Physics department, University of Aveiro, Aveiro, Portugal.
Medical Physics department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal.
Radiat Oncol. 2020 Mar 12;15(1):64. doi: 10.1186/s13014-020-01507-5.
This work aims at clinically validating a graphical tool developed for treatment plan assessment, named SPIDERplan, by comparing the plan choices based on its scoring with the radiation oncologists (RO) clinical preferences.
SPIDERplan validation was performed for nasopharynx pathology in two steps. In the first step, three ROs from three Portuguese radiotherapy departments were asked to blindly evaluate and rank the dose distributions of twenty pairs of treatment plans. For plan ranking, the best plan from each pair was selected. For plan evaluation, the qualitative classification of 'Good', 'Admissible with minor deviations' and 'Not Admissible' were assigned to each plan. In the second step, SPIDERplan was applied to the same twenty patient cases. The tool was configured for two sets of structures groups: the local clinical set and the groups of structures suggested in international guidelines for nasopharynx cancer. Group weights, quantifying the importance of each group and incorporated in SPIDERplan, were defined according to RO clinical preferences and determined automatically by applying a mixed linear programming model for implicit elicitation of preferences. Intra- and inter-rater ROs plan selection and evaluation were assessed using Brennan-Prediger kappa coefficient.
Two-thirds of the plans were qualitatively evaluated by the ROs as 'Good'. Concerning intra- and inter-rater variabilities of plan selection, fair agreements were obtained for most of the ROs. For plan evaluation, substantial agreements were verified in most cases. The choice of the best plan made by SPIDERplan was identical for all sets of groups and, in most cases, agreed with RO plan selection. Differences between RO choice and SPIDERplan analysis only occurred in cases for which the score differences between the plans was very low. A score difference threshold of 0.005 was defined as the value below which two plans are considered of equivalent quality.
Generally, SPIDERplan response successfully reproduced the ROs plan selection. SPIDERplan assessment performance can represent clinical preferences based either on manual or automatic group weight assignment. For nasopharynx cases, SPIDERplan was robust in terms of the definitions of structure groups, being able to support different configurations without losing accuracy.
本研究旨在通过比较基于评分的计划选择与放射肿瘤学家（RO）的临床偏好，对一种名为 SPIDERplan 的治疗计划评估图形工具进行临床验证。
SPIDERplan 的验证分两步进行。在第一步中，来自葡萄牙三个放疗部门的三名 RO 被要求对二十对治疗计划的剂量分布进行盲法评估和排序。对于计划排序，从每对计划中选择最佳计划。对于计划评估，将每个计划分为“良好”、“允许有小偏差”和“不允许”三种定性分类。在第二步中，将 SPIDERplan 应用于相同的二十个患者病例。该工具针对两组结构组进行了配置：局部临床组和国际鼻咽癌指南中建议的结构组。根据 RO 的临床偏好，为定量评估每个组的重要性的组权重进行了定义，并通过应用混合线性规划模型自动确定。使用 Brennan-Prediger kappa 系数评估 RO 对计划选择和评估的内部和内部评分者一致性。
三分之二的计划被 RO 定性评估为“良好”。在 RO 计划选择的内部和内部评分者变异性方面，大多数 RO 获得了公平的一致性。在大多数情况下，验证了计划评估的实质性一致性。SPIDERplan 为所有组选择的最佳计划在大多数情况下与 RO 计划选择一致。RO 选择和 SPIDERplan 分析之间的差异仅发生在计划之间的评分差异非常低的情况下。将 0.005 定义为两个计划质量相当的评分差异阈值。
总体而言，SPIDERplan 的反应成功地复制了 RO 的计划选择。SPIDERplan 的评估性能可以代表基于手动或自动组权重分配的临床偏好。对于鼻咽癌病例，SPIDERplan 在结构组的定义方面具有稳健性，能够支持不同的配置而不会降低准确性。
