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Title: Experience-Based Quality Control of Clinical Intensity-Modulated Radiotherapy Planning

Abstract

Purpose: To incorporate a quality control tool, according to previous planning experience and patient-specific anatomic information, into the intensity-modulated radiotherapy (IMRT) plan generation process and to determine whether the tool improved treatment plan quality. Methods and Materials: A retrospective study of 42 IMRT plans demonstrated a correlation between the fraction of organs at risk (OARs) overlapping the planning target volume and the mean dose. This yielded a model, predicted dose = prescription dose (0.2 + 0.8 [1 - exp(-3 overlapping planning target volume/volume of OAR)]), that predicted the achievable mean doses according to the planning target volume overlap/volume of OAR and the prescription dose. The model was incorporated into the planning process by way of a user-executable script that reported the predicted dose for any OAR. The script was introduced to clinicians engaged in IMRT planning and deployed thereafter. The script's effect was evaluated by tracking {delta} = (mean dose-predicted dose)/predicted dose, the fraction by which the mean dose exceeded the model. Results: All OARs under investigation (rectum and bladder in prostate cancer; parotid glands, esophagus, and larynx in head-and-neck cancer) exhibited both smaller {delta} and reduced variability after script implementation. These effects were substantial for the parotid glands, formore » which the previous {delta} = 0.28 {+-} 0.24 was reduced to {delta} = 0.13 {+-} 0.10. The clinical relevance was most evident in the subset of cases in which the parotid glands were potentially salvageable (predicted dose <30 Gy). Before script implementation, an average of 30.1 Gy was delivered to the salvageable cases, with an average predicted dose of 20.3 Gy. After implementation, an average of 18.7 Gy was delivered to salvageable cases, with an average predicted dose of 17.2 Gy. In the prostate cases, the rectum model excess was reduced from {delta} = 0.28 {+-} 0.20 to {delta} = 0.07 {+-} 0.15. On surveying dosimetrists at the end of the study, most reported that the script both improved their IMRT planning (8 of 10) and increased their efficiency (6 of 10). Conclusions: This tool proved successful in increasing normal tissue sparing and reducing interclinician variability, providing effective quality control of the IMRT plan development process.« less

Authors:
 [1];  [2]; ;  [1]
  1. Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States)
  2. Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA (United States)
Publication Date:
OSTI Identifier:
21587718
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 81; Journal Issue: 2; Other Information: DOI: 10.1016/j.ijrobp.2010.11.030; PII: S0360-3016(10)03642-4; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BLADDER; ESOPHAGUS; HAZARDS; HEAD; LARYNX; NECK; NEOPLASMS; PROSTATE; QUALITY CONTROL; RADIATION DOSES; RADIOTHERAPY; RECTUM; BODY; CONTROL; DIGESTIVE SYSTEM; DISEASES; DOSES; GASTROINTESTINAL TRACT; GLANDS; INTESTINES; LARGE INTESTINE; MALE GENITALS; MEDICINE; NUCLEAR MEDICINE; ORGANS; RADIOLOGY; RESPIRATORY SYSTEM; THERAPY; URINARY TRACT

Citation Formats

Moore, Kevin L., E-mail: kmoore@radonc.wustl.edu, Brame, R. Scott, Low, Daniel A., and Mutic, Sasa. Experience-Based Quality Control of Clinical Intensity-Modulated Radiotherapy Planning. United States: N. p., 2011. Web. doi:10.1016/j.ijrobp.2010.11.030.
Moore, Kevin L., E-mail: kmoore@radonc.wustl.edu, Brame, R. Scott, Low, Daniel A., & Mutic, Sasa. Experience-Based Quality Control of Clinical Intensity-Modulated Radiotherapy Planning. United States. doi:10.1016/j.ijrobp.2010.11.030.
Moore, Kevin L., E-mail: kmoore@radonc.wustl.edu, Brame, R. Scott, Low, Daniel A., and Mutic, Sasa. Sat . "Experience-Based Quality Control of Clinical Intensity-Modulated Radiotherapy Planning". United States. doi:10.1016/j.ijrobp.2010.11.030.
@article{osti_21587718,
title = {Experience-Based Quality Control of Clinical Intensity-Modulated Radiotherapy Planning},
author = {Moore, Kevin L., E-mail: kmoore@radonc.wustl.edu and Brame, R. Scott and Low, Daniel A. and Mutic, Sasa},
abstractNote = {Purpose: To incorporate a quality control tool, according to previous planning experience and patient-specific anatomic information, into the intensity-modulated radiotherapy (IMRT) plan generation process and to determine whether the tool improved treatment plan quality. Methods and Materials: A retrospective study of 42 IMRT plans demonstrated a correlation between the fraction of organs at risk (OARs) overlapping the planning target volume and the mean dose. This yielded a model, predicted dose = prescription dose (0.2 + 0.8 [1 - exp(-3 overlapping planning target volume/volume of OAR)]), that predicted the achievable mean doses according to the planning target volume overlap/volume of OAR and the prescription dose. The model was incorporated into the planning process by way of a user-executable script that reported the predicted dose for any OAR. The script was introduced to clinicians engaged in IMRT planning and deployed thereafter. The script's effect was evaluated by tracking {delta} = (mean dose-predicted dose)/predicted dose, the fraction by which the mean dose exceeded the model. Results: All OARs under investigation (rectum and bladder in prostate cancer; parotid glands, esophagus, and larynx in head-and-neck cancer) exhibited both smaller {delta} and reduced variability after script implementation. These effects were substantial for the parotid glands, for which the previous {delta} = 0.28 {+-} 0.24 was reduced to {delta} = 0.13 {+-} 0.10. The clinical relevance was most evident in the subset of cases in which the parotid glands were potentially salvageable (predicted dose <30 Gy). Before script implementation, an average of 30.1 Gy was delivered to the salvageable cases, with an average predicted dose of 20.3 Gy. After implementation, an average of 18.7 Gy was delivered to salvageable cases, with an average predicted dose of 17.2 Gy. In the prostate cases, the rectum model excess was reduced from {delta} = 0.28 {+-} 0.20 to {delta} = 0.07 {+-} 0.15. On surveying dosimetrists at the end of the study, most reported that the script both improved their IMRT planning (8 of 10) and increased their efficiency (6 of 10). Conclusions: This tool proved successful in increasing normal tissue sparing and reducing interclinician variability, providing effective quality control of the IMRT plan development process.},
doi = {10.1016/j.ijrobp.2010.11.030},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 2,
volume = 81,
place = {United States},
year = {2011},
month = {10}
}