Clinical acceptability of fully automated external beam radiotherapy for cervical cancer with three different beam delivery techniques

Abstract

Purpose To fully automate CT‐based cervical cancer radiotherapy by automating contouring and planning for three different treatment techniques. Methods We automated three different radiotherapy planning techniques for locally advanced cervical cancer: 2D 4‐field‐box (4‐field‐box), 3D conformal radiotherapy (3D‐CRT), and volumetric modulated arc therapy (VMAT). These auto‐planning algorithms were combined with a previously developed auto‐contouring system. To improve the quality of the 4‐field‐box and 3D‐CRT plans, we used an in‐house, field‐in‐field (FIF) automation program. Thirty‐five plans were generated for each technique on CT scans from multiple institutions and evaluated by five experienced radiation oncologists from three different countries. Every plan was reviewed by two of the five radiation oncologists and scored using a 5‐point Likert scale. Results Overall, 87%, 99%, and 94% of the automatically generated plans were found to be clinically acceptable without modification for the 4‐field‐box, 3D‐CRT, and VMAT plans, respectively. Some customizations of the FIF configuration were necessary on the basis of radiation oncologist preference. Additionally, in some cases, it was necessary to renormalize the plan after it was generated to satisfy radiation oncologist preference. Conclusion Approximately, 90% of the automatically generated plans were clinically acceptable for all three planning techniques. This fully automated planning system has been implemented into the radiation planning assistant for further testing in resource‐constrained radiotherapy departments in low‐ and middle‐income countries.

Hazard testing to reduce risk in the development of automated planning tools

“…The RPA is a web‐based system that uses artificial intelligence to simplify the planning process. The current version of the RPA can create plans for treating cancers of the head and neck, chest wall, cervix, and whole brain, with more sites under development 19–28 …”

“…The current version of the RPA can create plans for treating cancers of the head and neck, chest wall, cervix, and whole brain, with more sites under development. [19][20][21][22][23][24][25][26][27][28] For the RPA to generate treatment plans, the user must input a computed tomography (CT) scan and the prescription information for each patient. That information is then verified by the users to ensure that it matches the intended final treatment plan before the RPA begins the automated planning process.…”

Automatic end‐to‐end VMAT treatment planning for rectal cancers

“…10 Previous study has also explored producing clinically acceptable VMAT plans automatically for cervical cancers based on automatically segmented contours. 11 The goal of this project was to assess whether the entire VMAT planning process, including both segmentation and plan optimization, could be automated to achieve high clinical acceptability without user interventions for rectal cancers, using a 3D CNN architecture and an automated RapidPlan program. The study examined the quality of plans generated based on autosegmentations and evaluated holistically the feasibility and clinical impacts of using an end-to-end system in producing consistent and clinically acceptable plans, all based on extensive physician evaluations.…”

“…showed that RapidPlan can be used to achieve high‐quality automated plans consistently, even for challenging disease sites such as head‐and‐neck regions 10 . Previous study has also explored producing clinically acceptable VMAT plans automatically for cervical cancers based on automatically segmented contours 11 …”

“… 10 Previous study has also explored producing clinically acceptable VMAT plans automatically for cervical cancers based on automatically segmented contours. 11 …”