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Fully automated treatment plan generation in daily routine

Department of Radiation Oncology. Heijmen B , Voet P, Dirkx M, Sharfo A, Rossi L, Fransen D, Penninkhof J, Hoogeman M, Petit S, Mens J-W, Méndez Romero A, Al-Mamgani A, Incrocci L, Breedveld S. Fully automated treatment plan generation in daily routine.

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Fully automated treatment plan generation in daily routine

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  1. Department of Radiation Oncology Heijmen B, Voet P, Dirkx M, Sharfo A, Rossi L, Fransen D, Penninkhof J, Hoogeman M, Petit S, Mens J-W, Méndez Romero A, Al-Mamgani A, Incrocci L, Breedveld S. Fully automated treatment plan generationin daily routine 8th European Conference on Medical Physics, Athens, 2014

  2. Current treatment planning: an iterative trial-and-error procedure in which the dosimetrist tries to steer the TPS towards an acceptable plan by tweaking of parameters, such as objectives or weights • Issues • Plan quality is strongly dependent on skills and experience of thedosimetrist(operator dependence). • Plan quality is dependent on allotted time. • Difficult to decide when to stop; could more time result in a better plan? • Plan generation often based on templates (non-individualized) • Plan generation may take from 30 min. up to many hours • Due to involved workload, planning is costly An alternative: Automated Treatment Planning with Erasmus-iCycle/Monaco

  3. Erasmus-iCycle/Monaco • Erasmus-iCycle: Med Phys. 2012; 39(2): 951-963. • Monaco: Elekta AB, Stockholm, Sweden

  4. hard Prostate wishlist

  5. For each treatment site the wishlistis a priori established iterative procedure of Erasmus-iCycle plangenerations/evaluations,followed by wishlist updates Institutions can generate their own wishlists

  6. main features of Erasmus-iCycle/Monaco: • under the hood: lexicographic, multi-criterial optimization in Erasmus-iCycle, using priorities of objective functionsas defined in the wishlist • Erasmus-iCycle optimizes fluences, Monaco takes care of segmentation • planning is fully automatic (‘push button system’, no tweaking) huge reduction in planning workload and result is operator independent • works for IMRT and VMAT, IMRT plans are Pareto optimal • for IMRT Erasmus-iCyclehas automated selection of beam angles (coplanar and non-coplanar beam arrangements)

  7. How good is automated planning compared to ‘manual’ planning? Head and Neck cancer Int J Radiat Oncol Biol Phys. 2013; 85(3): 866-72.

  8. Study design • On average 1 in 5 patients got an automatic plan next to the regular clinical plan made by dosimetrists • Dosimetristsand treating physicians didn’t know whether or not there would be an automatic plan. • All plans were coplanar and had a maximum of 9 beams. • Treating radiation oncologist selected the plan for treatment Study results • in 32/33 cases automatic plan was selected by physician (almost always better sparing, often also better tumor coverage) • also objectively (DVHs, NTCP) automatic plans had higher quality.

  9. differences between automatic and manual planning inmean OAR doses

  10. How good is automated planning compared to ‘manual’ planning? Prostate cancer

  11. How good is automated planning compared to ‘manual’ planning? Prostate cancer Study design 30 previously treated prostate cancer patients (78 Gy, IMRT/IGRT) Compare VMAT plan, automatically generated with Erasmus-iCycle/Monaco with 1. IMRT plan, manually generated with Monaco in clinical routine, and actually delivered 2. VMAT plan, manually generated with Monaco by expert planner in absence of time pressure

  12. VMAT automatic vs. IMRT manual clinical

  13. VMAT automatic vs. VMAT manual expert planner no time pressure

  14. Conclusions for prostate cancer • With automated planning: • - Higher plan quality than in clinical routine • - No loss in plan quality compared to an expert planner in absence of time constraints (non-clinical condition) • ALWAYS: vast reduction in workload

  15. Same conclusions for 44 cervical cancer patients

  16. Conclusions • Compared to ‘manual’ planning, automated planning with Erasmus-iCycle/Monaco • has higher or non-inferior plan quality • plan quality is not operator dependent • plan quality is not dependent on allotted time in a busy clinic • has negligible workload • Automated planning is currently in clinical use for prostate cancer, head-and-neck cancer, and cervical cancer. Next step International validation study of automated planning with Erasmus-iCycle/Monaco, together with Florence, Leeds, Mannheim, Vienna, and Elekta AB.

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