Abstract
BackgroundAgreement between planners and treating radiation oncologists (ROs) on plan quality criteria is essential for consistent planning. Differences between ROs and planning medical physicists (MPs) in perceived quality of head and neck cancer plans were assessed.Materials and MethodsFive ROs and four MPs scored 65 plans for in total 15 patients. For each patient, the clinical (CLIN) plan and two or four alternative plans, generated with automated multi-criteria optimization (MCO), were included. There was always one MCO plan aiming at maximally adhering to clinical plan requirements, while the other MCO plans had a lower aimed quality. Scores were given as follows: 1–7 and 1–2, not acceptable; 3–5, acceptable if further planning would not resolve perceived weaknesses; and 6–7, straightway acceptable. One MP and one RO repeated plan scoring for intra-observer variation assessment.ResultsFor the 36 unique observer pairs, the median percentage of plans for which the two observers agreed on a plan score (100% = 65 plans) was 27.7% [6.2, 40.0]. In the repeat scoring, agreements between first and second scoring were 52.3% and 40.0%, respectively. With a binary division between unacceptable (scores 1 and 2) and acceptable (3–7) plans, the median inter-observer agreement percentage was 78.5% [63.1, 86.2], while intra-observer agreements were 96.9% and 86.2%. There were no differences in observed agreements between RO–RO, MP–MP, and RO–MP pairs. Agreements for the highest-quality, automatically generated MCO plans were higher than for the CLIN plans.ConclusionsInter-observer differences in plan quality scores were substantial and could result in inconsistencies in generated treatment plans. Agreements among ROs were not better than between ROs and MPs, despite large differences in training and clinical role. High-quality automatically generated plans showed the best score agreements.
Highlights
Advanced radiotherapy delivery approaches such as intensitymodulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) have substantially increased opportunities for sparing organs at risk (OARs) with proven clinical impact [1,2,3,4,5]
The DVH differences between the CLIN, MCOa, and MCOx plans were pairwise quantified by generating differential DVHs: volume differences as a function of dose
The 10th and 90th percentile curves point at large inter-patient variations in DVH differences between CLIN, MCOa, and MCOx plans
Summary
Advanced radiotherapy delivery approaches such as intensitymodulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) have substantially increased opportunities for sparing organs at risk (OARs) with proven clinical impact [1,2,3,4,5]. In case of large disparity, a plan with high quality from the planner’s point of view may be presented to the RO, while a different plan with lower quality according to the planner, but clearly more attractive to the RO if she/he would have been aware of it, is intentionally not generated or presented. In such cases, there is no guarantee that plan modifications are requested and, if requested, to what extent the adapted plans would satisfy the needs of the RO. Differences between ROs and planning medical physicists (MPs) in perceived quality of head and neck cancer plans were assessed
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
