Objective: To evaluate and quantify the planning performance of automatic planning (AP) with manual planning (MP) for nasopharyngeal carcinoma in the RayStation treatment planning system (TPS). Methods: A progressive and effective design method for AP of nasopharyngeal carcinoma was realized through automated scripts in this study. A total of 30 patients with nasopharyngeal carcinoma with initial treatment was enrolled. The target coverage, conformity index (CI), homogeneity index (HI), organs at risk sparing, and the efficiency of design and execution were compared between automatic and manual volumetric modulated arc therapy (VMAT) plans. Results: The results of the 2 design methods met the clinical dose requirement. The differences in D95 between the 2 groups in PTV1 and PTV2 showed statistical significance, and the MPs are higher than APs, but the difference in absolute dose was only 0.21% and 0.16%. The results showed that the conformity index of planning target volumes (PTV1, PTV2, PTVnd and PGTVnx+rpn [PGTVnx and PGTVrpn]), homogeneity index of PGTVnx+rpn, and HI of PTVnd in APs are better than that in MPs. For organs at risk, the APs are lower than the MPs, and the difference was statistically significant ( P < .05). The manual operation time in APs was 83.21% less than that in MPs, and the computer processing time was 34.22% more. Conclusion: IronPython language designed by RayStation TPS has clinical application value in the design of automatic radiotherapy plan for nasopharyngeal carcinoma. The dose distribution of tumor target and organs at risk in the APs was similar or better than those in the MPs. The time of manual operation in the plan design showed a sharp reduction, thus significantly improving the work efficiency in clinical application.
Purpose: To propose a multi-output fully convolutional network (MOFCN) to segment bilateral lung, heart and spinal cord in the planning thoracic computed tomography (CT) slices automatically and simultaneously. Methods: The MOFCN includes two components: one main backbone and three branches. The main backbone extracts the features about lung, heart and spinal cord. The extracted features are transferred to three branches which correspond to three organs respectively. The longest branch to segment spinal cord is nine layers, including input and output layers. The MOFCN was evaluated on 19,277 CT slices from 966 patients with cancer in the thorax. In these slices, the organs at risk (OARs) were delineated and validated by experienced radiation oncologists, and served as ground truth for training and evaluation. The data from 61 randomly chosen patients were used for training and validation. The remaining 905 patients’ slices were used for testing. The metric used to evaluate the similarity between the auto-segmented organs and their ground truth was Dice. Besides, we compared the MOFCN with other published models. To assess the distinct output design and the impact of layer number and dilated convolution, we compared MOFCN with a multi-label learning model and its variants. By analyzing the not good performances, we suggested possible solutions. Results: MOFCN achieved Dice of 0.95 ± 0.02 for lung, 0.91 ± 0.03 for heart and 0.87 ± 0.06 for spinal cord. Compared to other models, MOFCN could achieve a comparable accuracy with the least time cost. Conclusion: The results demonstrated the MOFCN’s effectiveness. It uses less parameters to delineate three OARs simultaneously and automatically, and thus shows a relatively low requirement for hardware and has potential for broad application.
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