Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiation Oncology, Radboud University, Nijmegen, The Netherlands; Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiation Oncology, Radboud University, Nijmegen, The Netherlands; Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Radiother Oncol. 2019 Apr;133:198-204. doi: 10.1016/j.radonc.2018.10.035. Epub 2018 Nov 15.
With the advent of automatic treatment planning options like Pinnacle's Autoplanning (PAP), the challenge arises how to assess the quality of a plan that no dosimetrist did work on. The aim of this study was to assess plan quality consistency of PAP prostate cancer patients in clinical practice.
100 prostate cancer patients were included from NKI and 129 from RadboudUMC (RUMC). Per institute a previously developed [1] treatment planning QA model, based on overlap volume histograms, was trained on PAP plans to predict achievable dose metrics which were then compared to the clinical PAP plans. A threshold of 3 Gy (DVH dose parameters)/3% (DVH volume parameters) was used to detect outliers. For the outlier plans, the PAP technique was adjusted with the aim of meeting the threshold.
The average difference between the prediction and the clinically achieved value was <0.5 Gy (mean dose parameters) and <1.2% (volume parameters), with standard deviation of 1.9 Gy/1.5% respectively. We found 8% (NKI)/25% (RUMC) of patients to exceed the 3 Gy/3% threshold, with deviations up to 6.7 Gy (mean dose rectum) and 6% (rectal wall V64Gy). In all cases the plans could be improved to fall within the thresholds, without compromising the other dose metrics.
Independent treatment planning QA was used successfully to assess the quality of clinical PAP in a multi-institutional setting. Respectively 8% and 25% suboptimal clinical PAP plans were detected that all could be improved with replanning. Therefore we recommend the use of independent treatment plan QA in combination with PAP for prostate cancer patients.
随着自动治疗计划选项（如 Pinnacle 的 Autoplanning，简称 PAP）的出现，如何评估没有剂量师参与的计划质量成为了一个挑战。本研究旨在评估临床实践中使用 PAP 治疗前列腺癌患者的计划质量一致性。
本研究纳入了来自 NKI 的 100 例前列腺癌患者和 RadboudUMC（简称 RUMC）的 129 例患者。根据各机构先前开发的[1]治疗计划质量保证（QA）模型，基于重叠体积直方图，对 PAP 计划进行了训练，以预测可实现的剂量指标，然后将这些指标与临床 PAP 计划进行比较。使用 3Gy（DVH 剂量参数）/3%（DVH 体积参数）作为阈值来检测离群值。对于离群值计划，调整了 PAP 技术，以达到阈值。
预测值与临床实现值之间的平均差异<0.5Gy（平均剂量参数）和<1.2%（体积参数），标准差分别为 1.9Gy/1.5%。我们发现 8%（NKI）/25%（RUMC）的患者超过了 3Gy/3%的阈值，最大偏离值可达 6.7Gy（直肠平均剂量）和 6%（直肠壁 V64Gy）。在所有情况下，都可以通过重新计划来改善计划，使其符合阈值，而不会影响其他剂量指标。
独立的治疗计划 QA 成功地用于评估多机构临床 PAP 的质量。分别检测到 8%和 25%的临床 PAP 计划不理想，所有这些计划都可以通过重新计划得到改善。因此，我们建议在前列腺癌患者中使用独立的治疗计划 QA 与 PAP 相结合。
