The feasibility of using Pareto fronts for comparison of treatment planning systems and delivery techniques

Ottosson, R.; Engström, Per; Sjöstrøm, D.; Behrens, C.F.; Karlsson, Anna; Knöös, Tommy; Ceberg, Crister

doi:10.1080/02841860802251559

Cited by 49 publications

(35 citation statements)

References 13 publications

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“…To definitively verify this claim, one needs to formally demonstrate that the resulting plans are Pareto‐optimal (i.e., no objective can be improved upon without simultaneously sacrificing at least one other) (27) . This task is formidable (28) even with the proposed reduction in the number of evaluated plans, 29 , 30 and typically five or fewer dose objectives were considered in the cited references. Therefore Pareto analysis, particularly exhaustive in terms of the structures, was beyond the scope of the current practical study.…”

Section: Discussionmentioning

confidence: 99%

Initial evaluation of automated treatment planning software

Gintz

Latifi

Caudell

et al. 2016

J Applied Clin Med Phys

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Even with advanced inverse‐planning techniques, radiation treatment plan optimization remains a very time‐consuming task with great output variability, which prompted the development of more automated approaches. One commercially available technique mimics the actions of experienced human operators to progressively guide the traditional optimization process with automatically created regions of interest and associated dose‐volume objectives. We report on the initial evaluation of this algorithm on 10 challenging cases of locoreginally advanced head and neck cancer. All patients were treated with VMAT to 70 Gy to the gross disease and 56 Gy to the elective bilateral nodes. The results of post‐treatment autoplanning (AP) were compared to the original human‐driven plans (HDP). We used an objective scoring system based on defining a collection of specific dosimetric metrics and corresponding numeric score functions for each. Five AP techniques with different input dose goals were applied to all patients. The best of them averaged the composite score 8% lower than the HDP, across the patient population. The difference in median values was statistically significant at the 95% confidence level (Wilcoxon paired signed‐rank test p=0.027). This result reflects the premium the institution places on dose homogeneity, which was consistently higher with the HDPs. The OAR sparing was consistently better with the APs, the differences reaching statistical significance for the mean doses to the parotid glands (p<0.001) and the inferior pharyngeal constrictor (p=0.016), as well as for the maximum doses to the spinal cord (p=0.018) and brainstem (p=0.040). If one is prepared to accept less stringent dose homogeneity criteria from the RTOG 1016 protocol, nine APs would comply with the protocol, while providing lower OAR doses than the HDPs. Overall, AP is a promising clinical tool, but it could benefit from a better process for shifting the balance between the target dose coverage/homogeneity and OAR sparing.PACS number(s): 87.55.D

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Section: Discussionmentioning

confidence: 99%

Initial evaluation of automated treatment planning software

Gintz

Latifi

Caudell

et al. 2016

J Applied Clin Med Phys

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“…7 In this study Pareto fronts are used to compare plans generated in SharePlan to plans generated in the TomoTherapy system and plans generated in the TPS (Oncentra® MasterPlan) used for IMRT planning in our clinic (henceforth referred to as "clinical TPS"). Optimized plans were generated for three prostate cases ( Figure 1) and for three head and neck (H&N) cases, receiving the treatment with a simultaneously integrated boost (SIB) technique (Figure 2).…”

Section: Iia Plan Comparisonmentioning

confidence: 99%

Conversion of helical tomotherapy plans to step-and-shoot IMRT plans-Pareto front evaluation of plans from a new treatment planning system

et al. 2011

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Purpose : The resulting plans from a new type of treatment planning system called SharePlan™ have been studied. This software allows for the conversion of treatment plans generated in a TomoTherapy system for helical delivery, into plans deliverable on C‐arm linear accelerators (linacs), which is of particular interest for clinics with a single TomoTherapy unit. The purpose of this work was to evaluate and compare the plans generated in the SharePlan system with the original TomoTherapy plans and with plans produced in our clinical treatment planning system for intensity‐modulated radiation therapy (IMRT) on C‐arm linacs. In addition, we have analyzed how the agreement between SharePlan and TomoTherapy plans depends on the number of beams and the total number of segments used in the optimization. Methods : Optimized plans were generated for three prostate and three head‐and‐neck (H&N) cases in the TomoTherapy system, and in our clinical treatment planning systems (TPS) used for IMRT planning with step‐and‐shoot delivery. The TomoTherapy plans were converted into step‐and‐shoot IMRT plans in SharePlan. For each case, a large number of Pareto optimal plans were created to compare plans generated in SharePlan with plans generated in the Tomotherapy system and in the clinical TPS. In addition, plans were generated in SharePlan for the three head‐and‐neck cases to evaluate how the plan quality varied with the number of beams used. Plans were also generated with different number of beams and segments for other patient cases. This allowed for an evaluation of how to minimize the number of required segments in the converted IMRT plans without compromising the agreement between them and the original TomoTherapy plans. Results : The plans made in SharePlan were as good as or better than plans from our clinical system, but they were not as good as the original TomoTherapy plans. This was true for both the head‐and‐neck and the prostate cases, although the differences between the plans for the latter were small. The evaluation of the head‐and‐neck cases also showed that the plans generated in SharePlan were improved when more beams were used. The SharePlan Pareto front came close to the front for the TomoTherapy system when a sufficient number of beams were added. The results for plans generated with varied number of beams and segments demonstrated that the number of segments could be minimized with maintained agreement between SharePlan and TomoTherapy plans when 10–19 beams were used. Conclusions : This study showed (using Pareto front evaluation) that the plans generated in SharePlan are comparable to plans generated in other TPSs. The evaluation also showed that the plans generated in SharePlan could be improved with the use of more beams. To minimize the number of segments needed in a plan with maintained agreement between the converted IMRT plans and the original TomoTherapy plans, 10–19 beams should be used, depending on target complexity. SharePlan has proved to be useful and should thereby be a time‐saving complemen...

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“…Pareto optimality can resolve this problem (1,2). For a given set of parameters, a plan is called Pareto optimal if it is not possible to improve on all parameters simultaneously.…”

Section: Introductionmentioning

confidence: 99%