Hansen Christian Rønn, Bertelsen Anders, Hazell Irene, Zukauskaite Ruta, Gyldenkerne Niels, Johansen Jørgen, Eriksen Jesper G, Brink Carsten
Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark.
Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
Clin Transl Radiat Oncol. 2016 Sep 19;1:2-8. doi: 10.1016/j.ctro.2016.08.001. eCollection 2016 Dec.
Treatment plans for head and neck (H&N) cancer are highly complex due to multiple dose prescription levels and numerous organs at risk (OARs) close to the target. The plan quality is inter-planner dependent since it is dependent on the skills and experience of the dosimetrist. This study presents a blinded prospective clinical comparison of automatic (AU) and manually (MA) generated H&N VMAT plans made for clinical use.
MA and AU plans were generated for 30 consecutive patients in Pinnacle using the IMRT optimisation module and the new Autoplan module, respectively. The plan quality was blindedly compared by three senior oncologists and the best plan was selected for treatment of the patient. Planning time was measured as the active operator time used. The plan quality was analysed with DVH metrics and the dose delivery accuracy validated on the ArcCheck phantom.
For twenty-nine out of the thirty patients the AU plan was chosen for treatment. Target doses were more homogenous with the AU plans and the OAR doses were significantly reduced, between 0.5 and 6.5 Gy. The average operator time spent on creating a manual plan was 64 min which was halved by Autoplan. The AU plans were more modulated as illustrated by an increase in MUs, which might cause the slightly lower pass rate of 97.7% in the ArcCheck measurements.
Target doses were similar between MA and AU plan, while AU plans spared all OAR considerably better than the MA plans.
由于存在多个剂量处方水平以及众多靠近靶区的危及器官（OAR），头颈部（H&N）癌的治疗计划极为复杂。计划质量取决于计划制定者，因为它依赖于剂量师的技能和经验。本研究对头颈部容积调强放疗（VMAT）自动（AU）生成和手动（MA）生成并用于临床的计划进行了一项盲法前瞻性临床比较。
分别使用Pinnacle中的调强放疗（IMRT）优化模块和新的自动计划模块为30例连续患者生成MA计划和AU计划。由三位资深肿瘤学家对计划质量进行盲法比较，并选择最佳计划用于患者治疗。将计划时间测量为实际操作人员所用时间。使用剂量体积直方图（DVH）指标分析计划质量，并在ArcCheck模体上验证剂量传递准确性。
30例患者中有29例选择了AU计划进行治疗。AU计划的靶区剂量更均匀，OAR剂量显著降低，降低幅度在0.5至6.5 Gy之间。创建手动计划的平均操作人员时间为64分钟，自动计划使其减半。AU计划的调制更多，如监测单位（MUs）增加所示，这可能导致ArcCheck测量中的通过率略低，为97.7%。
MA计划和AU计划的靶区剂量相似，而AU计划对所有OAR 的保护明显优于MA计划。
