采用混合调强放疗自动规划全乳放疗可提高效率和质量。
Automated planning of whole breast irradiation using hybrid IMRT improves efficiency and quality.
机构信息
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
出版信息
J Appl Clin Med Phys. 2019 Dec;20(12):87-96. doi: 10.1002/acm2.12767. Epub 2019 Nov 19.
PURPOSE
To develop an automated workflow for whole breast irradiation treatment planning using hybrid intensity modulated radiation therapy (IMRT) approach and to demonstrate that this workflow can improve planning quality and efficiency when compared to manual planning.
METHODS
The auto planning framework was built based on scripting with MIM and Pinnacle systems. MIM workflows were developed to automatically segment normal structures and targets, identify landmarks for beam placement, select beam energies, and set beam configurations. Pinnacle scripts were generated from the MIM workflow to create hybrid IMRT plans automatically. Each hybrid IMRT plan included two prescriptions: a three-dimensional (3D) prescription consisted of two open tangent beams, and an IMRT prescription consisted of two step-and-shoot IMRT beams. The 3D prescription delivered a full prescription dose to the maximum dose point, and the IMRT prescription was optimized to deliver a uniform dose to the entire breast while sparing dose to the normal structures. For 30 patients, the auto plans were compared with clinically accepted manual plans using the paired sample t-test.
RESULTS
The auto planning process took approximately 8 min to complete. The mean dice coefficients between auto-segmentation and manual contours were 0.98, 0.94 and 0.88 for the lungs, heart, and PTVeval_Breast, respectively. The MUs of the auto plans was on average 13% higher than that of the manual plans. Auto planning improved plan quality significantly: percentage volume receiving 95% of the prescription dose (V95%) of the PTVeval_Breast increased from 91.5% to 93.2% (P = 0.001), V105% of the PTVeval_Breast decreased from 7.2% to 1.2% (P = 0.013), V20Gy of the ipsilateral lung decreased from 13.1% to 10.4% (P = 0.001) and mean heart dose for left-sided breast patients decreased from 1.2 Gy to 0.9 Gy (P < 0.001).
CONCLUSION
An automated treatment planning process can make the planning process efficient with improved plan quality.
目的
开发一种使用混合调强放射治疗（IMRT）方法进行全乳照射治疗计划的自动化工作流程，并证明与手动计划相比，该工作流程可以提高计划质量和效率。
方法
自动规划框架是基于 MIM 和 Pinnacle 系统的脚本构建的。MIM 工作流程用于自动分割正常结构和靶区，识别光束放置的地标，选择光束能量，并设置光束配置。从 MIM 工作流程生成 Pinnacle 脚本，以自动创建混合 IMRT 计划。每个混合 IMRT 计划包括两个处方：一个由两个开放切线束组成的三维（3D）处方，以及一个由两个分步射击 IMRT 束组成的 IMRT 处方。3D 处方将全处方剂量输送至最大剂量点，而 IMRT 处方则优化为在不影响正常结构的情况下将均匀剂量输送至整个乳房。对 30 名患者的自动计划与临床可接受的手动计划进行比较，采用配对样本 t 检验。
结果
自动规划过程大约需要 8 分钟完成。自动分割与手动轮廓之间的平均 Dice 系数分别为肺部、心脏和 PTVeval_乳房的 0.98、0.94 和 0.88。自动计划的 MU 平均比手动计划高 13%。自动规划显著改善了计划质量：PTVeval_乳房接受 95%处方剂量的百分比体积（V95%）从 91.5%增加到 93.2%（P=0.001），PTVeval_乳房的 V105%从 7.2%减少到 1.2%（P=0.013），同侧肺的 V20Gy 从 13.1%减少到 10.4%（P=0.001），左乳患者的平均心脏剂量从 1.2Gy 减少到 0.9Gy（P<0.001）。
结论
自动化治疗计划过程可以提高计划质量，同时提高计划效率。
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