Abstract
Treatment planning is time‐consuming and the outcome depends on the person performing the optimization. A system that automates treatment planning could potentially reduce the manual time required for optimization and could also provide a method to reduce the variation between persons performing radiation dose planning (dosimetrist) and potentially improve the overall plan quality. This study evaluates the performance of the Auto‐Planning module that has recently become clinically available in the Pinnacle3 radiation therapy treatment planning system. Twenty‐six clinically delivered head and neck treatment plans were reoptimized with the Auto‐Planning module. Comparison of the two types of treatment plans were performed using DVH metrics and a blinded clinical evaluation by two senior radiation oncologists using a scale from one to six. Both evaluations investigated dose coverage of target and dose to healthy tissues. Auto‐Planning was able to produce clinically acceptable treatment plans in all 26 cases. Target coverages in the two types of plans were similar, but automatically generated plans had less irradiation of healthy tissue. In 94% of the evaluations, the autoplans scored at least as high as the previously delivered clinical plans. For all patients, the Auto‐Planning tool produced clinically acceptable head and neck treatment plans without any manual intervention, except for the initial target and OAR delineations. The main benefit of the method is the likely improvement in the overall treatment quality since consistent, high‐quality plans are generated which even can be further optimized, if necessary. This makes it possible for the dosimetrist to focus more time on difficult dose planning goals and to spend less time on the more tedious parts of the planning process.PACS number: 87.55.de
Highlights
A number of uncertainties and variations are present in radiotherapy such as absolute dose precision,(1) delivery precision,(2,3,4,5) precision of calculated dose distributions,(6,7,8,9) and radioresponsiveness of the specific tumor and normal tissues.[10,11,12,13,14,15] Two of the largest variations within radiotherapy are the heterogeneity in target definition[16,17,18] and the variation among treatment plans for a given geometry both intra- and interinstitutional.[19,20] Most treatment plans are likely to have sufficient dose coverage of the delineated targets, but large variations in dose to healthy tissues occur
If an automatically generated treatment plan of high clinical quality is available prior to manual optimization, it could serve as a quality reference and starting point for the specific treatment and thereby ensure a certain minimum quality
For PTV50, the autoplans had a small, but statistically significant, lower dose than the clinical plans below 95% of the 50 Gy and above ~ 110% of the 50 Gy
Summary
The dose distribution depends on the dose objective defined by the dosimetrist, typically in accordance with institution-specific guidelines. Even guidelines do not ensure an optimal dose distribution for the specific anatomy, since the lower achievable dose limit to an OAR for a specific patient is unknown. This is the reason why treatment plans are optimized for the individual patient by trained dosimetrists. If an automatically generated treatment plan of high clinical quality is available prior to manual optimization, it could serve as a quality reference and starting point for the specific treatment and thereby ensure a certain minimum quality. Sharing the optimization parameters between institutions could provide a method to share knowledge and standardize plan quality
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