
- Medical Physics Graduate Program, Department of Radiation Medicine, University Kentucky, Lexington, KY, USA
| | - Marcus Randall
- Medical Physics Graduate Program, Department of Radiation Medicine, University Kentucky, Lexington, KY, USA
| | - Damodar Pokhrel
- Medical Physics Graduate Program, Department of Radiation Medicine, University Kentucky, Lexington, KY, USA
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Castriconi R, Cattaneo GM, Mangili P, Esposito P, Broggi S, Cozzarini C, Deantoni C, Fodor A, Di Muzio NG, Vecchio AD, Fiorino C. Clinical Implementation of Knowledge-Based Automatic Plan Optimization for Helical Tomotherapy. Pract Radiat Oncol 2020; 11:e236-e244. [PMID: 33039673 DOI: 10.1016/j.prro.2020.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/07/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To implement knowledge-based (KB) automatic planning for helical TomoTherapy (HTT). The focus of the first clinical implementation was the case of high-risk prostate cancer, including pelvic node irradiation. METHODS AND MATERIALS One hundred two HTT clinical plans were selected to train a KB model using the RapidPlan tool incorporated in the Eclipse system (v13.6, Varian Inc). The individually optimized KB-based templates were converted into HTT-like templates and sent automatically to the HTT treatment planning system through scripting. The full dose calculation was set after 300 iterations without any additional planner intervention. Internal (20 patients in the training cohort) and external (28 new patients) validation were performed to assess the performance of the model: Automatic HTT plans (KB-TP) were compared against the original plans (TP) in terms of organs at risk and planning target volume (PTV) dose-volume parameters and by blinded clinical evaluation of 3 expert clinicians. RESULTS KB-TP plans were generally better than or equivalent to TP plans in both validation cohorts. A significant improvement in PTVs and rectum-PTV overlap dosimetry parameters were observed for both sets. Organ-at-risk sparing for KB-TP was slightly improved, which was more evident in the external validation group and for bladder and bowel. Clinical evaluation reported KB-TP to be better in 60% of cases and worse in 10% compared with TP (P < .05). CONCLUSIONS The fully KB-based automatic planning workflow was successfully implemented for HTT planning optimization in the case of high-risk patients with prostate cancer.
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Affiliation(s)
| | | | - Paola Mangili
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | | | - Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | | | - Chiara Deantoni
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Andrei Fodor
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | | | | | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
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Xu J, Wang J, Zhao F, Hu W, Yao G, Lu Z, Yan S. The benefits evaluation of abdominal deep inspiration breath hold based on knowledge-based radiotherapy treatment planning for left-sided breast cancer. J Appl Clin Med Phys 2020; 21:89-96. [PMID: 32918385 PMCID: PMC7592974 DOI: 10.1002/acm2.13013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To study the impact of abdominal deep inspiration breath hold (DIBH) technique on knowledge‐based radiotherapy treatment planning for left‐sided breast cancer to guide the application of DIBH technology. Materials and methods Two kernel density estimation (KDE) models were developed based on 40 left‐sided breast cancer patients with two CT acquisitions of free breathing (FB‐CT) and DIBH (DIBH‐CT). Each KDE model was used to predict dose volume histograms (DVHs) based on DIBH‐CT and FB‐CT for another 10 new patients similar to our training datasets. The predicted DVHs were taken as a substitute for dose constraints and objective functions in the Eclipse treatment planning system, with the same requirements for the planning target volume (PTV). The mean doses to the heart, the left anterior descending coronary artery (LADCA) and the ipsilateral lung were evaluated and compared using the T‐test among clinical plans, KDE predictions, and KDE plans. Results Our study demonstrated that the KDE model can generate deliverable simulations equivalent to clinically applicable plans. The T‐test was applied to test the consistency hypothesis on another ten left‐sided breast cancer patients. In cases of the same breathing status, there was no statistically significant difference between the predicted and the clinical plans for all clinically relevant DVH indices (P > 0.05), and all predicted DVHs can be transferred into deliverable plans. For DIBH‐CT images, significant differences were observed between FB model predictions and clinical plans (P < 0.05). DIBH model prediction cannot be optimized to a deliverable plan based on FB‐CT, with a counsel of perfection. Conclusion KDE models can predict DVHs well for the same breathing conditions but degrade with different breathing conditions. The benefits of DIBH for a given patient can be evaluated with a quick comparison of prediction results of the two models before treatment planning.
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Affiliation(s)
- Jiaqi Xu
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jiazhou Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Feng Zhao
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Guorong Yao
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhongjie Lu
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Senxiang Yan
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Marrazzo L, Arilli C, Pellegrini R, Bonomo P, Calusi S, Talamonti C, Casati M, Compagnucci A, Livi L, Pallotta S. Automated planning through robust templates and multicriterial optimization for lung VMAT SBRT of lung lesions. J Appl Clin Med Phys 2020; 21:114-120. [PMID: 32275353 PMCID: PMC7324702 DOI: 10.1002/acm2.12872] [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: 11/04/2019] [Revised: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose To develop and validate a robust template for VMAT SBRT of lung lesions, using the multicriterial optimization (MCO) of a commercial treatment planning system. Methods The template was established and refined on 10 lung SBRT patients planned for 55 Gy/5 fr. To improve gradient and conformity a ring structure around the planning target volume (PTV) was set in the list of objectives. Ideal fluence optimization was conducted giving priority to organs at risk (OARs) and using the MCO, which further pushes OARs doses. Segmentation was conducted giving priority to PTV coverage. Two different templates were produced with different degrees of modulation, by setting the Fluence Smoothing parameter to Medium (MFS) and High (HFS). Each template was applied on 20 further patients. Automatic and manual plans were compared in terms of dosimetric parameters, delivery time, and complexity. Statistical significance of differences was evaluated using paired two‐sided Wilcoxon signed‐rank test. Results No statistically significant differences in PTV coverage and maximum dose were observed, while an improvement was observed in gradient and conformity. A general improvement in dose to OARs was seen, which resulted to be significant for chest wall V30 Gy, total lung V20 Gy, and spinal cord D0.1 cc. MFS plans are characterized by a higher modulation and longer delivery time than manual plans. HFS plans have a modulation and a delivery time comparable to manual plans, but still present an advantage in terms of gradient. Conclusion The automation of the planning process for lung SBRT using robust templates and MCO was demonstrated to be feasible and more efficient.
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Affiliation(s)
- Livia Marrazzo
- Careggi University Hospital, Medical Physic Unit, Florence, Italy
| | - Chiara Arilli
- Careggi University Hospital, Medical Physic Unit, Florence, Italy
| | | | | | - Silvia Calusi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Cinzia Talamonti
- Careggi University Hospital, Medical Physic Unit, Florence, Italy.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Marta Casati
- Careggi University Hospital, Medical Physic Unit, Florence, Italy
| | | | - Lorenzo Livi
- Careggi University Hospital, Radiotherapy Unit, Florence, Italy.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Stefania Pallotta
- Careggi University Hospital, Medical Physic Unit, Florence, Italy.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
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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: 102] [Impact Index Per Article: 25.5] [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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Zhang J, Ge Y, Sheng Y, Wang C, Zhang J, Wu Y, Wu Q, Yin FF, Wu QJ. Knowledge-Based Tradeoff Hyperplanes for Head and Neck Treatment Planning. Int J Radiat Oncol Biol Phys 2020; 106:1095-1103. [PMID: 31982497 DOI: 10.1016/j.ijrobp.2019.12.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE To develop a tradeoff hyperplane model to facilitate tradeoff decision-making before inverse planning. METHODS AND MATERIALS We propose a model-based approach to determine the tradeoff hyperplanes that allow physicians to navigate the clinically viable space of plans with best achievable dose-volume parameters before planning. For a given case, a case reference set (CRS) is selected using a novel anatomic similarity metric from a large reference plan pool. Then, a regression model is built on the CRS to estimate the expected dose-volume histograms (DVHs) for the current case. This model also predicts the DVHs for all CRS cases and captures the variation from the corresponding DVHs in the clinical plans. Finally, these DVH variations are analyzed using the principal component analysis to determine the tradeoff hyperplane for the current case. To evaluate the effectiveness of the proposed approach, 244 head and neck cases were randomly partitioned into reference (214) and validation (30) sets. A tradeoff hyperplane was built for each validation case and evenly sampled for 12 tradeoff predictions. Each prediction yielded a tradeoff plan. The root-mean-square errors of the predicted and the realized plan DVHs were computed for prediction achievability evaluation. RESULTS The tradeoff hyperplane with 3 principal directions accounts for 57.8% ± 3.6% of variations in the validation cases, suggesting the hyperplanes capture a significant portion of the clinical tradeoff space. The average root-mean-square errors in 3 tradeoff directions are 5.23 ± 2.46, 5.20 ± 2.52, and 5.19 ± 2.49, compared with 4.96 ± 2.48 of the knowledge-based planning predictions, indicating that the tradeoff predictions are comparably achievable. CONCLUSIONS Clinically relevant tradeoffs can be effectively extracted from existing plans and characterized by a tradeoff hyperplane model. The hyperplane allows physicians and planners to explore the best clinically achievable plans with different organ-at-risk sparing goals before inverse planning and is a natural extension of the current knowledge-based planning framework.
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Affiliation(s)
- Jiahan Zhang
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Yaorong Ge
- College of Computing and Informatics, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Yang Sheng
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Chunhao Wang
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Jiang Zhang
- Medical Physics Graduate Program, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Yuan Wu
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Qiuwen Wu
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Q Jackie Wu
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
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Castriconi R, Fiorino C, Passoni P, Broggi S, Di Muzio NG, Cattaneo GM, Calandrino R. Knowledge-based automatic optimization of adaptive early-regression-guided VMAT for rectal cancer. Phys Med 2020; 70:58-64. [PMID: 31982788 DOI: 10.1016/j.ejmp.2020.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/10/2020] [Accepted: 01/15/2020] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To implement a knowledge-based (KB) optimization strategy to our adaptive (ART) early-regression guided boosting technique in neo-adjuvant radio-chemotherapy for rectal cancer. MATERIAL AND METHODS The protocol consists of a first phase delivering 27.6 Gy to tumor/lymph-nodes (2.3 Gy/fr-PTV1), followed by the ART phase concomitantly delivering 18.6 Gy (3.1 Gy/fr) and 13.8 Gy (2.3 Gy/fr) to the residual tumor (PTVART) and to PTV1 respectively. PTVART is obtained by expanding the residual GTV, as visible on MRI at fraction 9. Forty plans were used to generate a KB-model for the first phase using the RapidPlan tool. Instead of building a new model, a robust strategy scaling the KB-model to the ART phase was applied. Both internal and external validation were performed for both phases: all automatic plans (RP) were compared in terms of OARs/PTVs parameters against the original plans (RA). RESULTS The resulting automatic plans were generally better than or equivalent to clinical plans. Of note, V30Gy and V40Gy were significantly improved in RP plans for bladder and bowel; gEUD analysis showed improvement for KB-modality for all OARs, up to 3 Gy for the bowel. CONCLUSIONS The KB-model generated for the first phase was robust and it was also efficiently adapted to the ART phase. The performance of automatically generated plans were slightly better than the corresponding manual plans for both phases.
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Affiliation(s)
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy.
| | - Paolo Passoni
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
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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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Roy A, Cutright D, Gopalakrishnan M, Yeh AB, Mittal BB. A Risk-Adjusted Control Chart to Evaluate Intensity Modulated Radiation Therapy Plan Quality. Adv Radiat Oncol 2019; 5:1032-1041. [PMID: 33089020 PMCID: PMC7560572 DOI: 10.1016/j.adro.2019.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose This study aimed to develop a quality control framework for intensity modulated radiation therapy plan evaluations that can account for variations in patient- and treatment-specific risk factors. Methods and Materials Patient-specific risk factors, such as a patient's anatomy and tumor dose requirements, affect organs-at-risk (OARs) dose-volume histograms (DVHs), which in turn affects plan quality and can potentially cause adverse effects. Treatment-specific risk factors, such as the use of chemotherapy and surgery, are clinically relevant when evaluating radiation therapy planning criteria. A risk-adjusted control chart was developed to identify unusual plan quality after accounting for patient- and treatment-specific risk factors. In this proof of concept, 6 OAR DVH points and average monitor units serve as proxies for plan quality. Eighteen risk factors are considered for modeling quality: planning target volume (PTV) and OAR cross-sectional areas; volumes, spreads, and surface areas; minimum and centroid distances between OARs and the PTV; 6 PTV DVH points; use of chemotherapy; and surgery. A total of 69 head and neck cases were used to demonstrate the application of risk-adjusted control charts, and the results were compared with the application of conventional control charts. Results The risk-adjusted control chart remains robust to interpatient variations in the studied risk factors, unlike the conventional control chart. For the brainstem, the conventional chart signaled 4 patients with unusual (out-of-control) doses to 2% brainstem volume. However, the adjusted chart did not signal any plans after accounting for their risk factors. For the spinal cord doses to 2% brainstem volume, the conventional chart signaled 2 patients, and the adjusted chart signaled a separate patient after accounting for their risk factors. Similar adjustments were observed for the other DVH points when evaluating brainstem, spinal cord, ipsilateral parotid, and average monitor units. The adjustments can be directly attributed to the patient- and treatment-specific risk factors. Conclusions A risk-adjusted control chart was developed to evaluate plan quality, which is robust to variations in patient- and treatment-specific parameters.
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Affiliation(s)
- Arkajyoti Roy
- Department of Management Science and Statistics, University of Texas at San Antonio, San Antonio, Texas
| | - Dan Cutright
- Department of Radiation Oncology, University of Chicago Medical Center, Chicago, Illinois
| | - Mahesh Gopalakrishnan
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Arthur B Yeh
- Department of Applied Statistics and Operations Research, Bowling Green State University, Bowling Green, Ohio
| | - Bharat B Mittal
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Kubo K, Monzen H, Ishii K, Tamura M, Nakasaka Y, Kusawake M, Kishimoto S, Nakahara R, Matsuda S, Nakajima T, Kawamorita R. Inter-planner variation in treatment-plan quality of plans created with a knowledge-based treatment planning system. Phys Med 2019; 67:132-140. [PMID: 31706149 DOI: 10.1016/j.ejmp.2019.10.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE This study aimed to clarify the inter-planner variation of plan quality in knowledge-based plans created by nine planners. METHODS Five hypofractionated prostate-only (HPO) volumetric modulated arc therapy (VMAT) plans and five whole-pelvis (WP) VMAT plans were created by each planner using a knowledge-based planning (KBP) system. Nine planners were divided into three groups of three planners each: Senior, Junior, and Beginner. Single optimization with only priority modification for all objectives was performed to stay within the dose constraints. The coefficients of variation (CVs) for dosimetric parameters were evaluated, and a plan quality metric (PQM) was used to evaluate comprehensive plan quality. RESULTS Lower CVs (<0.05) were observed at dosimetric parameters in the planning target volume for both HPO and WP plans, while the CVs in the rectum and bladder for WP plans (<0.91) were greater than those for HPO plans (<0.17). The PQM values of HPO plans for Cases1-5 (average ± standard deviation) were 41.2 ± 7.1, 40.9 ± 5.6, and 39.9 ± 4.6 in the Senior, Junior, and Beginner groups, respectively. For the WP plans, the PQM values were 51.9 ± 6.3, 47.5 ± 4.3, and 40.0 ± 6.6, respectively. The number of clinically acceptable HPO and WP plans were 13/15 and 11/15 in the Senior group, 13/15 and 10/15 plans in the Junior group, and 8/15 and 2/15 plans in the Beginner group, respectively. CONCLUSION Inter-planner variation in the plan quality with RapidPlan remains, especially for the complicated VMAT plans, due to planners' heuristics.
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Affiliation(s)
- Kazuki Kubo
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi, Osaka 550-0025, Japan
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Ohno-higashi, Osaka-sayama, Osaka 589-8511, Japan.
| | - Kentaro Ishii
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi, Osaka 550-0025, Japan
| | - Mikoto Tamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Ohno-higashi, Osaka-sayama, Osaka 589-8511, Japan
| | - Yuta Nakasaka
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi, Osaka 550-0025, Japan
| | - Masayuki Kusawake
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi, Osaka 550-0025, Japan
| | - Shun Kishimoto
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi, Osaka 550-0025, Japan
| | - Ryuta Nakahara
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi, Osaka 550-0025, Japan
| | - Shogo Matsuda
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi, Osaka 550-0025, Japan
| | - Toshifumi Nakajima
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi, Osaka 550-0025, Japan
| | - Ryu Kawamorita
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi, Osaka 550-0025, Japan
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Xu H, Lu J, Wang J, Fan J, Hu W. Implement a knowledge-based automated dose volume histogram prediction module in Pinnacle 3 treatment planning system for plan quality assurance and guidance. J Appl Clin Med Phys 2019; 20:134-140. [PMID: 31343821 PMCID: PMC6698760 DOI: 10.1002/acm2.12689] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/18/2018] [Accepted: 07/08/2019] [Indexed: 11/16/2022] Open
Abstract
Purpose This work aims to develop a knowledge‐based automated dose volume histogram (DVH) prediction module that serves as a plan quality evaluation tool and treatment planning guidance in commercial Pinnacle3 treatment planning system (Philips Radiation Oncology Systems, Fitchburg, WI, USA). Methods The knowledge‐based automated DVH prediction module was developed with kernel density estimation (KDE) method and applied for Pinnacle3 treatment planning system. Treatment plan data from 20 esophageal cancer cases were used for creating a module to predict DVHs. Twenty additional esophageal clinical plans were evaluated on the developed module. Predicted DVHs were compared with manual ones. Differences between the predicted and achieved DVHs were analyzed. Results The plan evaluation module was successfully implemented in Pinnacle3 treatment planning system. Strong linear correlations were found between predicted and achieved DVH for organs at risk. Suboptimal treatment plan quality could be improved according to the predicted DVHs by the module. Conclusion The knowledge‐based automated DVH prediction module implemented in Pinnacle3 could be used to efficiently evaluate the treatment plan quality and as guidance for further plan optimization.
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Affiliation(s)
- Hao Xu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiayu Lu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiazhou Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiawei Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Zhang J, Ge Y, Sheng Y, Yin FF, Wu QJ. Modeling of multiple planning target volumes for head and neck treatments in knowledge-based treatment planning. Med Phys 2019; 46:3812-3822. [PMID: 31236943 DOI: 10.1002/mp.13679] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 11/06/2022] Open
Abstract
PURPOSE The purpose of this study is to develop an accurate and reliable dose volume histogram (DVH) prediction method for external beam radiation therapy plans with multiple planning target volumes (PTVs). MATERIALS AND METHODS We present a novel DVH prediction workflow, including new features and a modeling methodology, that makes better use of multiple PTVs: (a) We propose a generalized feature to characterize the geometric relationship of organ-at-risk (OARs) with respect to two or more PTVs with different prescribed dose levels; (b) We incorporate a novel data augmentation method to improve the data distribution in the feature space; (c) A similarity metric that leverages such information is subsequently used to select a subset of similar cases from the training dataset for model building; (d) Finally, a DVH prediction model is trained with these selected cases. To evaluate this new modeling workflow, we used 120 head and neck (HN) cases to tune the model, and used a separate dataset consisting of 148 cases for validation. The proposed model has been compared with the conventional knowledge-based model in terms of model prediction accuracy, which was measured by the root mean squared error (RMSE) between the predicted DVHs and the actual clinical plan DVHs. Furthermore, 25 randomly selected plans were replanned guided by the proposed model and evaluated against clinical plans using clinical evaluation criteria. RESULTS The proposed modeling workflow significantly improved DVH prediction accuracy for brainstem (P < 0.001), cord (P < 0.001), larynx (P = 0.004), mandible (P < 0.001), oral cavity (P = 0.011), parotid (P < 0.001) and pharynx (P = 0.001). Cases replanned with the guidance of the proposed model spared OARs significantly better by clinical evaluation criteria. The replanned cases showed a 15% increase in the number of satisfied criteria, compared with clinical plans. CONCLUSIONS The proposed modeling workflow generates DVH predictions with improved accuracy and robustness when multiple PTVs exist in a plan. It has demonstrated that the improvement in the DVH prediction model translates into better plan quality in knowledge-based planning.
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Affiliation(s)
- Jiahan Zhang
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Yaorong Ge
- Department of Software and Information Systems, University of North Carolina at Charlotte, Charlotte, NC, 28223, USA
| | - Yang Sheng
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Q Jackie Wu
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, 27710, USA
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Villaggi E, Hernandez V, Fusella M, Moretti E, Russo S, Vaccara EML, Nardiello B, Esposito M, Saez J, Cilla S, Marino C, Stasi M, Mancosu P. Plan quality improvement by DVH sharing and planner's experience: Results of a SBRT multicentric planning study on prostate. Phys Med 2019; 62:73-82. [PMID: 31153401 DOI: 10.1016/j.ejmp.2019.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/12/2019] [Accepted: 05/02/2019] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To evaluate, in a multi-institutional context, the role of Dose Volume Histogram (DVH) sharing in order to achieve higher plan quality, to harmonize prostate Stereotactic Body Radiation Therapy (SBRT) plans and to assess if the planner's experience in SBRT could lead to lower dose at organs at risk (OARs). METHODS During the first phase five patients enrolled for prostate SBRT were planned by multiple physicists according to common protocol. The prescription dose was 35 Gy in 5 fractions. Dosimetric parameters, modulation index (MIt), plan parameters, and planner experience level (EL) were statistically analyzed. During the second phase median DVHs from all centers were shared and physicists replanned one patient of the five, aiming at inter-planner harmonization and further OARs sparing. Data were summarized by Spearman-correlogram (p < 0.05) and boxplots. The Kruskal-Wallis test was used to compare the re-plans to the original plans. RESULTS Seventy-eight SBRT plans from 13 centers were evaluated. EL correlated with modulation of plan parameters and reduction of OARs doses, such as volume receiving 28 Gy of rectum (rectum-V28Gy), rectum-V32Gy, and bladder-V30Gy. The re-plans showed significant reduced variability in rectum-V28Gy and increased PTV dose homogeneity. No significant difference in plan complexity metrics and plan parameters between plans and re-plans were obtained. CONCLUSIONS Planner's experience in prostate SBRT was correlated with dosimetric parameters. Sharing median DVHs reduced variability among centers whilst keeping the same level of plan complexity. SBRT planning skills can benefit from a replanning phase after sharing DVHs from multiple centers, improving plan quality and concordance among centers.
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Affiliation(s)
- Elena Villaggi
- Medical Physics Unit, Azienda Unità Sanitaria Locale di Piacenza, Italy.
| | - Victor Hernandez
- Hospital Universitari Sant Joan de Reus, Department of Medical Physics, Tarragona, Spain
| | - Marco Fusella
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Eugenia Moretti
- Department of Medical Physics, Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | - Serenella Russo
- Medical Physics Unit, Azienda USL Toscana Centro, Firenze I-50012, Italy
| | | | | | - Marco Esposito
- Medical Physics Unit, Azienda USL Toscana Centro, Firenze I-50012, Italy
| | - Jordi Saez
- Hospital Clinic de Barcelona, Department of Radiation Oncology, Barcelona, Spain
| | - Savino Cilla
- Medical Physics Unit, Fondazione di Ricerca e Cura "Giovanni Paolo II", Campobasso, Italy
| | | | - Michele Stasi
- Department of Medical Physics, Azienda Ospedaliera Ordine Mauriziano di Torino, Turin, Italy
| | - Pietro Mancosu
- Medical Physics Unit of Radiation Oncology Dept., Humanitas Research Hospital, Milano, Italy
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Zhang J, Wu QJ, Ge Y, Wang C, Sheng Y, Palta J, Salama JK, Yin FF, Zhang J. Knowledge-Based Statistical Inference Method for Plan Quality Quantification. Technol Cancer Res Treat 2019; 18:1533033819857758. [PMID: 31221025 PMCID: PMC6589991 DOI: 10.1177/1533033819857758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: The aim of the study is to develop a geometrically adaptive and statistically robust plan quality inference method. Methods and Materials: We propose a knowledge-based plan quality inference method that references to similar plans in the historical database for patient-specific plan quality evaluation. First, a novel plan similarity metric with high-dimension geometrical difference quantification is utilized to retrieve similar plans. Subsequently, dosimetric statistical inferences are obtained from the selected similar plans. Two plan quality metrics—dosimetric result probability and dose deviation index—are proposed to quantify plan quality among prior similar plans. To evaluate the performance of the proposed method, we exported 927 clinically approved head and neck treatment plans. Eight organs at risk, including brain stem, cord, larynx, mandible, pharynx, oral cavity, left parotid and right parotid, were analyzed. Twelve suboptimal plans identified by dosimetric result probability were replanned to validate the capability of the proposed methods in identifying inferior plans. Results: After replanning, left and right parotid median doses are reduced by 31.7% and 18.2%, respectively; 83% of these cases would not be identified as suboptimal without the proposed similarity plan selection. Analysis of population plan quality reveals that average parotid sparing has been improving significantly over time (21.7% dosimetric result probability reduction from year 2006-2007 to year 2016-2017). Notably, the increasing dose sparing over time in retrospective plan quality analysis is strongly correlated with the increasing dose prescription ratios to the 2 planning targets, revealing the collective trend in planning conventions. Conclusions: The proposed similar plan retrieval and analysis methodology has been proven to be predictive of the current plan quality. Therefore, the proposed workflow can potentially be applied in the clinics as a real-time plan quality assurance tool. The proposed metrics can also serve the purpose of plan quality analytics in finding connections and historical trends in the clinical treatment planning workflow.
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Affiliation(s)
- Jiang Zhang
- 1 Division of Medical Physics, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Q Jackie Wu
- 2 Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Yaorong Ge
- 3 College of Computing and Informatics, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Chunhao Wang
- 2 Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Yang Sheng
- 2 Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Jatinder Palta
- 4 Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - Joseph K Salama
- 2 Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Fang-Fang Yin
- 2 Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Jiahan Zhang
- 2 Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
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Marrazzo L, Meattini I, Arilli C, Calusi S, Casati M, Talamonti C, Livi L, Pallotta S. Auto-planning for VMAT accelerated partial breast irradiation. Radiother Oncol 2018; 132:85-92. [PMID: 30825975 DOI: 10.1016/j.radonc.2018.11.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 11/11/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the quality of accelerated partial breast irradiation (APBI) plans generated by the Auto-Planning module of a commercial treatment planning system (TPS). MATERIAL AND METHODS Twenty patients, previously planned and treated with manual planning in a TPS (manM), were re-planned using manual (manP) and automatic (AP) module of a different TPS. Plans were compared in terms of dosimetric parameters, degree of modulation, monitor units and treatment time, and by blind qualitative scoring by a physician. Dosimetric verification was evaluated in terms of γ passing rate and point dose measurements. Statistical differences were evaluated using paired two-sided Wilcoxon's signed-rank test. RESULTS A statistically significant improvement in PTV coverage was observed for AP plans compared to clinical plans, while no differences in organs at risk doses were observed. When compared to manP plans, a statistically significant improvement was observed for PTV coverage and homogeneity and for the ipsilateral breast and lung dosimetric parameters. The modulation degree was reduced with AP compared to manM treatment plans, while it was increased compared to manP treatment plans. No differences were observed in γ passing rate. Planning time was reduced from (54.5 ± 8.0) min for manM planning and (62.8 ± 15.0) min for manP planning to (9.8 ± 1.1) min for AP. In the qualitative scoring, AP plans were considered superior both to manM (10/20 cases) and manP plans (12/20 cases) with high clinical relevance. CONCLUSION Automatic planning for VMAT APBI was always at least equivalent and overall superior to manual planning.
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Affiliation(s)
- Livia Marrazzo
- Medical Physic Unit, Azienda Ospedaliero - Universitaria Careggi, Florence, Italy.
| | - Icro Meattini
- Radiation Oncology Unit, Azienda Ospedaliero - Universitaria Careggi, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Chiara Arilli
- Medical Physic Unit, Azienda Ospedaliero - Universitaria Careggi, Florence, Italy
| | - Silvia Calusi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Marta Casati
- Medical Physic Unit, Azienda Ospedaliero - Universitaria Careggi, Florence, Italy
| | - Cinzia Talamonti
- Medical Physic Unit, Azienda Ospedaliero - Universitaria Careggi, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliero - Universitaria Careggi, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Stefania Pallotta
- Medical Physic Unit, Azienda Ospedaliero - Universitaria Careggi, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
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Castriconi R, Fiorino C, Broggi S, Cozzarini C, Di Muzio N, Calandrino R, Cattaneo GM. Comprehensive Intra-Institution stepping validation of knowledge-based models for automatic plan optimization. Phys Med 2018; 57:231-237. [PMID: 30545736 DOI: 10.1016/j.ejmp.2018.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/23/2018] [Accepted: 12/05/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To develop and apply a stepping approach for the validation of Knowledge-based (KB) models for planning optimization: the method was applied to the case of concomitant irradiation of pelvic nodes and prostate + seminal-vesicles bed irradiation in post-prostatectomy patients. METHODS The clinical VMAT plans of 52 patients optimized by two reference planners were selected to generate a KB-model (RapidPlan, v.13.5 Varian). A stepping-validation approach was followed by comparing KB-generated plans (with and without planner-interaction, RP and only-RP respectively) against delivered clinical plans (RA). The validation followed three steps, gradually extending its generalization: 20 patients used to develop the model (closed-loop); 20 new patients, same planners (open-loop); 20 new patients, different planners (wide-loop). All plans were compared, in terms of relevant dose-volume parameters and generalized equivalent uniform dose (gEUD). RESULTS KB-plans were generally better than or equivalent to clinical plans. For RPvsRA, PTVs coverage was comparable, for OARs RP was always better. Comparing only-RPvsRA, PTVs coverage was always better; bowel\bladder V50Gy and D1%, bowel\bladder\rectum Dmean, femoral heads V40Gy and penile bulb V50Gy were significantly improved. For RPvsRA gEUD reduction >1 Gy was seen in 80% of plans for rectum, bladder and bowel; for only-RPvsRA, this was found in 50% for rectum/bladder and in 70% for bowel. CONCLUSION An extensive stepping validation approach of KB-model for planning optimization showed better or equal performances of automatically generated KB-plan compared to clinical plans. The interaction of a planner further improved planning performances.
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Affiliation(s)
- R Castriconi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy.
| | - C Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - S Broggi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - C Cozzarini
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - N Di Muzio
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - R Calandrino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - G M Cattaneo
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
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Delaney AR, Verbakel WF, Lindberg J, Koponen TK, Slotman BJ, Dahele M. Evaluation of an Automated Proton Planning Solution. Cureus 2018; 10:e3696. [PMID: 30788187 PMCID: PMC6372253 DOI: 10.7759/cureus.3696] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/05/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose Intensity-modulated proton therapy (IMPT) treatments are increasing, however, treatment planning remains complex and prone to variability. RapidPlanTMPT (Varian Medical Systems, Palo Alto, California, USA) is a pre-clinical, proton-specific, automated knowledge-based planning solution which could reduce variability and increase efficiency. It uses a library of previous IMPT treatment plans to generate a model which can predict organ-at-risk (OAR) dose for new patients, and guide IMPT optimization. This study details and evaluates RapidPlanTMPT. Methods IMPT treatment plans for 50 head-and-neck cancer patients populated the model-library. The model was then used to create knowledge-based plans (KBPs) for 10 evaluation-patients. Model quality and accuracy were evaluated using model-provided OAR regression plots and examining the difference between predicted and achieved KBP mean dose. KBP quality was assessed through comparison with respective manual IMPT plans on the basis of boost/elective planning target volume (PTVB/PTVE) homogeneity and OAR sparing. The time to create KBPs was recorded. Results Model quality was good, with an average R2 of 0.85 between dosimetric and geometric features. The model showed high predictive accuracy with differences of <3 Gy between predicted and achieved OAR mean doses for 88/109 OARs. On average, KBPs were comparable to manual IMPT plans with differences of <0.6% in homogeneity. Only 2 of 109 OARs in KBPs had a mean dose >3 Gy more than the manual plan. On average, dose-volume histogram (DVH) predictions required 0.7 minutes while KBP optimization and dose calculation required 4.1 minutes (a 'continue optimization' phase, if required, took an additional 2.8 minutes, on average). Conclusions RapidPlanTMPT demonstrated efficiency and consistency and IMPT KBPs were comparable to manual plans. Because worse OAR sparing in a KBP was not always associated with geometric-outlier warnings, manual plan checks remain important. Such an automated planning solution could also assist in clinical trial quality assurance and overcome the learning curve associated with IMPT.
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Affiliation(s)
| | - Wilko F Verbakel
- Radiation Oncology, VU University Medical Center, Amsterdam, NLD
| | - Jari Lindberg
- Miscellaneous, Varian Medical Systems, Helsinki, FIN
| | | | - Ben J Slotman
- Radiation Oncology, VU University Medical Center, Amsterdam, NLD
| | - Max Dahele
- Radiation Oncology, VU University Medical Center, Amsterdam, NLD
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Rossi L, Sharfo AW, Aluwini S, Dirkx M, Breedveld S, Heijmen B. First fully automated planning solution for robotic radiosurgery - comparison with automatically planned volumetric arc therapy for prostate cancer. Acta Oncol 2018; 57:1490-1498. [PMID: 29966472 DOI: 10.1080/0284186x.2018.1479068] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND For conventional radiotherapy treatment units, automated planning can significantly improve plan quality. For robotic radiosurgery, systems for automatic generation of clinically deliverable plans do not yet exist. For prostate stereotactic body radiation therapy (SBRT), few studies have systematically compared VMAT with robotic treatment. MATERIAL AND METHODS The multi-criteria autoplanning optimizer, developed at our institute, was coupled to the commercial treatment planning system of our robotic treatment unit, for fully automated generation of clinically deliverable plans (autoROBOT). The system was then validated by comparing autoROBOT plans with manually generated plans. Next, the autoROBOT system was used for systematic comparisons between autoROBOT plans and VMAT plans, that were also automatically generated (autoVMAT). CTV-PTV margins of 3 mm were used for autoROBOT (clinical routine) and autoVMAT plan generation. For autoVMAT, an extra plan was generated with 5 mm margin (often applied for VMAT). Plans were generated for a 4 × 9.5 Gy fractionation scheme. RESULTS Compared to manual planning, autoROBOT improved rectum D[Formula: see text] (16%), V[Formula: see text] (75%) and D[Formula: see text] (41%), and bladder D[Formula: see text] (37%) (all p [Formula: see text] .002), with equal PTV coverage. In the autoROBOT and autoVMAT comparison, both with 3 mm margin, rectum doses were lower for autoROBOT by 5% for rectum D[Formula: see text] (p=.002), 33% for V[Formula: see text] (p=.001) and 4% for D[Formula: see text] (p=.05), with comparable PTV coverage and other OAR sparing. With 5 mm margin for VMAT, 18/20 plans had a PTV coverage lower than requested (<95%) and all plans had higher rectum doses than autoROBOT (mean percentage differences of 13% for D[Formula: see text], 69% for V[Formula: see text] and 32% for D[Formula: see text] (all p<.001)). CONCLUSIONS The first system for fully automated generation of clinically deliverable robotic plans was built. Autoplanning did largely enhance robotic plan quality, compared to manual planning. Using autoplanning for both the robotic system and VMAT, superiority of non-coplanar robotic treatment compared to coplanar VMAT for prostate SBRT was demonstrated.
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Affiliation(s)
- Linda Rossi
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Abdul Wahab Sharfo
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Shafak Aluwini
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Maarten Dirkx
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Sebastiaan Breedveld
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ben Heijmen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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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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Lin YH, Hong LX, Hunt MA, Berry SL. Use of a constrained hierarchical optimization dataset enhances knowledge-based planning as a quality assurance tool for prostate bed irradiation. Med Phys 2018; 45:4364-4369. [PMID: 30168160 DOI: 10.1002/mp.13163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 05/15/2018] [Accepted: 08/21/2018] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To investigate whether building a knowledge-based planning (KBP) model with prostate bed plans constructed from constrained hierarchical optimization (CHO) would result in more efficient model construction with more consistent output than a model built using plans from a traditional, trial-and-error-based optimization (TEO) technique. METHODS Three KBP models were constructed from plans from subsets of 58 post-prostatectomy patients treated with intensity-modulated radiation therapy. TEO54 was built from 54 TEO plans, selected to represent typical clinical variations in target and organ-at-risk sizes and shapes. CHO30 and TEO30 were built from the same 30 patients populated with CHO and TEO plans, respectively. The three models were each applied to a new set of 18 patient scans and dose-volume histogram estimates (DVHEs) were generated for rectal and bladder walls and compared for each patient. RESULTS CHO30 resulted in a significantly tighter range in DVHEs (P < 0.01) for both the rectal and bladder walls compared with either of the TEO models, indicating less uncertainty in the dose estimation. Plans resulting from KBP optimization using each model were very similar. CONCLUSION Populating a KBP model with CHO data resulted in a high quality model. Since CHO plans can be generated automatically offline in a process that necessitates little to no user interaction, a CHO-KBP model can quickly adapt to changes in plan evaluation criteria or planning techniques without the need to wait to accrue sufficient numbers of clinical TEO plans. This may facilitate the use of KBP approaches for initial or ongoing quality assurance procedures and plan quality audits.
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Affiliation(s)
- Yen Hwa Lin
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Linda X Hong
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Margie A Hunt
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Sean L Berry
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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Scaggion A, Fusella M, Roggio A, Bacco S, Pivato N, Rossato MA, Peña LMA, Paiusco M. Reducing inter- and intra-planner variability in radiotherapy plan output with a commercial knowledge-based planning solution. Phys Med 2018; 53:86-93. [PMID: 30241759 DOI: 10.1016/j.ejmp.2018.08.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 08/01/2018] [Accepted: 08/15/2018] [Indexed: 02/02/2023] Open
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Wang M, Li S, Huang Y, Yue H, Li T, Wu H, Gao S, Zhang Y. An interactive plan and model evolution method for knowledge-based pelvic VMAT planning. J Appl Clin Med Phys 2018; 19:491-498. [PMID: 29984464 PMCID: PMC6123168 DOI: 10.1002/acm2.12403] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 05/07/2018] [Accepted: 06/05/2018] [Indexed: 12/21/2022] Open
Abstract
Purpose To test if a RapidPlan DVH estimation model and its training plans can be improved interactively through a closed‐loop evolution process. Methods and materials Eighty‐one manual plans (P0) that were used to configure an initial rectal RapidPlan model (M0) were reoptimized using M0 (closed‐loop), yielding 81 P1 plans. The 75 improved P1 (P1+) and the remaining 6 P0 were used to configure model M1. The 81 training plans were reoptimized again using M1, producing 23 P2 plans that were superior to both their P0 and P1 forms (P2+). Hence, the knowledge base of model M2 composed of 6 P0, 52 P1+, and 23 P2+. Models were tested dosimetrically on 30 VMAT validation cases (Pv) that were not used for training, yielding Pv(M0), Pv(M1), and Pv(M2) respectively. The 30 Pv were also optimized by M2_new as trained by the library of M2 and 30 Pv(M0). Results Based on comparable target dose coverage, the first closed‐loop reoptimization significantly (P < 0.01) reduced the 81 training plans’ mean dose to femoral head, urinary bladder, and small bowel by 2.65 Gy/15.63%, 2.06 Gy/8.11%, and 1.47 Gy/6.31% respectively, which were further reduced significantly (P < 0.01) in the second closed‐loop reoptimization by 0.04 Gy/0.28%, 0.18 Gy/0.77%, 0.22 Gy/1.01% respectively. However, open‐loop VMAT validations displayed more complex and intertwined plan quality changes: mean dose to urinary bladder and small bowel decreased monotonically using M1 (by 0.34 Gy/1.47%, 0.25 Gy/1.13%) and M2 (by 0.36 Gy/1.56%, 0.30 Gy/1.36%) than using M0. However, mean dose to femoral head increased by 0.81 Gy/6.64% (M1) and 0.91 Gy/7.46% (M2) than using M0. The overfitting problem was relieved by applying model M2_new. Conclusions The RapidPlan model and its constituent plans can improve each other interactively through a closed‐loop evolution process. Incorporating new patients into the original training library can improve the RapidPlan model and the upcoming plans interactively.
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Affiliation(s)
- Meijiao Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Beijing Cancer Hospital & Institute, Peking University Cancer Hospital & Institute, Beijing, China
| | - Sha Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Beijing Cancer Hospital & Institute, Peking University Cancer Hospital & Institute, Beijing, China.,Department of Medical Physics, Institute of Medical Humanities, Peking University, Beijing, China
| | - Yuliang Huang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Beijing Cancer Hospital & Institute, Peking University Cancer Hospital & Institute, Beijing, China
| | - Haizhen Yue
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Beijing Cancer Hospital & Institute, Peking University Cancer Hospital & Institute, Beijing, China
| | - Tian Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Beijing Cancer Hospital & Institute, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hao Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Beijing Cancer Hospital & Institute, Peking University Cancer Hospital & Institute, Beijing, China
| | - Song Gao
- Department of Medical Physics, Institute of Medical Humanities, Peking University, Beijing, China
| | - Yibao Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Beijing Cancer Hospital & Institute, Peking University Cancer Hospital & Institute, Beijing, China.,Beijing City Key Lab for Medical Physics and Engineering, School of Physics, Institute of Heavy Ion Physics, Peking University, Beijing, China
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Huang Y, Yue H, Wang M, Li S, Zhang J, Liu Z, Zhang Y. Fully automated searching for the optimal VMAT jaw settings based on Eclipse Scripting Application Programming Interface (ESAPI) and RapidPlan knowledge-based planning. J Appl Clin Med Phys 2018; 19:177-182. [PMID: 29577614 PMCID: PMC5978713 DOI: 10.1002/acm2.12313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 01/25/2018] [Accepted: 02/21/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Eclipse treatment planning system has not been able to optimize the jaw positions for Volumetric Modulated Arc Therapy (VMAT). The arbitrary and planner-dependent jaw placements define the maximum field size within which multi-leaf-collimator (MLC) sequences can be optimized to modulate the beam. Considering the mechanical constraints of MLC transitional speed and range, suboptimal X jaw settings may impede the optimization or undermine the deliverability. This work searches optimal VMAT jaw settings automatically based on Eclipse Scripting Application Programming Interface (ESAPI) and RapidPlan knowledge-based planning. METHODS AND MATERIALS Using an ESAPI script, the X jaws of rectal VMAT plans were initially set to conform the planning-target-volume (PTV), and were gradually extended toward the isocenter (PTV center) in 5-7 mm increments. Using these jaw pairs, 592 plans were automatically created for 10 patients and quantitatively evaluated using a comprehensive scoring function. A published RapidPlan model was evoked by ESAPI to generate patient-specific optimization objectives without manual intervention. All candidate plans were first stored as text files to save storage space, and only the best, worst, and conformal plans were consequently recreated for comparison. RESULTS Although RapidPlan estimates dose-volume histogram (DVH) based on individual anatomy, the geometry-based expected dose (GED) algorithm does not recognize different jaw settings but uses PTV-conformal jaws as default; hence, identical DVHs were observed regardless of planner-defined jaws. Therefore, ESAPI finalized dose-volume calculation and eliminated the plans with unacceptable hotspots before comparison. The plan quality varied dramatically with different jaw settings. Trade-offs among different organs-at-risk (OARs) were collectively considered by the proposed scoring method, which identified the best and worst plans correctly. The plans using conformal jaws were neither the best nor the worst of all candidates. CONCLUSIONS VMAT plans using optimal jaw locations can be created automatically using ESAPI and RapidPlan. Conformal jaws are not the optimal choice.
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Affiliation(s)
- Yuliang Huang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)Department of Radiation OncologyPeking University Cancer Hospital & InstituteBeijing Cancer Hospital & Institute BeijingBeijingChina
| | - Haizhen Yue
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)Department of Radiation OncologyPeking University Cancer Hospital & InstituteBeijing Cancer Hospital & Institute BeijingBeijingChina
| | - Meijiao Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)Department of Radiation OncologyPeking University Cancer Hospital & InstituteBeijing Cancer Hospital & Institute BeijingBeijingChina
| | - Sha Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)Department of Radiation OncologyPeking University Cancer Hospital & InstituteBeijing Cancer Hospital & Institute BeijingBeijingChina
- Department of Medical PhysicsSchool of Foundational Education & Institute of Medical HumanitiesPeking University Health Science CenterBeijingChina
| | - Jian Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)Department of Radiation OncologyPeking University Cancer Hospital & InstituteBeijing Cancer Hospital & Institute BeijingBeijingChina
| | - Zhuolun Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)Department of Radiation OncologyPeking University Cancer Hospital & InstituteBeijing Cancer Hospital & Institute BeijingBeijingChina
| | - Yibao Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)Department of Radiation OncologyPeking University Cancer Hospital & InstituteBeijing Cancer Hospital & Institute BeijingBeijingChina
- Beijing City Key Lab for Medical Physics and EngineeringInstitute of Heavy Ion PhysicsSchool of PhysicsPeking UniversityBeijingChina
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Yu G, Li Y, Feng Z, Tao C, Yu Z, Li B, Li D. Knowledge-based IMRT planning for individual liver cancer patients using a novel specific model. Radiat Oncol 2018; 13:52. [PMID: 29587782 PMCID: PMC5870074 DOI: 10.1186/s13014-018-0996-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/09/2018] [Indexed: 12/31/2022] Open
Abstract
Background The purpose of this work is to benchmark RapidPlan against clinical plans for liver Intensity-modulated radiotherapy (IMRT) treatment of patients with special anatomical characteristics, and to investigate the prediction capability of the general model (Model-G) versus our specific model (Model-S). Methods A library consisting of 60 liver cancer patients with IMRT planning was used to set up two models (Model-S, Model-G), using the RapidPlan knowledge-based planning system. Model-S consisted of 30 patients with special anatomical characteristics where the distance from planning target volume (PTV) to the right kidney was less than three centimeters and Model-G was configurated using all 60 patients in this library. Knowledge-based IMRT plans were created for the evaluation group formed of 13 patients similar to those included in Model-S by Model-G, Model-S and manually (M), named RPG-plans, RPS-plans and M-plans, respectively. The differences in the dose-volume histograms (DVHs) were compared, not only between RP-plans and their respective M-plans, but also between RPG-plans and RPS-plans. Results For all 13 patients, RapidPlan could automatically produce clinically acceptable plans. Comparing RP-plans to M-plans, RP-plans improved V95% of PTV and had greater dose sparing in the right kidney. For the normal liver, RPG-plans delivered similar doses, while RPS-plans delivered a higher dose than M-plans. With respect to RapidPlan models, RPS-plans had better conformity index (CI) values and delivered lower doses to the right kidney V20Gy and maximizing point doses to spinal cord, while delivering higher doses to the normal liver. Conclusion The study shows that RapidPlan can create high-quality plans, and our specific model can improve the CI of PTV, resulting in more sparing of OAR in IMRT for individual liver cancer patients.
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Affiliation(s)
- Gang Yu
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, School of Physics and Electronics, Shandong Normal University, No.88, Wenhua East Road, Lixia District, Jinan, Shandong, 250014, China
| | - Yang Li
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, School of Physics and Electronics, Shandong Normal University, No.88, Wenhua East Road, Lixia District, Jinan, Shandong, 250014, China
| | - Ziwei Feng
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, School of Physics and Electronics, Shandong Normal University, No.88, Wenhua East Road, Lixia District, Jinan, Shandong, 250014, China
| | - Cheng Tao
- Shandong Medical Imaging and Radiotherapy Engineering Research Center, Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, 250014, People's Republic of China
| | - Zuyi Yu
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, School of Physics and Electronics, Shandong Normal University, No.88, Wenhua East Road, Lixia District, Jinan, Shandong, 250014, China
| | - Baosheng Li
- Shandong Medical Imaging and Radiotherapy Engineering Research Center, Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, 250014, People's Republic of China.
| | - Dengwang Li
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, School of Physics and Electronics, Shandong Normal University, No.88, Wenhua East Road, Lixia District, Jinan, Shandong, 250014, China.
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Zhang J, Wu QJ, Xie T, Sheng Y, Yin FF, Ge Y. An Ensemble Approach to Knowledge-Based Intensity-Modulated Radiation Therapy Planning. Front Oncol 2018; 8:57. [PMID: 29616187 PMCID: PMC5868365 DOI: 10.3389/fonc.2018.00057] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/21/2018] [Indexed: 11/23/2022] Open
Abstract
Knowledge-based planning (KBP) utilizes experienced planners’ knowledge embedded in prior plans to estimate optimal achievable dose volume histogram (DVH) of new cases. In the regression-based KBP framework, previously planned patients’ anatomical features and DVHs are extracted, and prior knowledge is summarized as the regression coefficients that transform features to organ-at-risk DVH predictions. In our study, we find that in different settings, different regression methods work better. To improve the robustness of KBP models, we propose an ensemble method that combines the strengths of various linear regression models, including stepwise, lasso, elastic net, and ridge regression. In the ensemble approach, we first obtain individual model prediction metadata using in-training-set leave-one-out cross validation. A constrained optimization is subsequently performed to decide individual model weights. The metadata is also used to filter out impactful training set outliers. We evaluate our method on a fresh set of retrospectively retrieved anonymized prostate intensity-modulated radiation therapy (IMRT) cases and head and neck IMRT cases. The proposed approach is more robust against small training set size, wrongly labeled cases, and dosimetric inferior plans, compared with other individual models. In summary, we believe the improved robustness makes the proposed method more suitable for clinical settings than individual models.
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Affiliation(s)
- Jiahan Zhang
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States
| | - Q Jackie Wu
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States
| | - Tianyi Xie
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States
| | - Yang Sheng
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States
| | - Yaorong Ge
- Department of Software and Information Systems, University of North Carolina at Charlotte, Charlotte, NC, United States
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Younge KC, Marsh RB, Owen D, Geng H, Xiao Y, Spratt DE, Foy J, Suresh K, Wu QJ, Yin FF, Ryu S, Matuszak MM. Improving Quality and Consistency in NRG Oncology Radiation Therapy Oncology Group 0631 for Spine Radiosurgery via Knowledge-Based Planning. Int J Radiat Oncol Biol Phys 2018; 100:1067-1074. [PMID: 29485048 DOI: 10.1016/j.ijrobp.2017.12.276] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/14/2017] [Accepted: 12/19/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE To use knowledge-based planning (KBP) as a method of producing high-quality, consistent, protocol-compliant treatment plans in a complex setting of spine stereotactic body radiation therapy on NRG Oncology Radiation Therapy Oncology Group (RTOG) 0631. METHODS AND MATERIALS An internally developed KBP model was applied to an external validation cohort of 22 anonymized cases submitted under NRG Oncology RTOG 0631. The original and KBP plans were compared via their protocol compliance, target conformity and gradient index, dose to critical structures, and dose to surrounding normal tissues. RESULTS The KBP model generated plans meeting all protocol objectives in a single optimization when tested on both internal and protocol-submitted NRG Oncology RTOG 0631 cases. Two submitted plans that were considered to have a protocol-unacceptable deviation were made protocol compliant through the use of the model. There were no statistically significant differences in protocol spinal cord metrics (D10% and D0.03cc) between the manually optimized plans and the KBP plans. The volume of planning target volume receiving prescription dose increased from 93.3% ± 3.2% to 98.3% ± 1.4% (P = .01) when using KBP. High-dose spillage to surrounding normal tissues (V105%) showed no significant differences (2.1 ± 7.3 cm3 for manual plans to 1.8 ± 0.6 cm3 with KBP), and dosimetric outliers with large amounts of spillage were eliminated through the use of KBP. Knowledge-based planning plans were also found to be significantly more consistent in several metrics, including target coverage and high dose outside of the target. CONCLUSION Incorporation of KBP models into the clinical trial setting may have a profound impact on the quality of trial results, owing to the increase in consistency and standardization of planning, especially for treatment sites or techniques that are nonstandard.
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Affiliation(s)
- Kelly C Younge
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
| | - Robin B Marsh
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Dawn Owen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Huaizhi Geng
- Imaging and Radiation Oncology Core Group, Philadelphia, Pennsylvania
| | - Ying Xiao
- Imaging and Radiation Oncology Core Group, Philadelphia, Pennsylvania
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Joseph Foy
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Krithika Suresh
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Q Jackie Wu
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - Samuel Ryu
- Department of Radiation Oncology, Stony Brook University, Stony Brook, New York
| | - Martha M Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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Berry SL, Tierney KP, Elguindi S, Mechalakos JG. Five years' experience with a customized electronic checklist for radiation therapy planning quality assurance in a multicampus institution. Pract Radiat Oncol 2017; 8:279-286. [PMID: 29429922 DOI: 10.1016/j.prro.2017.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/27/2017] [Accepted: 12/20/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION An electronic checklist has been designed with the intention of reducing errors while minimizing user effort in completing the checklist. We analyze the clinical use and evolution of the checklist over the past 5 years and review data in an incident learning system (ILS) to investigate whether it has contributed to an improvement in patient safety. METHODS AND MATERIALS The checklist is written as a standalone HTML application using VBScript. User selection of pertinent demographic details limits the display of checklist items only to those necessary for the particular clinical scenario. Ten common clinical scenarios were used to illustrate the difference between the maximum possible number of checklist items available in the code versus the number displayed to the user at any one time. An ILS database of errors and near misses was reviewed to evaluate whether the checklist influenced the occurrence of reported events. RESULTS Over 5 years, the number of checklist items available in the code nearly doubled, whereas the number displayed to the user at any one time stayed constant. Events reported in our ILS related to the beam energy used with pacemakers, projection of anatomy on digitally reconstructed radiographs, orthogonality of setup fields, and field extension beyond match lines, did not recur after the items were added to the checklist. Other events related to bolus documentation and breakpoints continued to be reported. CONCLUSION Our checklist is adaptable to the introduction of new technologies, transitions between planning systems, and to errors and near misses recorded in the ILS. The electronic format allows us to restrict user display to a small, relevant, subset of possible checklist items, limiting the planner effort needed to review and complete the checklist.
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Affiliation(s)
- Sean L Berry
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Kevin P Tierney
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sharif Elguindi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James G Mechalakos
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
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