SBRT planning for spinal metastasis: indications from a large multicentric study

Esposito, Marco; Masi, Laura; Zani, M.; Doro, R.; Fedele, David A.; Garibaldi, Cristina; Clemente, Stefania; Fiandra, C.; Giglioli, F.R.; Marino, C.; Orsingher, L.; Russo, S.; Stasi, M.; Strigari, Lidia; Villaggi, E.; Mancosu, P.

doi:10.1007/s00066-018-1383-2

Cited by 25 publications

(22 citation statements)

References 26 publications

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“…However, the Sequential optimizer has several limitations when managing MLC-based plans due to the use of segments with limited predefined shapes [10], the large memory required for the optimization and the long optimization time. VOLO was implemented to overcome these limitations and it is expected to offer, especially for [31][32][33][34][35][36][37][38] MLC plans, much shorter optimization time, to improve delivery efficiency and possibly to achieve a better plan quality especially for complex SBRT treatments. An evaluation of VOLO over MLC-based SBRT plans is therefore required.…”

Section: Discussionmentioning

confidence: 99%

“…Mathematical scores that combine dosimetric parameters have been proposed following different strategies [17,19,20,[29][30][31][32][33][34] and their use is highly recommended to objectively compare treatment plans [18]. In [33] a special index was defined to evaluate simultaneously plan modulation, PTV coverage and dose to heart for breast treatments; in [34] a quality index was defined combining PTV coverage, dose conformity, dose fall-off and the cord maximum dose for spinal cases. In the study by Akpati et al [29] and Licon et al [32] two indexes were defined measuring the deviations of the created plan with respect to an ideal plan.…”

Section: Discussionmentioning

confidence: 99%

“…These optimization process for complex plans where several objectives are necessary, can require an extremely long time. Moreover the optimization of delivery efficiency may require two additional optional steps: time reduction and beam/ [31][32][33][34][35][36][37][38] node reduction [15]. If a high delivery efficiency is required, these processes can lead to a deterioration of target coverage.…”

Section: Treatment Plans Optimizationmentioning

confidence: 99%

“…All plans were evaluated as clinically acceptable by both radiation [31][32][33][34][35][36][37][38] oncologists, who preferred VOLO solutions in 20/25 cases, basing their decision on target coverage, sparing of healthy tissues, dose conformity and low dose bath, and plan delivery efficiency. One observer preferred Sequential plans in 4/25 cases and expressed no preferences in 1 case, while the other observer selected the Sequential solution in 3/25 cases and had no preferences in 2/25 cases.…”

Section: Sequential and Volo Plans Comparison: Clinical Selectionmentioning

confidence: 99%

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Performance assessment of a new optimization system for robotic SBRT MLC-based plans

Calusi

Doro²,

Cataldo³

et al. 2020

Physica Medica

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A B S T R A C TPurpose: To assess the performance of a new optimization system, VOLO, for CyberKnife MLC-based SBRT plans in comparison with the existing Sequential optimizer. Methods: MLC-plans were created for 25 SBRT cases (liver, prostate, pancreas and spine) using both VOLO and Sequential. Monitor units (MU), delivery time (DT), PTV coverage, conformity (nCI), dose gradient (R50%) and OAR doses were used for comparison and combined to obtain a mathematical score (MS) of plan quality for each solution. MS strength was validated by changing parameter weights and by a blinded clinical plan evaluation. The optimization times (OT) and the average segment areas (SA) were also compared. Results: VOLO solutions offered significantly lower mean DT (−19%) and MU (−13%). OT were below 15 min for VOLO, whereas for Sequential, values spanned from 8 to 160 min. SAs were significantly larger for VOLO: on average 10 cm 2 versus 7 cm 2 . VOLO optimized plans achieved a higher MS than Sequential for all tested parameter combinations. PTV coverage and OAR sparing were comparable for both groups of solutions. Although slight differences in R50% and nCI were found, the parameters most affecting MS were MU and DT. VOLO solutions were selected in 80% of cases by both physicians with 88% inter-observer agreement. Conclusions: The good performance of the VOLO optimization system, together with the large reduction in OT, make it a useful tool to improve the efficiency of CK SBRT planning and delivery. The proposed methodology for comparing different planning solutions can be applied in other contexts.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Treatment Plans Optimizationmentioning

confidence: 99%

Section: Sequential and Volo Plans Comparison: Clinical Selectionmentioning

confidence: 99%

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Performance assessment of a new optimization system for robotic SBRT MLC-based plans

Calusi

Doro²,

Cataldo³

et al. 2020

Physica Medica

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“…Treatment planning techniques (e.g., coplanar vs. non-coplanar techniques including table angle selection [157] and number of fields or beam energy) are strongly method dependent and significantly influence the treatment plan quality [155,156,[163][164][165][166]. While this has been investigated for numerous indications and well-described methods exist to improve treatment planning [167], center or even user credentialing for stereotactic radiotherapy is still lacking in Germany.…”

Section: Discussionmentioning

confidence: 99%

Technological quality requirements for stereotactic radiotherapy

et al. 2020

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This review details and discusses the technological quality requirements to ensure the desired quality for stereotactic radiotherapy using photon external beam radiotherapy as defined by the DEGRO Working Group Radiosurgery and Stereotactic Radiotherapy and the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The covered aspects of this review are 1) imaging for target volume definition, 2) patient positioning and target volume localization, 3) motion management, 4) collimation of the irradiation and beam directions, 5) dose calculation, 6) treatment unit accuracy, and 7) dedicated quality assurance measures. For each part, an expert review for current state-of-the-art techniques and their particular technological quality requirement to reach the necessary accuracy for stereotactic radiotherapy divided into intracranial stereotactic radiosurgery in one single fraction (SRS), intracranial fractionated stereotactic radiotherapy (FSRT), and extracranial stereotactic body radiotherapy (SBRT) is presented. All recommendations and suggestions for all mentioned aspects of stereotactic radiotherapy are formulated and related uncertainties and potential sources of error discussed. Additionally, further research and development needs in terms of insufficient data and unsolved problems for stereotactic radiotherapy are identified, which will serve as The authors D. Schmitt and O. Blanck contributed equally to the manuscript.

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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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SBRT planning for spinal metastasis: indications from a large multicentric study

Cited by 25 publications

References 26 publications

Performance assessment of a new optimization system for robotic SBRT MLC-based plans

Performance assessment of a new optimization system for robotic SBRT MLC-based plans

Technological quality requirements for stereotactic radiotherapy

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

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