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He L, Peng X, Chen N, Wei Z, Wang J, Liu Y, Xiao J. Automated treatment planning for liver cancer stereotactic body radiotherapy. Clin Transl Oncol 2023; 25:3230-3240. [PMID: 37097529 DOI: 10.1007/s12094-023-03196-4] [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: 11/26/2022] [Accepted: 04/07/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE To evaluate the quality of fully automated stereotactic body radiation therapy (SBRT) planning based on volumetric modulated arc therapy, which can reduce the reliance on historical plans and the experience of dosimetrists. METHODS Fully automated re-planning was performed on twenty liver cancer patients, automated plans based on automated SBRT planning (ASP) program and manual plans were conducted and compared. One patient was randomly selected and evaluate the repeatability of ASP, ten automated and ten manual SBRT plans were generated based on the same initial optimization objectives. Then, ten SBRT plans were generated for another selected randomly patient with different initial optimization objectives to assess the reproducibility. All plans were clinically evaluated in a double-blinded manner by five experienced radiation oncologists. RESULTS Fully automated plans provided similar planning target volume dose coverage and statistically better organ at risk sparing compared to the manual plans. Notably, automated plans achieved significant dose reduction in spinal cord, stomach, kidney, duodenum, and colon, with a median dose of D2% reduction ranging from 0.64 to 2.85 Gy. R50% and Dmean of ten rings for automated plans were significantly lower than those of manual plans. The average planning time for automated and manual plans was 59.8 ± 7.9 min vs. 127.1 ± 16.8 min (- 67.3 min). CONCLUSION Automated planning for SBRT, without relying on historical data, can generate comparable or even better plan quality for liver cancer compared with manual planning, along with better reproducibility, and less clinically planning time.
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Affiliation(s)
- Ling He
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Na Chen
- School of Pharmacy, Chengdu Medical College, Xindu Avenue No. 783, Chengdu, 610500, Sichuan, China
| | - Zhigong Wei
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingjing Wang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yingtong Liu
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan, China
| | - Jianghong Xiao
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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WATANABE HIROYUKI, SUGIMOTO SATORU, KAWABATA TORU, NAGATA HIRONORI, KUROKAWA CHIE, USUI KEISUKE, INOUE TATSUYA, TAKATSU JUN, KATO KYOICHI, SASAI KEISUKE. Semiautomatic Treatment Planning for the Field-in-field Technique in Whole Brain Irradiation. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2022; 68:375-386. [PMID: 39021429 PMCID: PMC11250019 DOI: 10.14789/jmj.jmj22-0003-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/01/2022] [Indexed: 07/20/2024]
Abstract
Objectives In radiation therapy, the field-in-field (FIF) technique is used to prevent the administration of unnecessarily high doses to reduce toxicity. Recently, the FIF technique has been used for whole brain irradiation (WBI). Using the FIF technique, the volume that receives a higher than prescribed dose (hotspot) can be largely reduced; however, the treatment planning requires time. Therefore, to reduce the burden on the treatment planners, we propose a semiautomatic treatment planning method for the FIF technique. Methods In the semiautomatic FIF technique, hotspot regions in a treatment plan without the FIF technique are identified three-dimensionally, and beams with blocks that cover the hotspot regions using a multileaf collimator (sub-beams) are automatically created. The sub-beams are added to the original plan, and weights are assigned based on the maximum dose of the original plan to decrease the doses in the hotspot regions. This method was applied to 22 patients previously treated with WBI, wherein treatment plans were originally created without the FIF technique. Results In the semiautomatic FIF plans, the hotspots almost disappeared. The dose to 95% of the volume and the volume receiving at least 95% of the prescribed dose in the planning target volume decreased by only 0.3% ± 0.2% and 0.0% ± 0.1%, respectively, on average compared with those in the original plan. The average semiautomatic FIF processing time was 28 ± 4 s. Conclusions The proposed method reduced the hotspot regions with a slight change in the target coverage.
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Affiliation(s)
- HIROYUKI WATANABE
- Corresponding author: Hiroyuki Watanabe, Department of Radiation Oncology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan, TEL: +81-3-6426-3055 FAX: +81-3-3784-8404 E-mail:
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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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Huang X, Quan H, Zhao B, Zhou W, Chen C, Chen Y. A plan template‐based automation solution using a commercial treatment planning system. J Appl Clin Med Phys 2020; 21:13-25. [PMID: 32180351 PMCID: PMC7286016 DOI: 10.1002/acm2.12848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 01/05/2020] [Accepted: 02/08/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose The purpose of this study was to develop an auto‐planning platform to be interfaced with a commercial treatment planning system (TPS). The main goal was to obtain robust and high‐quality plans for different anatomic sites and various dosimetric requirements. Methods Monaco (Elekta, St. Louis, US) was the TPS in this work. All input parameters for inverse planning could be defined in a plan template inside Monaco. A software tool called Robot Framework was used to launch auto‐planning trials with updated plan templates. The template modifier external to Monaco was the major component of our auto‐planning platform. For current implementation, it was a rule‐based system that mimics the trial‐and‐error process of an experienced planner. A template was automatically updated by changing the optimization constraints based on dosimetric evaluation of the plan obtained in the previous trial, along with the data of the iterative optimization extracted from Monaco. Treatment plans generated by Monaco with all plan evaluation criteria satisfied were considered acceptable, and such plans would be saved for further evaluation by clinicians. The auto‐planning platform was validated for 10 prostate and 10 head‐and‐neck cases in comparison with clinical plans generated by experienced planners. Results The performance and robustness of our auto‐planning platform was tested with clinical cases of prostate and head and neck treatment. For prostate cases, automatically generated plans had very similar plan quality with the clinical plans, and the bladder volume receiving 62.5 Gy, 50 Gy, and 40 Gy in auto‐plans was reduced by 1%, 3%, and 5%, respectively. For head and neck cases, auto‐plans had better conformity with reduced dose to the normal structures but slightly higher dose inhomogeneity in the target volume. Remarkably, the maximum dose in the spinal cord and brain stem was reduced by more than 3.5 Gy in auto‐plans. Fluence map optimization only with less than 30 trials was adequate to generate acceptable plans, and subsequent optimization for final plans was completed by Monaco without further intervention. The plan quality was weakly dependent on the parameter selection in the initial template and the choices of the step sizes for changing the constraint values. Conclusion An automated planning platform to interface with Monaco was developed, and our reported tests showed preliminary results for prostate and head and neck cases.
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Affiliation(s)
- Xiaotian Huang
- School of Physics and TechnologyWuhan UniversityWuhanChina
- Elekta (Shanghai) Instruments LtdShanghaiChina
| | - Hong Quan
- School of Physics and TechnologyWuhan UniversityWuhanChina
| | - Bo Zhao
- Department of Radiation OncologyPeking University First HospitalBeijingChina
| | - Wing Zhou
- Elekta (Shanghai) Instruments LtdShanghaiChina
| | | | - Yan Chen
- Elekta (Shanghai) Instruments LtdShanghaiChina
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Ayala R, Ruiz G, Valdivielso T. Automatizing a nonscripting TPS for optimizing clinical workflow and reoptimizing IMRT/VMAT plans. Med Dosim 2019; 44:409-414. [PMID: 30952384 DOI: 10.1016/j.meddos.2019.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/31/2019] [Accepted: 02/21/2019] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to design a toolkit that interacts with the Monaco (Elekta AB, Stockholm, Sweden) treatment planning system (TPS) for optimization of intensity-modulated radiation therapy and volumetric-modulated arc therapy without the need for a dedicated application programming interface. Successful inverse planning of radiotherapeutic treatment depends on the tweaking of many parameters; a tool was thus needed to explore these parameters more exhaustively without significantly increasing planning time. The software that we used was based on an open-source library that mimics human interaction with Microsoft Windows applications. We developed a simple Autoflow software routine that analyzes and optimizes calculated plans by considering the relative impact of different cost functions and modifying constraints accordingly. It was also designed to change segmentation parameters to fit more complex treatments. The toolkit is publicly available for download at https://bitbucket.org/hgugmradiofisica/pymonaco/src/master/. A study of prostate cancer cases was conducted to compare automatically created plans with previously treated cases. The toolkit fully automated the radiotherapy planning procedure, allowing the TPS to calculate or optimize plans during nonworking hours. In the prostate study, the use of this tool reduced the dose to organs at risk with a negligible decrease in target coverage. This tool enables the efficient use of the TPS, allowing research and clinical applications to coexist without conflict. It provides consistency and efficiency throughout the treatment planning process, which may be of great value to clinics with few resources. The impact of this tool on clinical workflow is important, as it not only provides better efficiency, but also increases treatment quality.
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Affiliation(s)
- Rafael Ayala
- Servicio de Dosimetría y Radioprotección, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Gema Ruiz
- Servicio de Dosimetría y Radioprotección, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Teresa Valdivielso
- Servicio de Dosimetría y Radioprotección, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Kim H, Kwak J, Jung J, Jeong C, Yoon K, Lee SW, Ahn SD, Choi EK, Kim SS, Cho B. Automated Field-In-Field (FIF) Plan Framework Combining Scripting Application Programming Interface and User-Executed Program for Breast Forward IMRT. Technol Cancer Res Treat 2019; 17:1533033818810391. [PMID: 30384804 PMCID: PMC6259058 DOI: 10.1177/1533033818810391] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose: To develop an one-click option on treatment planning system that enables for the
automated breast FIF planning by combining the Eclipse Scripting application programming
interfaces and user-executed programming in Windows. Methods: Scripting application programming interfaces were designed to promote automation in
clinical workflow associated with radiation oncology. However, scripting cannot provide
all functions that users want to perform. Thus, a new framework proposes to integrate
the benefits of the scripting application and user-executed programming for the
automated field-in-field technique. We adopted the Eclipse Scripting applications, which
provide an interface between treatment planning system server and client and enable for
running the executed program to create dose clouds and adjust the planning parameters
such as multi-leaf collimator placements and monitor unit values. Importantly, all tasks
are designed to perform with one-click option on treatment planning system, including
the automated pushback of the proposed plan to the treatment planning system. Results: The plans produced from the proposed framework were validated against the manual
field-in-field plans with 40 retrospective breast patient cases in planning efficiency
and plan quality. The elapsed time for running the framework was less than 1 minute,
which significantly reduced the manual multi-leaf collimator/monitor unit adjustment
time. It decreased the total planning time by more than 50%, relative to the manual
field-in-field planning. In dosimetric aspects, the mean and maximum dose of the heart,
lung, and whole breast did not exceed 1% deviation from the manual plans in most patient
cases, while maintaining the target dose coverage and homogeneity index inside the
target volume. From numerical analysis, the automated plans were demonstrated to be
sufficiently close to the manual plans. Conclusion: The combination of scripting applications and user-executed programming for automated
breast field-in-field planning accomplished a significant enhancement in planning
efficiency without degrading the plan quality, relative to the manual field-in-field
procedure.
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Affiliation(s)
- Hojin Kim
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jungwon Kwak
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinhong Jung
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chiyoung Jeong
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoungjun Yoon
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Wook Lee
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Do Ahn
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Kyung Choi
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su Ssan Kim
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byungchul Cho
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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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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Kim H, Kwak J, Jeong C, Cho B. Institutional Applications of Eclipse Scripting Programming Interface to Clinical Workflows in Radiation Oncology. ACTA ACUST UNITED AC 2017. [DOI: 10.14316/pmp.2017.28.3.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hojin Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jungwon Kwak
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chiyoung Jeong
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byungchul Cho
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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