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      Reducing variability among treatment machines using knowledge‐based planning for head and neck, pancreatic, and rectal cancer

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          Abstract

          Purpose

          This study aimed to assess dosimetric indices of RapidPlan model‐based plans for different energies (6, 8, 10, and 15 MV; 6‐ and 10‐MV flattening filter‐free), multileaf collimator (MLC) types (Millennium 120, High Definition 120, dual‐layer MLC), and disease sites (head and neck, pancreatic, and rectal cancer) and compare these parameters with those of clinical plans.

          Methods

          RapidPlan models in the Eclipse version 15.6 were used with the data of 28, 42, and 20 patients with head and neck, pancreatic, and rectal cancer, respectively. RapidPlan models of head and neck, pancreatic, and rectal cancer were created for TrueBeam STx (High Definition 120) with 6 MV, TrueBeam STx with 10‐MV flattening filter‐free, and Clinac iX (Millennium 120) with 15 MV, respectively. The models were used to create volumetric‐modulated arc therapy plans for a 10‐patient test dataset using all energy and MLC types at all disease sites. The Holm test was used to compare multiple dosimetric indices in different treatment machines and energy types.

          Results

          The dosimetric indices for planning target volume and organs at risk in RapidPlan model‐based plans were comparable to those in the clinical plan. Furthermore, no dose difference was observed among the RapidPlan models. The variability among RapidPlan models was consistent regardless of the treatment machines, MLC types, and energy.

          Conclusions

          Dosimetric indices of RapidPlan model‐based plans appear to be comparable to the ones based on clinical plans regardless of energies, MLC types, and disease sites. The results suggest that the RapidPlan model can generate treatment plans independent of the type of treatment machine.

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          Most cited references31

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          Experience-based quality control of clinical intensity-modulated radiotherapy planning.

          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. 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 δ = (mean dose-predicted dose)/predicted dose, the fraction by which the mean dose exceeded the model. All OARs under investigation (rectum and bladder in prostate cancer; parotid glands, esophagus, and larynx in head-and-neck cancer) exhibited both smaller δ and reduced variability after script implementation. These effects were substantial for the parotid glands, for which the previous δ = 0.28 ± 0.24 was reduced to δ = 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 δ = 0.28 ± 0.20 to δ = 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). This tool proved successful in increasing normal tissue sparing and reducing interclinician variability, providing effective quality control of the IMRT plan development process. Copyright © 2011 Elsevier Inc. All rights reserved.
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            On the pre-clinical validation of a commercial model-based optimisation engine: application to volumetric modulated arc therapy for patients with lung or prostate cancer.

            To evaluate the performance of a model-based optimisation process for volumetric modulated arc therapy applied to advanced lung cancer and to low risk prostate carcinoma patients.
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              Clinical validation and benchmarking of knowledge-based IMRT and VMAT treatment planning in pelvic anatomy.

              The aim of this work was to determine whether a commercial knowledge-based treatment planning (KBP) module can efficiently produce IMRT and VMAT plans in the pelvic region (prostate & cervical cancer), and to assess sensitivity of plan quality to training data and model parameters.
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                Author and article information

                Contributors
                hhideaki@kuhp.kyoto-u.ac.jp
                Journal
                J Appl Clin Med Phys
                J Appl Clin Med Phys
                10.1002/(ISSN)1526-9914
                ACM2
                Journal of Applied Clinical Medical Physics
                John Wiley and Sons Inc. (Hoboken )
                1526-9914
                20 June 2021
                July 2021
                : 22
                : 7 ( doiID: 10.1002/acm2.v22.7 )
                : 245-254
                Affiliations
                [ 1 ] Department of Radiation Oncology and Image‐applied Therapy Graduate School of Medicine Kyoto University Kyoto Japan
                [ 2 ] Division of Medical Physics, Department of Information Technology and Medical Engineering Faculty of Human Health Science Graduate School of Medicine Kyoto University Kyoto Japan
                Author notes
                [*] [* ] Author to whom correspondence should be addressed. Hideaki Hirashima

                E‐mail: hhideaki@ 123456kuhp.kyoto-u.ac.jp

                Author information
                https://orcid.org/0000-0003-1548-1970
                https://orcid.org/0000-0002-8135-8746
                Article
                ACM213316
                10.1002/acm2.13316
                8292706
                34151503
                e627902f-fa86-47cd-a72a-e5a0fceef247
                © 2021 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 May 2021
                : 23 January 2021
                : 17 May 2021
                Page count
                Figures: 3, Tables: 3, Pages: 10, Words: 6101
                Funding
                Funded by: Ministry of Education, Culture, Sports, Science and Technology of Japan
                Award ID: JP
                Award ID: 18K07700
                Categories
                Radiation Oncology Physics
                Radiation Oncology Physics
                Custom metadata
                2.0
                July 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.4 mode:remove_FC converted:21.07.2021

                different treatment machine,disease site,energy,knowledge‐based planning,multileaf collimator type

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