Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark.
Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
J Med Imaging Radiat Oncol. 2022 Mar;66(2):267-278. doi: 10.1111/1754-9485.13374.
A high-quality treatment plan aims to best achieve the clinical prescription, balancing high target dose to maximise tumour control against sufficiently low organ-at-risk dose for acceptably low toxicity. Treatment planning (TP) includes multiple steps from simulation/imaging and segmentation to technical plan production and reporting. Consistent quality across this process requires close collaboration and communication between clinical and technical experts, to clearly understand clinical requirements and priorities and also practical uncertainties, limitations and compromises. TP quality depends on many aspects, starting from commissioning and quality management of the treatment planning system (TPS), including its measured input data and detailed understanding of TPS models and limitations. It requires rigorous quality assurance of the whole planning process and it links to plan deliverability, assessable by measurement-based verification. This review highlights some factors influencing plan quality, for consideration for optimal plan construction and hence optimal outcomes for each patient. It also indicates some challenges, sources of difference and current developments. The topics considered include: the evolution of TP techniques; dose prescription issues; tools and methods to evaluate plan quality; and some aspects of practical TP. The understanding of what constitutes a high-quality treatment plan continues to evolve with new techniques, delivery methods and related evidence-based science. This review summarises the current position, noting developments in the concept and the need for further robust tools to help achieve it.
高质量的治疗计划旨在最好地实现临床处方，在最大化肿瘤控制的高目标剂量与可接受低毒性的足够低的器官风险剂量之间取得平衡。治疗计划（TP）包括从模拟/成像和分割到技术计划制作和报告的多个步骤。在这个过程中，临床和技术专家之间需要密切合作和沟通，以清楚地了解临床需求和优先级，以及实际的不确定性、限制和妥协，从而实现整个过程的质量一致。TP 质量取决于许多方面，从治疗计划系统（TPS）的委托和质量管理开始，包括其测量输入数据以及对 TPS 模型和限制的详细了解。它需要对整个规划过程进行严格的质量保证，并与可交付计划的能力相关联，可通过基于测量的验证进行评估。这篇综述强调了一些影响计划质量的因素，以供考虑最佳计划构建，从而为每个患者获得最佳结果。它还指出了一些挑战、差异来源和当前的发展。所考虑的主题包括：TP 技术的演变；剂量处方问题；评估计划质量的工具和方法；以及实际 TP 的一些方面。随着新技术、交付方法和相关循证科学的发展，高质量治疗计划的概念仍在不断发展。这篇综述总结了当前的情况，指出了概念的发展以及进一步开发强大工具的必要性，以帮助实现这一目标。
