Multi-center planning study of radiosurgery for intracranial metastases through Automation (MC-PRIMA) by crowdsourcing prior web-based plan challenge study

Abstract

Background: Planning radiosurgery to multiple intracranial metastases is complex and shows large variability in dosimetric quality among planners and treatment planning systems (TPS). This project aimed to determine whether autoplanning using the Muliple Brain Mets (AutoMBM) software can improve plan quality and reduce inter-planner variability by crowdsourcing results from prior international planning study. Methods: Twenty-four institutions autoplanned with AutoMBM on a five metastases case from a prior international planning competition from which population statistics (means and variances) of 23 dosimetric metrics and resulting composite plan score (maximum score = 150) of other TPS (Eclipse, Monaco, RayStation, iPlan, GammaPlan, MultiPlan) were crowdsourced. Plan results of AutoMBM and each of the other TPS were compared using two sample t-tests for means and Levene's tests for variances. Plan quality of AutoMBM was correlated with the planner' experience and compared between academic and non-academic centers. Results: AutoMBM produced plans with comparable composite plan score to GammaPlan, MultiPlan, Eclipse and iPlan (127.6 vs. 131.7 vs. 127.3 vs. 127.3 and 126.7; all p > 0.05) and superior to Monaco and RayStation (118.3 and 108.6; both p < 0.05). Inter-planner variability of overall plan quality was lowest for AutoMBM among all TPS (all p < 0.05). AutoMBM's plan quality did not differ between academic and non-academic centers and uncorrelated with planning experience (all p > 0.05).

Sub-analysis of multi-center planning radiosurgery for intracranial metastases through automation (MC-PRIMA) comparing plan quality between UK and International Centers

“…For the six UK centers that participated both in the MC-PRIMA and RTTQA studies [1,5], we found that there was a drastic improvement of the planning e ciency by autoplanning. For this studied case of ve metastases, 610 minutes (or 10.2 hours) would have been saved if it had been planned using AutoMBM.…”

“…The study case was originally from the Local-HER-0 trial protocol [6] and was used in a prior international planning competition hosted by the ProKnow 1 system. Details of this study case was described in [5,7].…”

“…Twenty-three dosimetric metrics and resulting composite plan score (maximum score=150) were calculated for each center that were in the cloud-based plan challenge platform called ProKnow [1] as well as previously in the MC-PRIMA study [5]. These dosimetric metrics and composite plan score were compared between the UK and other international centers by Mann-Whitney U tests for difference in their values and squared rank tests for equality of their variations.…”

“…Recently, a mutlicenter study (MC-PRIMA) benchmarked a single case of ve brain metastases autoplanned on the Elements Multiple Brain Mets (AutoMBM) SRS™ treatment planning solution (TPS) against 160 other plans on six other TPS (GammaPlan, MultiPlan, Eclipse, Monaco, RayStation and iPlan) [5]. Six of the participating centers were from UK and took part in the previous NHSE/RTTQA programme.…”

Improving the Efficiency of Single-Isocenter Multiple Metastases Stereotactic Radiosurgery Treatment

“…The solid gray area indicates 0 difference ± the 95% reproducibility limits in volume-averaged CI or GI from a multicenter planning study. 7

Figure 4 Plot of the differences in the volume of normal brain local to each metastasis receiving 12 Gy (local V12 Gy) for each planning target volume (PTV) between the clinical plan and the automatic plans with clinical starting tables (blue markers, left) and generic starting tables (green markers, right). Differences are shown as a function of PTV volume.

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