Baker Lindsey, Olson Robert, Braich Taran, Koulis Theodora, Ye Allison, Ahmed Nisar, Tran Eric, Lawyer Kim, Otto Karl, Smith Sally, Mestrovic Ante, Matthews Quinn
Department of Radiation Therapy, BC Cancer - Centre for the North, 1215 Lethbridge St, Prince George, BC V2M 7E9, Canada.
Department of Radiation Oncology, BC Cancer - Centre for the North, 1215 Lethbridge St, Prince George, BC V2M 7E9, Canada.
Phys Imaging Radiat Oncol. 2019 Apr 4;9:83-88. doi: 10.1016/j.phro.2019.03.002. eCollection 2019 Jan.
Planning complex radiotherapy treatments can be inefficient, with large variation in plan quality. In this study we evaluated plan quality and planning efficiency using real-time interactive planning (RTIP) for head and neck (HN) volumetric modulated arc therapy (VMAT).
RTIP allows manipulation of dose volume histograms (DVHs) in real-time to assess achievable planning target volume (PTV) coverage and organ at risk (OAR) sparing. For 20 HN patients previously treated with VMAT, RTIP was used to minimize OAR dose while maintaining PTV coverage. RTIP DVHs were used to guide VMAT optimization. Dosimetric differences between RTIP-assisted plans and original clinical plans were assessed. Five blinded radiation oncologists indicated their preference for each PTV, OAR and overall plan. To assess efficiency, ten patients were planned by experienced and novice planners and a RTIP user.
The average planning time with RTIP was <20 min, and most plans required only one optimization. All 20 RTIP plans were preferred by a majority of oncologists due to improvements in OAR sparing. The average maximum dose to the spinal cord was reduced by 10.5 Gy (from 49.5 to 39.0 Gy), and the average mean doses for the oral cavity, laryngopharynx, contralateral parotid and submandibular glands were reduced by 3.5 Gy (39.1-35.7 Gy), 6.8 Gy (42.5-35.7 Gy), 1.7 Gy (17.0-15.3 Gy) and 3.3 Gy (22.9-19.5 Gy), respectively.
Incorporating RTIP into clinical workflows may increase both planning efficiency and OAR sparing.
复杂放疗计划的制定可能效率低下，计划质量差异很大。在本研究中，我们使用头颈部（HN）容积调强弧形放疗（VMAT）的实时交互式计划（RTIP）评估计划质量和计划效率。
RTIP允许实时操作剂量体积直方图（DVH），以评估可实现的计划靶体积（PTV）覆盖范围和危及器官（OAR）的保护情况。对于20例先前接受VMAT治疗的HN患者，使用RTIP在维持PTV覆盖的同时尽量减少OAR剂量。RTIP DVH用于指导VMAT优化。评估RTIP辅助计划与原始临床计划之间的剂量差异。五位不知情的放射肿瘤学家表明了他们对每个PTV、OAR和总体计划的偏好。为评估效率，由经验丰富的和新手计划者以及一名RTIP用户为10例患者制定计划。
使用RTIP的平均计划时间<20分钟，大多数计划仅需一次优化。由于OAR保护得到改善，所有20个RTIP计划都得到了大多数肿瘤学家的青睐。脊髓的平均最大剂量降低了10.5 Gy（从49.5降至39.0 Gy），口腔、下咽、对侧腮腺和下颌下腺的平均平均剂量分别降低了3.5 Gy（39.1 - 35.7 Gy）、6.8 Gy（42.5 - 35.7 Gy）、1.7 Gy（17.0 - 15.3 Gy）和3.3 Gy（22.9 - 19.5 Gy）。
将RTIP纳入临床工作流程可能会提高计划效率并改善OAR保护。
