Template-based breast IMRT planning for increased workload efficiency

Nguyen, Sonia; Cao, Fred; Ramaseshan, R.; Kristensen, Sarah; Kuncewicz, Krista; Huang, Vicky; Elith, Craig A.; Steiner, Péter; Hayes, Jennifer; Lester, Beverly; McGregor, C. H.; Shahine, Bilal; Kwan, Winkle

doi:10.1186/1748-717x-8-67

Cited by 4 publications

(5 citation statements)

References 20 publications

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“…Based on patient‐specific anatomy, planners manually select tangent beam configuration (gantry angles and collimator angles) and beam energies, design the beam apertures (including segments), and set beam weights through a time‐consuming trial and error approach. Planning time was on average 39 min (range: 15–70 min) in a 20 patient study . Several auto and semi‐auto planning techniques have been developed to improve the efficiency of each step of WBI treatment planning.…”

Section: Introductionmentioning

confidence: 99%

Automated planning of whole breast irradiation using hybrid IMRT improves efficiency and quality

Guo

Shah

Xia

2019

J Applied Clin Med Phys

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Telephone: 216-445-1831. AbstractPurpose: To develop an automated workflow for whole breast irradiation treatment planning using hybrid intensity modulated radiation therapy (IMRT) approach and to demonstrate that this workflow can improve planning quality and efficiency when compared to manual planning.Methods: The auto planning framework was built based on scripting with MIM and Pinnacle systems. MIM workflows were developed to automatically segment normal structures and targets, identify landmarks for beam placement, select beam energies, and set beam configurations. Pinnacle scripts were generated from the MIM workflow to create hybrid IMRT plans automatically. Each hybrid IMRT plan included two prescriptions: a three-dimensional (3D) prescription consisted of two open tangent beams, and an IMRT prescription consisted of two step-and-shoot IMRT beams. The 3D prescription delivered a full prescription dose to the maximum dose point, and the IMRT prescription was optimized to deliver a uniform dose to the entire breast while sparing dose to the normal structures. For 30 patients, the auto plans were compared with clinically accepted manual plans using the paired sample t-test. Results:The auto planning process took approximately 8 min to complete. The mean dice coefficients between auto-segmentation and manual contours were 0.98, 0.94 and 0.88 for the lungs, heart, and PTVeval_Breast, respectively. The MUs of the auto plans was on average 13% higher than that of the manual plans. Auto planning improved plan quality significantly: percentage volume receiving 95% of the prescription dose (V95%) of the PTVeval_Breast increased from 91.5% to 93.2% (P = 0.001), V105% of the PTVeval_Breast decreased from 7.2% to 1.2% (P = 0.013), V20Gy of the ipsilateral lung decreased from 13.1% to 10.4% (P = 0.001) and mean heart dose for left-sided breast patients decreased from 1.2 Gy to 0.9 Gy (P < 0.001).Conclusion: An automated treatment planning process can make the planning process efficient with improved plan quality. K E Y W O R D Sauto-segmentation, auto planning, breast IMRT, whole breast irradiation ---

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Section: Introductionmentioning

confidence: 99%

Automated planning of whole breast irradiation using hybrid IMRT improves efficiency and quality

Guo

Shah

Xia

2019

J Applied Clin Med Phys

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“…While conventional breast RT planning methods may take a few hours to design, automated planning software can reduce dosimetrist workload by reproducibly generating treatment plans in <10 minutes 14 . Application of similar automated planning methods in breast, prostate, head and neck, and anal canal disease sites have demonstrated numerous benefits including improved treatment planning consistency, efficiency and plan quality 29 – 32 . Although presently limited in accessibility, automated planning tools will undoubtedly continue its integration into current and future clinical practice 13 , 30 , 32 , 33 and adoption of these technologies will reduce human resources resulting in direct cost-savings to the department while securing timely RT treatment delivery.…”

Section: Discussionmentioning

confidence: 99%

QuickStart radiotherapy: an inter-professional approach to expedite radiotherapy treatment in early breast cancer

et al. 2015

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Background and purposeThis study aims to develop an expedited radiotherapy (RT) process and evaluate its time savings in women requiring whole breast RT.Material and methodsAn inter-professional RT team streamlined the computed tomography (CT) simulation and treatment pathway for a ‘QuickStart’ process. Target delineation was performed by an advanced practice radiation therapist and approved by the radiation oncologist (RO) for planning. Automated breast planning software was used for treatment planning and standard quality checks were performed. To assess time savings, the initial 25 QuickStart patients were matched with women who underwent whole breast simulation on the same day (±3 days), treated using the conventional process.ResultsA total of 73 post-lumpectomy women were treated through the QuickStart process; the median consent-to-RT was 2 days (range: 0–13) and the mean CT simulation-to-RT treatment was 2 hours and 42 minutes (SD 0:30). In the subgroup analysis, QuickStart patients saved an average of 11 days from CT simulation-to-RT and had shorter median wait-times for both surgery/chemotherapy-to-RT (60 versus 38 days;p=0·002) and consultation-to-RT (7 versus 20 days;p<0·001).ConclusionsThrough inter-professional team efforts and the application of automated planning software, we have achieved a process that significantly decreases patient wait-times while maintaining the quality of whole breast RT.

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“…Both FP FIF and IP IMRT techniques achieve comparable excellent dose distribution 16. The aim of this paper was to evaluate whether IMRT is ready for prime time based on the following three points: 1) workload impact, 2) clinical impact on the patient’s QoL, and 3) appropriateness and applicability to clinical practice.…”

Section: Types Of Breast Imrt Techniquesmentioning

confidence: 99%

“…However, IMRT is more complex as deliberate attempts must be made to reduce dose homogeneity and lower the maximum dose 15,16…”

Section: Types Of Breast Imrt Techniquesmentioning

confidence: 99%

Intensity-modulated radiation therapy for early-stage breast cancer: is it ready for prime time?

Chan¹,

Tan²,

Tang³

2017

BCTT

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Whole breast external beam radiotherapy (WBEBRT) is commonly used as an essential arm in the treatment management of women with early-stage breast cancer. Dosimetry planning for conventional WBEBRT typically involves a pair of tangential fields. Advancement in radiation technology and techniques has the potential to improve treatment outcomes with clinically meaningful long-term benefits. However, this advancement must be balanced with safety and improved efficacy. Intensity-modulated radiation therapy (IMRT) is an advanced technique that shows promise in improving the planning process and radiation delivery. Early data on utilizing IMRT for WBEBRT demonstrate more homogenous dose distribution with reduction in organs at risk doses. This translates to toxicities reduction. The two common descriptors for IMRT are forward-planning “fields in field” and inverse planning. Unlike IMRT for other organs, the aim of IMRT for breast planning is to achieve dose homogeneity and not organ conformality. The aim of this paper was to evaluate whether IMRT is ready for prime time based on these three points: 1) workload impact, 2) the clinical impact on the patient’s quality of life, and 3) the appropriateness and applicability to clinical practice.

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Template-based breast IMRT planning for increased workload efficiency

Cited by 4 publications

References 20 publications

Automated planning of whole breast irradiation using hybrid IMRT improves efficiency and quality

Automated planning of whole breast irradiation using hybrid IMRT improves efficiency and quality

QuickStart radiotherapy: an inter-professional approach to expedite radiotherapy treatment in early breast cancer

Intensity-modulated radiation therapy for early-stage breast cancer: is it ready for prime time?

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