Implementation of automated personalised breast radiotherapy planning techniques with scripting in Raystation

Abstract

Objectives: Implement scripted automatic breast planning (AP) for breast techniques within Raystation. Methods: Manual plans (MP) were re-planned and compared with AP plans for whole breast (WB), partial breast (PB), hybrid VMAT SIB and VMAT nodal plans. Results: WB AP plans took 7 min comparing well to MP. One WB AP failed a mandatory dose constraint. Small statistically significant differences showed improved coverage for AP at expense of slightly hotter plans, however absolute differences were small (mean differences < 1% or D 0.5cc <0.2 Gy). PB AP plans took 9 min, showing improved coverage (V 24.7Gy97.6versus 96.4 %). One PB AP case failed a mandatory constraint. Other dosimetric differences were non-significant. SIB AP plans took 14 mins with one case failing a mandatory constraint with minor differences compared with MP except larger V 42.8Gy (3vs 1.5 %) and more μ. VMAT AP plans took 12 mins and were hotter for PTVp_4000 but had higher nodal coverage. Contra_Lung V 2.5Gy was higher (8.8 %) than MP plans (6.5 %). Conclusion: Automatic planning of modern breast techniques has been successfully introduced using a commercial planning system. AP plans are very similar to MP, requiring little manual interaction for most cases with significant timesaving potential. Advances in knowledge: Scripted breast plans produced within minutes for WB, PB, SIB and VMAT. Successfully introduced into large busy department. Plans similar to manual plans, requiring little manual interaction.

Comparative Study of Plan Robustness for Breast Radiotherapy: Volumetric Modulated Arc Therapy Plans with Robust Optimization versus Manual Flash Approach

“…The MF approach is the standard breast VMAT planning technique. Previous studies reported that the MF plans were more robust than the no-flash VMAT plans for the whole breast irradiation due to the achievement of a skin flashing effect [2,31]. Figure 6 confirms that the RO could achieve a similar skin flashing effect but without any need for manual creation of pseudo skin flash, which could result in potential time saving despite not being the focus of this study.…”

“…The prescription was standardized to deliver 50 Gy in 25 fractions without simultaneous integrated boost. The plans were optimized using a maximum of 40 iterations per optimization cycle and the final dose was calculated using a collapsed cone [31].…”

Dosimetric evaluation of different planning strategies for hypofractionated whole-breast irradiation technique

“…Another disadvantage is that the positions of the secondary field and jaw need reference objects based on the V105 dose distribution; however, a quantifiable reference target typically does not exist. Based on geometric or dosimetric means, limiting edge beams to 5-10°may help clarify the ideal angle of secondary field placement (Zhao et al 2012, Gleeson et al 2023.…”

Addressing the Global Expertise Gap in Radiation Oncology: The Radiation Planning Assistant

“…In addition, the availability of scripting in some commercial treatment planning systems has further increased the ability of clinical teams to develop tools to improve their workflows. 38 , 39 The role of the RPA in this environment is likely to constantly change, as we work to help clinics that are not benefitting from these other available tools, with the long-term goal of helping to improve equality and equity in the availability of cancer treatments across the world.…”