Evaluation of Elements Spine SRS Plan Quality for SRS and SBRT Treatment of Spine Metastases

Träger, M.; Landers, Angelia; Yu, Yan; Shi, Wenyin; Liu, Haisong

doi:10.3389/fonc.2020.00346

Cited by 6 publications

(10 citation statements)

References 12 publications

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“…Previous evaluation studies have shown the advances of Elements Spine SRS in dosimetry (15)(16)(17). Moreover, the autosegmentation tool Elements SmartBrush Spine (ESS) was developed for fast target delineation, which can potentially improve the efficiency of the clinical workflow.…”

Section: Introductionmentioning

confidence: 99%

Clinical Evaluation of an Auto-Segmentation Tool for Spine SBRT Treatment

Chen

Vinogradskiy

et al. 2022

Front. Oncol.

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PurposeSpine SBRT target delineation is time-consuming due to the complex bone structure. Recently, Elements SmartBrush Spine (ESS) was developed by Brainlab to automatically generate a clinical target volume (CTV) based on gross tumor volume (GTV). The aim of this project is to evaluate the accuracy and efficiency of ESS auto-segmentation.MethodsTwenty spine SBRT patients with 21 target sites treated at our institution were used for this retrospective comparison study. Planning CT/MRI images and physician-drawn GTVs were inputs for ESS. ESS can automatically segment the vertebra, split the vertebra into 6 sectors, and generate a CTV based on the GTV location, according to the International Spine Radiosurgery Consortium (ISRC) Consensus guidelines. The auto-segmented CTV can be edited by including/excluding sectors of the vertebra, if necessary. The ESS-generated CTV contour was then compared to the clinically used CTV using qualitative and quantitative methods. The CTV contours were compared using visual assessment by the clinicians, relative volume differences (RVD), distance of center of mass (DCM), and three other common contour similarity measurements such as dice similarity coefficient (DICE), Hausdorff distance (HD), and 95% Hausdorff distance (HD95).ResultsQualitatively, the study showed that ESS can segment vertebra more accurately and consistently than humans at normal curvature conditions. The accuracy of CTV delineation can be improved significantly if the auto-segmentation is used as the first step. Conversely, ESS may mistakenly split or join different vertebrae when large curvatures in anatomy exist. In this study, human interactions were needed in 7 of 21 cases to generate the final CTVs by including/excluding sectors of the vertebra. In 90% of cases, the RVD were within ±15%. The RVD, DCM, DICE, HD, and HD95 for the 21 cases were 3% ± 12%, 1.9 ± 1.5 mm, 0.86 ± 0.06, 13.34 ± 7.47 mm, and 4.67 ± 2.21 mm, respectively.ConclusionESS can auto-segment a CTV quickly and accurately and has a good agreement with clinically used CTV. Inter-person variation and contouring time can be reduced with ESS. Physician editing is needed for some occasions. Our study supports the idea of using ESS as the first step for spine SBRT target delineation to improve the contouring consistency as well as to reduce the contouring time.

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Section: Introductionmentioning

confidence: 99%

Clinical Evaluation of an Auto-Segmentation Tool for Spine SBRT Treatment

Chen

Vinogradskiy

et al. 2022

Front. Oncol.

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“…Alternative algorithms for the automation of treatment planning have been implemented for spine SBRT (19)(20)(21)(22). Compared with these alternative methods, the Autoplanning and Personalized engines present a clear advantage.…”

Section: Discussionmentioning

confidence: 99%

“…( 20 ) explored the feasibility of knowledge-based planning strategy using Varian RapidPlan software for 10 spine SBRT cases, reporting an overall improved quality and a decrease of total planning time from approximately 1.5 h to 15 min. Last, a dedicated TPS, the Elements Spine SRS (Brainlab AG, Munich, Germany), has been recently evaluated for the generation of automated quality plans in spine SBRT ( 21 , 22 ). Comparison with previous clinical plans obtained with other TPS resulted in sharpest dose gradient and in lower spinal cord maximum point doses.…”

Section: Introductionmentioning

confidence: 99%

Personalized Automation of Treatment Planning for Linac-Based Stereotactic Body Radiotherapy of Spine Cancer

et al. 2022

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Purpose/Objective(s)Stereotactic ablative body radiotherapy (SBRT) for vertebral metastases is a challenging treatment process. Planning automation has recently reported the potential to improve plan quality and increase planning efficiency. We performed a dosimetric evaluation of the new Personalized engine implemented in Pinnacle3 for full planning automation of SBRT spine treatments in terms of plan quality, treatment efficiency, and delivery accuracy.Materials/MethodsThe Pinnacle3 treatment planning system was used to reoptimize six patients with spinal metastases, employing two separate automated engines. These two automated engines, the existing Autoplanning and the new Personalized, are both template-based algorithms that employ a wishlist to construct planning goals and an iterative technique to replicate the planning procedure performed by skilled planners. The boost tumor volume (BTV) was defined as the macroscopically visible lesion on RM examination, and the planning target volume (PTV) corresponds with the entire vertebra. Dose was prescribed according to simultaneous integrated boost strategy with BTV and PTV irradiated simultaneously over 3 fractions with a dose of 30 and 21 Gy, respectively. Dose-volume histogram (DVH) metrics and conformance indices were used to compare clinically accepted manual plans (MP) with automated plans developed using both Autoplanning (AP) and Personalized engines (Pers). All plans were evaluated for planning efficiency and dose delivery accuracy.ResultsFor similar spinal cord sparing, automated plans reported a significant improvement of target coverage and dose conformity. On average, Pers plans increased near-minimal dose D98% by 10.4% and 8.9% and target coverage D95% by 8.0% and by 4.6% for BTV and PTV, respectively. Automated plans provided significantly superior dose conformity and dose contrast by 37%–47% and by 4.6%–5.7% compared with manual plans. Overall planning times were dramatically reduced to about 15 and 23 min for Pers and AP plans, respectively. The average beam-on times were found to be within 3 min for all plans. Despite the increased complexity, all plans passed the 2%/2 mm γ-analysis for dose verification.ConclusionAutomated planning for spine SBRT through the new Pinnacle3 Personalized engine provided an overall increase of plan quality in terms of dose conformity and a major increase in efficiency. In this complex anatomical site, Personalized strongly reduce the tradeoff between optimal accurate dosimetry and planning time.

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“…Simultaneously, specialized planning solutions are also elaborated. The Elements TPS (Brainlab, Munich) has been developed according to this philosophy, with specific modules dedicated to stereotactic radiosurgery (SRS): Cranial SRS, Multiple Brain Mets SRS or Spine SRS [6], [7]. Elements Spine SRS (E-SRS) allows an automated VMAT planning process, based on the use of templates defining beam geometry and dosimetric objectives on organs at risk (OAR) and target volumes.…”

Section: Introductionmentioning

confidence: 99%

“…The optimization algorithm includes an arc duplication option enabling PTV splitting into several low complexity elementary volumes treated separately with one or several arc each. Such a decomposition should also result in treatment plans with the same or higher quality than non-dedicated TPS [6]. Another advantage of E-SRS is that the planning process is semi-automated.…”

Section: Introductionmentioning

confidence: 99%