Plan quality assessment in clinical practice: Results of the 2020 ESTRO survey on plan complexity and robustness

A novel dose fall‐off index and preliminary application in brain and lung stereotactic radiotherapy

“…To date, the incorporation of complexity indexes into optimization algorithms has not been realized. Controlling the number of monitor units was the most frequently mentioned method to restrict and evaluate plan complexity, according to the 2020 ESTRO survey 34 . It was difficult for physicists to use current dosimetric indexes to evaluate plan complexity.…”

Assessment of Set-Up Error in Three-Dimensional Conformal Radiotherapy (3-Dcrt) During the Treatment of Patients With Prostate or Bladder Cancers in Ayadi El-Mostakbal Hospital (Alexandria, Egypt)

“…It is evident now that margins are inadequate and there is an international need for both improved commercial tools to control and evaluate plan complexity and robustness towards relevant uncertainties and international guidelines on how to manage plan complexity and robustness in the different steps of the RT workflow [34].…”

Multi-institutional generalizability of a plan complexity machine learning model for predicting pre-treatment quality assurance results in radiotherapy

“…Volumetric modulated arc therapy (VMAT) is currently a state-of-the-art technique for the treatment of different tumour sites by providing a highly conformal dose distribution to the target volume while minimizing the dose deposition in the surrounding organs at risk (OARs) [1] . Despite its advantages compared to previous techniques, the creation of deliverable VMAT plans involves repeatedly solving a large-scale modulation problem with iteratively updated treatment parameters, which in parallel may lead to an (unnecessary) increase in treatment plan complexity [2] . Although a certain degree of complexity may be required to achieve an acceptable dose distribution, it has been reported that increasing plan complexity may lead to higher uncertainties both in dose calculation and in treatment delivery due to limitations in the calculation algorithm or in the defined beam model [2] .…”

“…Despite its advantages compared to previous techniques, the creation of deliverable VMAT plans involves repeatedly solving a large-scale modulation problem with iteratively updated treatment parameters, which in parallel may lead to an (unnecessary) increase in treatment plan complexity [2] . Although a certain degree of complexity may be required to achieve an acceptable dose distribution, it has been reported that increasing plan complexity may lead to higher uncertainties both in dose calculation and in treatment delivery due to limitations in the calculation algorithm or in the defined beam model [2] . In addition, the dose accuracy can be further influenced by mechanical uncertainties as well as patient’s position.…”

“…However, there are still challenges in this RT field and the clinical implementation of methods to control and evaluate plan complexity is very heterogeneous across different RT centres according to the results of a 2020 ESTRO survey [2] . Different PCMs that focus on different plan parameters give different results and there is no clear consensus which ones should be used, and which tolerance level should be assigned.…”