Automated instead of manual treatment planning? A plan comparison based on dose-volume statistics and clinical preference

Publication date: Available online 2 June 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Barbara Vanderstraeten, Bruno Goddeeris, Katrien Vandecasteele, Marc van Eijkeren, Carlos De Wagter, Yolande Lievens
Purpose/ObjectiveAutomated planning aims to speed up treatment planning and improve plan quality. We compared manual to automated planning for lung stereotactic body radiation therapy (SBRT) based on dose-volume histogram (DVH) statistics and clinical preference.Methods and MaterialsManual (MP) and automated (AP) intensity-modulated radiation therapy (IMRT) plans were generated for 56 patients using in-house developed software and Pinnacle 9.10 Auto-Planning, respectively. Optimization times were measured in 10 patients and the impact of AP on the total treatment cost was estimated. For the remaining 46 patients each plan was checked against our clinical objectives and a pairwise DVH comparison was performed. Three experienced radiation oncologists (ROs) evaluated each plan and indicated their preference.ResultsAP reduced the average optimization time by 77.3% but only affected the total treatment cost by 3.6%. 3 AP / 0 MP failed our clinical objectives, while 13 AP / 9 MP showed a minor deviation. AP significantly reduced D2% for the spinal cord, esophagus, heart, aorta and main stem bronchus (p<0.05), while preserving target coverage. The ROs found over 75% of the AP clinically acceptable without any further fine tuning.ConclusionsAP may help to create satisfactory treatment plans fast and effectively. As the critical appraisal by qualified professionals remains necessary, there is no such thing as "fully automated" planning yet.

Teaser

Automated planning aims to improve the efficiency of the treatment planning process as well as the final plan quality. We compared automated plans to manual plans for 56 patients based on clinical objectives, DVH metrics and a blind clinical assessment by three experienced radiation oncologists. We observed a statistically significant reduction in OAR dose while maintaining PTV coverage for the automated plans. Clinically, however, the automated plans were not always preferred over their manual counterparts.


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