Abstract
BackgroundKnowledge-based planning (KBP) is a promising technique that can improve plan quality and increase planning efficiency. However, no attempts have been made to extend the domain of KBP for planners with different planning experiences so far. The purpose of this study was to quantify the potential gains for planners with different planning experiences after implementing KBP in intensity modulated radiation therapy (IMRT) plans for left-sided breast cancer patients.MethodsThe model libraries were populated with 80 expert clinical plans from treated patients who previously received left-sided breast-conserving surgery and IMRT with simultaneously integrated boost. The libraries were created on the RapidPlanTM. 6 planners with different planning experiences (2 beginner planners, 2 junior planners and 2 senior planners) generated manual and KBP optimized plans for additional 10 patients, similar to those included in the model libraries. The plan qualities were compared between manual and KBP plans.ResultsAll plans were capable of achieving the prescription requirement. There were almost no statistically significant differences in terms of the planning target volume (PTV) coverage and dose conformality. It was demonstrated that the doses for most of organs-at-risk (OARs) were on average lower or equal in KBP plans compared to manual plans except for the senior planners, where the very small differences were not statistically significant. KBP data showed a systematic trend to have superior dose sparing at most parameters for the heart and ipsilateral lung. The observed decrease in the doses to these OARs could be achieved, particularly for the beginner and junior planners. Many differences were statistically significant.ConclusionsIt is feasible to generate acceptable IMRT plans after implementing KBP for left-sided breast cancer. KBP helps to effectively improve the quality of IMRT plans against the benchmark of manual plans for less experienced planners without any manual intervention. KBP showed promise for homogenizing the plan quality by transferring planning expertise from more experienced to less experienced planners.
Highlights
Knowledge-based planning (KBP) is a promising technique that can improve plan quality and increase planning efficiency
planning target volume (PTV) coverage Table 1 presents the detailed statistical analysis of the PTV coverage and conformation number (CN) for the entire evaluation group (EG) divided per planner
The dose distributions for one representative patient on coronal planes of manual and KBP plans are shown in Fig. 1(a) and (b) for one beginner planner, Fig. 1(e) and (f ) for one junior planner and Fig. 1(i) and (j) for one senior planner, respectively
Summary
Knowledge-based planning (KBP) is a promising technique that can improve plan quality and increase planning efficiency. The purpose of this study was to quantify the potential gains for planners with different planning experiences after implementing KBP in intensity modulated radiation therapy (IMRT) plans for left-sided breast cancer patients. Intensity modulated radiation therapy (IMRT) has the capability of maintaining the adequate planning target volume (PTV) coverage, without compromising the surrounding critical organs-at-risk (OARs) sparing. The greatest difficulty in IMRT planning is the determination of the ideal dose–volume constraints for OARs. The most common dose-volume constraints have typically been determined using the Radiation Therapy Oncology Group protocol recommendations, or a physician’s intuition based recommendations. The most common dose-volume constraints have typically been determined using the Radiation Therapy Oncology Group protocol recommendations, or a physician’s intuition based recommendations These population-based recommendations can be meaningful in many situations. The potential of IMRT can not be fully explored until ideal IMRT optimization algorithms are widely used
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