Development and evaluation of a three-step automatic planning technique for lung SBRT based on performance examination of advanced settings in Pinnacle's auto-planning module.

The benefits of Pinnacle's auto-planning module on clinical practice have been well documented. However, little is known regarding the efficiency of its Advanced Settings and the practicality of incorporating this module into Stereotactic Body Radiation Therapy (SBRT), which is why this research was conducted. To characterize the impact of Advanced Settings on plan quality, a total of 25 previously delivered postoperative cervical cases were re-planned and evaluated. Then a three-step automatic planning technique was developed and tested on ten lung SBRT cases based on the investigation. The differences between plans with fine-tuned Advanced Settings and the default were compared using a Wilcoxon signed-rank test with a significance threshold of 5%. The same statistical analysis was implemented to examine the quality variations in manual and automatic SBRT planning. When the Tuning Balance, Dose Fall-Off Margin, and Hot-Spot Maximum Goal were set to 100%, 1 cm, and 250%, respectively, better organ-at-risk (OAR) sparing was reached, but target quality was compromised. The OAR dose reduction and target homogeneity deterioration showed a strong correlation. The three-step methodology improved high dose spillage while saving time, with statistically significant reductions of 66.7% in V105% of non-PTV and 58.1% in planning time to the human-driven strategy. Except for urgent requirements for sparing OARs or processing SBRT plans, keeping the default is appropriate for Advanced Settings. The three-step methodology automatically searches for the available solution with purposeful Advanced Settings adjustments, demonstrating its ability to produce high-quality plans in less time. For the inexperienced or under-resourced clinics, our procedure can be introduced as a robust and handy strategy in SBRT, notably for expedited quality planning.