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Abstract
PurposeTo develop and validate a robust template for VMAT SBRT of lung lesions, using the multicriterial optimization (MCO) of a commercial treatment planning system.MethodsThe 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.ResultsNo 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.ConclusionThe automation of the planning process for lung SBRT using robust templates and MCO was demonstrated to be feasible and more efficient.
Highlights
The planning and quality assurance (QA) required for intensity‐modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) are more complex and time consuming compared with conventional conformal radiotherapy (CRT) techniques, which can have significant impact on the resources of a radiotherapy department.[1]
Automatic planning was proposed as an option in several treatment planning systems (TPS), with different approaches, with the purpose of decreasing the time required for planning and the interoperator heterogeneities.[3,4,5,6]
We describe the development of a class solution for patients treated with lung SBRT (55 Gy in 5 fractions) using VMAT and the Monaco treatment planning system (Elekta AB, Sweden)
Summary
The planning and quality assurance (QA) required for intensity‐modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) are more complex and time consuming compared with conventional conformal radiotherapy (CRT) techniques, which can have significant impact on the resources of a radiotherapy department.[1]Besides constituting a huge workload, manual planning is considerably dependent on planner experience and available planning time, producing large variations in plan quality.[2]Quite recently, automatic planning was proposed as an option in several treatment planning systems (TPS), with different approaches, with the purpose of decreasing the time required for planning and the interoperator heterogeneities.[3,4,5,6] A common finding of several studies investigating the effect of automatic planning was the increase in planning efficiency and consistency when these tools are introduced.[7,8,9,10]the commercial automatic planning systems are not available in all radiotherapy departments, since they are proprietary systems, requiring specific licenses. The planning and quality assurance (QA) required for intensity‐modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) are more complex and time consuming compared with conventional conformal radiotherapy (CRT) techniques, which can have significant impact on the resources of a radiotherapy department.[1]. Besides constituting a huge workload, manual planning is considerably dependent on planner experience and available planning time, producing large variations in plan quality.[2]. The commercial automatic planning systems are not available in all radiotherapy departments, since they are proprietary systems, requiring specific licenses. Being able to automate the planning process through the use of the available tools would constitute a large advantage, making eventually exportable the developed automated technique to different centers that make use of the same TPS
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