AOU Careggi, Medical Physic Unit, Florence, Italy.
AOU Careggi, Medical Physic Unit, Florence, Italy.
Phys Med. 2022 Jun;98:122-130. doi: 10.1016/j.ejmp.2022.05.001. Epub 2022 May 7.
To implement a semi-automatic planning technique for whole breast irradiation with two tangential IMRT fields and to test the produced dose distribution against clinical 3DCRT plans, for introducing the technique in clinical practice.
The Auto-Planning module of the Pinnacle (Philips) treatment planning system was used for generating a Treatment Technique on left-sided breast cancer patients treated in free breathing or in deep inspiration breath hold (DIBH) and to right-sided breast cancer patients. The technique was evaluated against 3DCRT clinical plans in terms of dosimetric plan parameters. Plan robustness toward patient displacements was assessed on a subset of patients by inducing shifts to the isocenter.
A statistically significant improvement in target coverage and dose homogeneity was observed for autoIMRT. No statistically significant differences were observed for ipsilateral organs, except for the ipsilateral lung in left DIBH, where slightly lower D and V are registered for autoIMRT. Slightly higher D doses (although far below the constraints) to contralateral organs were observed for autoIMRT plans. AutoIMRT plans were shown to be as robust as 3DCRT plans toward isocenter shifts, with a maximum decrease in CTV coverage of -2.2% and -2.1% for autoIMRT and 3DCRT, respectively. Average planning times were 40 min for 3DCRT and 6 min for IMRT plans.
The developed autoIMRT technique was proven to be advantageous for target coverage and homogeneity and sufficiently robust towards isocenter displacements. The use of automated planning consistently reduces the planning workload with improvements in plan quality.
为了在两个切线调强放疗（IMRT）野中实现全乳照射的半自动计划技术，并将产生的剂量分布与临床 3DCRT 计划进行比较，以将该技术引入临床实践。
使用 Pinnacle（飞利浦）治疗计划系统的 Auto-Planning 模块为左侧乳腺癌患者在自由呼吸或深吸气屏气（DIBH）下以及右侧乳腺癌患者生成治疗技术。从剂量学计划参数方面，将该技术与 3DCRT 临床计划进行了评估。通过诱导等中心点移位，对一部分患者进行了计划稳健性评估。
与 3DCRT 相比，自动调强放疗在靶区覆盖和剂量均匀性方面有显著改善。同侧器官除了左侧 DIBH 中的同侧肺外，没有观察到统计学差异，在左侧 DIBH 中，自动调强放疗的 D 和 V 略低。对侧器官的 D 剂量略高（尽管远低于限制），但观察到自动调强放疗计划。自动调强放疗计划在等中心点移位方面与 3DCRT 计划一样稳健，CTV 覆盖率的最大下降分别为-2.2%和-2.1%，用于自动调强放疗和 3DCRT。3DCRT 计划的平均规划时间为 40 分钟，IMRT 计划的平均规划时间为 6 分钟。
所开发的自动调强放疗技术在靶区覆盖和均匀性方面具有优势，并且对等中心点位移具有足够的稳健性。自动化计划的使用可以持续减少规划工作量，并提高计划质量。
