Plan quality improvement by DVH sharing and planner’s experience: Results of a SBRT multicentric planning study on prostate

Villaggi, E.; Hernández, Víctor; Fusella, M.; Moretti, E.; Russo, S.; Vaccara, E.M.L.; Nardiello, B.; Esposito, Marco; Saez, Jordi; Cilla, Savino; Marino, C.; Stasi, M.; Mancosu, P.

doi:10.1016/j.ejmp.2019.05.003

Cited by 29 publications

(26 citation statements)

References 62 publications

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“…In the optimization II, the planners visualized the previous DVH curves (a, b) to optimize the target (c) and rectum curves (d). Modified from Villaggi et al 21 approach. 44 Lean principles engage health-care professionals to improve safety and quality in the provided services.…”

Section: Discussionmentioning

confidence: 99%

“…In detail, 15 full papers. [19][20][21][22][23][28][29][30][31][32][34][35][36]38,40 5 reviews, 18,27,33,37,41 1 editorial, 25 and 3 letters to the editor 24,26,39 were published. A total of more than 100 medical physicists were authors of at least one article, showing high level of members' engagement.…”

Section: B Engagement Metricsmentioning

confidence: 99%

“…Moreover, in these years, the WG performed many international activities (Supplementary Material, Section D), including a couple of collaborations with Germany and Spain. 18,21 3.C. Optimization goal: Small field dosimetry standardization Among the goals of the WG, a reduction of systematic errors in small field output factor evaluation emerged as a prior factor to be analyzed and addressed.…”

Section: B Engagement Metricsmentioning

confidence: 99%

“…23 Furthermore, an analysis of the planner experience was assessed on prostate SBRT over 13 centers. 21 Many parameters were considered. Planner's experience in prostate SBRT was correlated with dosimetric parameters in the awareness phase.…”

Section: D Optimization Goal: Planning Standardizationmentioning

confidence: 99%

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Lean Thinking to manage a national working group on physics aspects of Stereotactic Body Radiation Therapy

Mancosu

Russo

Antonucci³

et al. 2021

Medical Physics

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To report how the adoption of a Lean Thinking mindset in the management of a national working group (WG) on the physics of stereotactic body radiation therapy (SBRT) contributed to achieve SBRT standardization objectives. Methods: Vision for the WG has been established as fragmentation reduction and process harmonization enhancement in SBRT for Italian centers. Two main research themes of the technical aspects of SBRT emerged as areas with major standardization improvement needs, small field dosimetry and SBRT planning comparisons, to be investigated through multi-institutional studies. The management of the WG leveraged on the Lean concept of fostering self-organization in a non-hierarchical environment. Four progressive involvement levels were defined for each study. No specific "scientific" preexperience was required to propose and coordinate a project, just requiring a voluntary commitment. People engagement was measured in terms of number of published articles. The standardization goals have been conducted through a simplified "5S" (Sort, Set in Order, Shine, Standardize, and Sustain) methodology, first considering a phase of awareness (the first three "S"), then identifying and implementing standardization actions (the last two "S"). Results: Since the beginning, 157 medical physicists joined the AIFM/SBRT-WG. Twenty-four papers/reviews/letters have been published in the period 2014-2019 on major radiation oncology journals, authored by >100 physicists (>50% working in small hospitals). Six over 12 first authors worked in peripheral/small hospitals, with no prior publication as first author. These studies contributed to the awareness and standardization phases for both small-field dosimetry and planning. In particular, errors in small-field measurements in 8% of centers were detected thanks to a generalized output factor curve in function of the effective field size created by averaging data available from different Linacs. Furthermore, planner's experience in SBRT was correlated with dosimetric parameters in the awareness phase; while sharing median dose volume histograms (DVHs) reduced variability among centers while keeping the same level of plan complexity. Finally, all the dosimetric parameters statistically significant to the planner experience during the awareness phase, were no longer significantly different in the standardization phase. Conclusions: The experience of our SBRT-WG has shown how a Lean Thinking mindset could foster the SBRT procedure standardization and spread the physics of SBRT knowledge, enhancing personal growth. Our expectation is to inspire other scientific societies that have to deal with fragmented contexts or pursue processes harmonization through Lean principles.

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Section: Discussionmentioning

confidence: 99%

Section: B Engagement Metricsmentioning

confidence: 99%

Section: B Engagement Metricsmentioning

confidence: 99%

Section: D Optimization Goal: Planning Standardizationmentioning

confidence: 99%

See 2 more Smart Citations

Lean Thinking to manage a national working group on physics aspects of Stereotactic Body Radiation Therapy

Mancosu

Russo

Antonucci³

et al. 2021

Medical Physics

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“…Villaggi et al evaluated other plan metrics such as PI (Plan Irregularity: deviations in field aperture shape compared to a circle) and MIt (Modulation Index total, which considers variations in gantry speed and acceleration, dose rate variation, etc.) Evaluating additional plan complexity metrics in the current study might have revealed stronger correlations between plan characteristics and the dosimetric impact of motion.…”

Section: Discussionmentioning

confidence: 99%

Dose deviations induced by respiratory motion for radiotherapy of lung tumors: Impact of CT reconstruction, plan complexity, and fraction size

Sande

Roa

Hellebust

2020

J Applied Clin Med Phys

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A thorax phantom was used to assess radiotherapy dose deviations induced by respiratory motion of the target volume. Both intensity modulated and static, non-modulated treatment plans were planned on CT scans of the phantom. The plans were optimized using various CT reconstructions, to investigate whether they had an impact on robustness to target motion during delivery. During irradiation, the target was programmed to simulate respiration-induced motion of a lung tumor, using both patient-specific and sinusoidal motion patterns in three dimensions. Dose was measured in the center of the target using an ion chamber. Differences between reference measurements with a stationary target and dynamic measurements were assessed. Possible correlations between plan complexity metrics and measured dose deviations were investigated. The maximum observed motion-induced dose differences were 7.8% and 4.5% for single 2 Gy and 15 Gy fractions, respectively. The measurements performed with the largest target motion amplitude in the superiorinferior direction yielded the largest dosimetric deviations. For 2 Gy fractionation schemes, the summed dose deviation after 33 fractions is likely to be less than 2%.Measured motion-induced dose deviations were significantly larger for one CT reconstruction compared to all the others. Static, non-modulated plans showed superior robustness to target motion during delivery. Moderate correlations between the modulation complexity score applied to VMAT (MCSv) and measured dose deviations were found for 15 Gy SBRT treatment plans. Correlations between other plan complexity metrics and measured dose deviations were not found. K E Y W O R D S complexity, interplay, lung, radiotherapy, SBRT, VMAT

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

Hirashima

Nakamura

Mukumoto

et al. 2021

J Applied Clin Med Phys

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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 filterfree), multileaf collimator (MLC) types (Millennium 120, High Definition 120, duallayer 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 10patient 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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Plan quality improvement by DVH sharing and planner’s experience: Results of a SBRT multicentric planning study on prostate

Cited by 29 publications

References 62 publications

Lean Thinking to manage a national working group on physics aspects of Stereotactic Body Radiation Therapy

Lean Thinking to manage a national working group on physics aspects of Stereotactic Body Radiation Therapy

Dose deviations induced by respiratory motion for radiotherapy of lung tumors: Impact of CT reconstruction, plan complexity, and fraction size

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

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