Radiotherapy Treatment plannINg study Guidelines (RATING): A framework for setting up and reporting on scientific treatment planning studies

Hansen, Christian Rønn; Crijns, Wouter; Hussein, Mohammad; Rossi, L.; Gallego, P.; Verbakel, Wilko F.A.R.; Unkelbach, Jan; Thwaites, David; Heijmen, B.

doi:10.1016/j.radonc.2020.09.033

Cited by 91 publications

(66 citation statements)

References 21 publications

(31 reference statements)

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“…Finally, plan parameter differences were analyzed. In line with the recently published RATING guidelines for planning studies ( 28 ), recommending the provision of a complete overview of dose differences, apart from the clinically evaluated plan parameters, we also evaluated and compared D mean for both rectum and bladder, V 40GyEq and V 60GyEq (2 Gy/fx equivalent dose, i.e., V 22.9Gy and V 29.2Gy , respectively) for rectum, as suggested by QUANTEC ( 27 ), as well as the dose bath, looking at patient volumes receiving > 30, > 20, > 10, > 5 and > 2 Gy. Paired two-sided Wilcoxon signed-rank tests were performed to assess clinical significance of observed differences ( p < 0.05).…”

Section: Methodssupporting

confidence: 55%

Complementing Prostate SBRT VMAT With a Two-Beam Non-Coplanar IMRT Class Solution to Enhance Rectum and Bladder Sparing With Minimum Increase in Treatment Time

et al. 2021

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PurposeEnhance rectum and bladder sparing in prostate SBRT with minimum increase in treatment time by complementing dual-arc coplanar VMAT with a two-beam non-coplanar IMRT class solution (CS).MethodsFor twenty patients, an optimizer for automated multi-criterial planning with integrated beam angle optimization (BAO) was used to generate dual-arc VMAT plans, supplemented with five non-coplanar IMRT beams with individually optimized orientations (VMAT+5). In all plan generations, reduction of high rectum dose had the highest priority after obtaining adequate PTV coverage. A CS with two most preferred directions in VMAT+5 and largest rectum dose reductions compared to dual-arc VMAT was then selected to define VMAT+CS. VMAT+CS was compared with automatically generated i) dual-arc coplanar VMAT plans (VMAT), ii) VMAT+5 plans, and iii) IMRT plans with 30 patient-specific non-coplanar beam orientations (30-NCP). Plans were generated for a 4 x 9.5 Gy fractionation scheme. Differences in PTV doses, healthy tissue sparing, and computation and treatment delivery times were quantified.ResultsFor equal PTV coverage, VMAT+CS, consisting of dual-arc VMAT supplemented with two fixed, non-coplanar IMRT beams with fixed Gantry/Couch angles of 65°/30° and 295°/-30°, significantly reduced OAR doses and the dose bath, compared to dual-arc VMAT. Mean relative differences in rectum Dmean, D1cc, V40GyEq and V60GyEq were 19.4 ± 10.6%, 4.2 ± 2.7%, 34.9 ± 20.3%, and 39.7 ± 23.2%, respectively (all p<0.001). There was no difference in bladder D1cc, while bladder Dmean reduced by 17.9 ± 11.0% (p<0.001). Also, the clinically evaluated urethra D5%, D10%, and D50% showed small, but statistically significant improvements. All patient VX with X = 2, 5, 10, 20, and 30 Gy were reduced with VMAT+CS, with a maximum relative reduction for V10Gy of 19.0 ± 7.3% (p<0.001). Total delivery times with VMAT+CS only increased by 1.9 ± 0.7 min compared to VMAT (9.1 ± 0.7 min). The dosimetric quality of VMAT+CS plans was equivalent to VMAT+5, while optimization times were reduced by a factor of 25 due to avoidance of individualized BAO. Compared to VMAT+CS, the 30-NCP plans were only favorable in terms of dose bath, at the cost of much enhanced optimization and delivery times.ConclusionsThe proposed two-beam non-coplanar class solution to complement coplanar dual-arc VMAT resulted in substantial plan quality improvements for OARs (especially rectum) and reduced irradiated patient volumes with minor increases in treatment delivery times.

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Section: Methodssupporting

confidence: 55%

Complementing Prostate SBRT VMAT With a Two-Beam Non-Coplanar IMRT Class Solution to Enhance Rectum and Bladder Sparing With Minimum Increase in Treatment Time

et al. 2021

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“…The RATING guidelines for treatment planning studies [41] were used for preparing the manuscript. Two authors (RB, LR) Pre-clinical validation of novel autoplanning system independently arrived at RATING scores of 79% and 83%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Pre-clinical validation of a novel system for fully-automated treatment planning

Bijman¹,

Sharfo²,

Rossi³

et al. 2021

Radiotherapy and Oncology

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Introduction: Many approaches for automated treatment planning (autoplanning) have been proposed and investigated. Autoplanning can enhance plan quality compared to 'manual' trial-and-error planning, and decrease routine planning workload. A few approaches have been implemented in commercial treatment planning systems (TPSs). We performed a pre-clinical validation of a new system ('NovelATP') that is based on fully-automated multi-criterial optimization (MCO). The aim of NovelATP is to automatically generate for each patient a single high-quality, Pareto-optimal plan without manual Pareto navigation. Material and methods: Validation was performed by generating VMAT/IMRT plans for conventional treatment of prostate cancer (101 pts), prostate SBRT (20 pts), bilateral head-and-neck cancer (50 pts) and rectal cancer treated at an MR-Linac (23 pts). NovelATP autoplans were compared to plans that were generated with our in-house autoplanning system. In many previous validation studies, the latter system consistently showed enhanced plan quality when compared to manual planning. Results: Dosimetrical differences between NovelATP and benchmark plans were on average small and presumably not clinically relevant, pointing at high NovelATP dosimetric plan quality. MUs were 11-19% higher with NovelATP. NovelATP delivery times were up to 12% longer. Overall, there was a slight disadvantage for NovelATP regarding gamma analyses. Calculation times for NovelATP plans were between 29 and 151 min with no overall differences with the benchmark plans. Conclusion:The new autoplanning system was able to produce high-quality plans for four highly different planning protocols/treatment sites with a total of 194 patients investigated.

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“…Writing of the manuscript was steered by the RATING guidelines for treatment planning [32]. The authors concluded that the RATING score was 86%.…”

Section: Discussionmentioning

confidence: 99%

Model based patient pre-selection for intensity-modulated proton therapy (IMPT) using automated treatment planning and machine learning

Kouwenberg

Penninkhof

Habraken

et al. 2021

Radiotherapy and Oncology

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Background and purpose: Patient selection for intensity modulated proton therapy (IMPT), using comparative photon therapy planning, is workload-intensive and time-consuming. Pre-selection aims at avoidance of manual IMPT planning for patients that are in the end ineligible. We investigated the use of machine learning together with automated IMPT treatment planning for pre-selection of head and neck cancer patients, and validated the methodology for the Dutch model based selection (MBS) approach. Materials & methods: For forty-five head and neck patients with a previous MBS, an IMPT plan was generated with non-clinical, fully-automated planning. Dosimetric differences of these plans with the corresponding previously generated photon plans, and the outcomes of the former MBS, were used to train a Gaussian naïve Bayes classifier for MBS outcome prediction. During training, strong emphasis was placed on avoiding misclassification of IMPT eligible patients (i.e. false negatives). Results: Pre-selection with the classifier resulted in 0 false negatives, 12 (27%) true negatives, 27 (60%) true positives, and only 6 (13%) false positive predictions. Using this pre-selection, the number of formal selection procedures with involved manual IMPT planning that resulted in a negative outcome could be reduced by 67%. Conclusion: With pre-selection, using machine learning and automated treatment planning, the percentage of patients with unnecessary manual IMPT planning for MBS could be drastically reduced, thereby saving costs, labor and time. With the developed approach, larger patient populations can be screened, and likely bias in pre-selection of patients can be mitigated by assisting the physician during patient pre-selection.

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Radiotherapy Treatment plannINg study Guidelines (RATING): A framework for setting up and reporting on scientific treatment planning studies

Cited by 91 publications

References 21 publications

Complementing Prostate SBRT VMAT With a Two-Beam Non-Coplanar IMRT Class Solution to Enhance Rectum and Bladder Sparing With Minimum Increase in Treatment Time

Complementing Prostate SBRT VMAT With a Two-Beam Non-Coplanar IMRT Class Solution to Enhance Rectum and Bladder Sparing With Minimum Increase in Treatment Time

Pre-clinical validation of a novel system for fully-automated treatment planning

Model based patient pre-selection for intensity-modulated proton therapy (IMPT) using automated treatment planning and machine learning

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