Clinical Experience With Machine Learning-Based Automated Treatment Planning for Whole Breast Radiation Therapy

Abstract

Purpose The machine learning–based automated treatment planning (MLAP) tool has been developed and evaluated for breast radiation therapy planning at our institution. We implemented MLAP for patient treatment and assessed our clinical experience for its performance. Methods and Materials A total of 102 patients of breast or chest wall treatment plans were prospectively evaluated with institutional review board approval. A human planner executed MLAP to create an auto-plan via automation of fluence maps generation. If judged necessary, a planner further fine-tuned the fluence maps to reach a final plan. Planners recorded the time required for auto-planning and manual modification. Target (ie, breast or chest wall and nodes) coverage and dose homogeneity were compared between the auto-plan and final plan. Results Cases without nodes (n = 71) showed negligible (<1%) differences for target coverage and dose homogeneity between the auto-plan and final plan. Cases with nodes (n = 31) also showed negligible difference for target coverage. However, mean ± standard deviation of volume receiving 105% of the prescribed dose and maximum dose were reduced from 43.0% ± 26.3% to 39.4% ± 23.7% and 119.7% ± 9.5% to 114.4% ± 8.8% from auto-plan to final plan, respectively, all with P ≤ .01 for cases with nodes (n = 31). Mean ± standard deviation time spent for auto-plans and additional fluence modification for final plans were 12.1 ± 9.3 and 13.1 ± 12.9 minutes, respectively, for cases without nodes, and 16.4 ± 9.7 and 26.4 ± 16.4 minutes, respectively, for cases with nodes. Conclusions The MLAP tool has been successfully implemented for routine clinical practice and has significantly improved planning efficiency. Clinical experience indicates that auto-plans are sufficient for target coverage, but improvement is warranted to reduce high dose volume for cases with nodal irradiation. This study demonstrates the clinical implementation of auto-planning for patient treatment and the significant importance of integrating human experience and feedback to improve MLAP for better clinical translation.

Organ‐at‐risk dose prediction using a machine learning algorithm: Clinical validation and treatment planning benefit for lung SBRT

“…1 Recently, substantial progress has been made in the field of knowledge-based planning (KBP) as a way to automate the treatment planning process and assist treatment planners. [2][3][4][5][6][7][8] Currently, the main goals of KBP strategies are to increase efficiency by reducing the time and effort needed to generate a clinically acceptable treatment plan and to reduce the inter-and intra-planner variability in plan quality that is inherent to manual treatment plan generation, which has been shown previously using a set of prostate cancer cases. 4 Head and neck cancer (HNC) is another site where KBP efforts have been focused, with one group successfully showing that KBP strategies developed at one institution can be implemented for patients at other institutions.…”