Abstract
Purposes: To evaluate whether the auto-planning (AP) module can achieve clinically acceptable treatment plans for lung stereotactic body radiotherapy (SBRT) and to evaluate the effectiveness of a dose prediction model.Methods: Twenty lung SBRT cases planned manually with 50 Gy in five fractions were replanned using the Pinnacle (Philips Radiation Oncology Systems, Fitchburg, WI) AP module according to the dose constraint tables from the Radiation Therapy Oncology Group (RTOG) 0813 protocol. Doses to the organs at risk (OAR) were compared between the manual and AP plans. Using a dose prediction model from a commercial product, PlanIQ (Sun Nuclear Corporation, Melbourne, FL), we also compared OAR doses from AP plans with predicted doses.Results: All manual and AP plans achieved clinically required dose coverage to the target volumes. The AP plans achieved equal or better OAR sparing when compared to the manual plans, most noticeable in the maximum doses of the spinal cord, ipsilateral brachial plexus, esophagus, and trachea. Predicted doses to the heart, esophagus, and trachea were highly correlated with the doses of these OARs from the AP plans with the highest correlation coefficient of 0.911, 0.823, and 0.803, respectively.Conclusion: Auto-planning for lung SBRT improved OAR sparing while keeping the same dose coverage to the tumor. The dose prediction model can provide useful planning dose guidance.
Highlights
Beyond accuracy in dose calculation, computer-aided optimization and automation aim to improve planning efficiency, consistency, and quality
The AP module mimics the manual planning process, separates overlapped contours, creates tuning structures, adjusts hot and cold spots, and optimizes the plan iteratively [8]. Both the original manual plans and AP replans were prescribed with 50 Gy in five fractions according to the Radiation Therapy Oncology Group (RTOG) 0813 protocol and planned using the Pinnacle treatment planning system
The quality of AP vs. manual plans was “better” in 15%, “ acceptable” in 80%, and “worse” in 5% per physician judgment based on the target coverage, organs at risk (OAR) sparing, and three-dimensional isodose distributions
Summary
Beyond accuracy in dose calculation, computer-aided optimization and automation aim to improve planning efficiency, consistency, and quality. Tools such as auto-planning, RapidPlan (Varian Medical Systems, Palo Alto, CA), and multi-criteria optimization (MCO) are developed by different vendors and implemented for clinical use. With increased automation in treatment planning, the resultant plan quality is less dependent on the user experience, while the planning efficiency and consistency can be improved. Auto-planning (AP) is an integrated module in the Pinnacle (Philips Radiation Oncology Systems, Fitchburg, WI) treatment planning system. It mimics the iterative manual planning process to achieve the prescription doses and spare organs at risk (OARs) [2]. Studies have confirmed that the AP module produced clinically acceptable treatment plans for the brain, head, neck, esophagus, lung, and prostate [3,4,5,6,7,8,9,10]
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