Department of Radiation Oncology, Stanford University, Stanford, California.
Department of Radiation Oncology, Stanford University, Stanford, California.
Pract Radiat Oncol. 2021 Sep-Oct;11(5):415-423. doi: 10.1016/j.prro.2021.02.010. Epub 2021 Mar 10.
Our purpose was to automate the treatment planning process for total body irradiation (TBI) with volumetric modulated arc therapy (VMAT).
Two scripts were developed to facilitate autoplanning: the binary plug-in script automating the creation of optimization structures, plan generation, beam placement, and setting of the optimization constraints and the stand-alone executable performing successive optimizations. Ten patients previously treated in our clinic with VMAT TBI were used to evaluate the efficacy of the proposed autoplanning process. Paired t tests were used to compare the dosimetric indices of the produced auto plans to the manually generated clinical plans. In addition, 3 physicians were asked to evaluate the manual and autoplans for each patient in a blinded retrospective review.
No significant differences were observed between the manual and autoplan global D (P < .893), planning target volume V110% (P < .734), kidneys D (P < .351), and bowel D (P < .473). Significant decreases in the D to the lungs and lungs-1cm (ie, lungs with 1-cm inner margin) volumes of 5.4% ± 6.4% (P < .024) and 6.8% ± 7.4% (P < .017), respectively, were obtained with the autoplans compared with the manual plans. The autoplans were selected 77% of the time by the reviewing physicians as equivalent or superior to the manual plans. The required time for treatment planning was estimated to be 2 to 3 days for the manual plans compared with approximately 3 to 5 hours for the autoplans.
Large reductions in planning time without sacrificing plan quality were obtained using the developed autoplanning process compared with manual planning, thus reducing the required effort of the treatment planning team. Superior lung sparing with the same target coverage and similar global D were observed with the autoplans as compared with the manual treatment plans. The developed scripts have been made open-source to improve access to VMAT TBI at other institutions and clinics.
我们的目的是通过容积旋转调强放疗（VMAT）实现全身照射（TBI）的治疗计划自动化。
我们开发了两个脚本以实现自动计划：二进制插件脚本用于自动创建优化结构、计划生成、光束放置和优化约束设置，以及执行连续优化的独立可执行文件。我们使用十个先前在我们诊所接受 VMAT TBI 治疗的患者来评估所提出的自动计划过程的功效。采用配对 t 检验比较了生成的自动计划与手动生成的临床计划的剂量学指标。此外，我们要求 3 位医生在盲法回顾性审查中对每位患者的手动和自动计划进行评估。
手动和自动总剂量（D）（P＜.893）、计划靶区 V110%（P＜.734）、肾脏 D（P＜.351）和肠 D（P＜.473）无显著差异。与手动计划相比，自动计划使肺和肺 1cm（即肺内缘 1cm 处）体积的 D 降低了 5.4%±6.4%（P＜.024）和 6.8%±7.4%（P＜.017）。放射科医生有 77%的时间选择自动计划，认为其与手动计划等效或更优。与手动计划相比，自动计划的治疗计划所需时间估计为 2 至 3 天，而自动计划大约需要 3 至 5 小时。
与手动计划相比，使用开发的自动计划过程可显著减少计划时间，同时不牺牲计划质量，从而减少治疗计划团队的工作量。与手动治疗计划相比，自动计划可使肺部受量明显减少，同时保持相同的靶区覆盖和相似的总剂量。我们已经将开发的脚本开源，以提高其他机构和诊所对 VMAT TBI 的访问权限。
