Marco Esposito1, Laura Masi2, Margherita Zani2, Raffaela Doro2, David Fedele3, Cristina Garibaldi4, Stefania Clemente5, Christian Fiandra6, Francesca Romana Giglioli7, Carmelo Marino8, Laura Orsingher9, Serenella Russo10, Michele Stasi11, Lidia Strigari12, Elena Villaggi13, Pietro Mancosu14. 1. Medical Physics Complex Unit, Azienda USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Italy. marco1.esposito@uslcentro.toscana.it. 2. Department of Medical Physics and Radiation Oncology, IFCA, Florence, Italy. 3. Medical Physics Complex Unit, Azienda USL Toscana Centro, Pistoia, Italy. 4. Radiation Research Unit, European Institute of Oncology IRCCS, Milan, Italy. 5. UOS di Fisica Sanitaria e Radioprotezione, Azienda Ospedaliera Universitaria Federico II, Naples, Italy. 6. Department of Oncology, Radiation Oncology Unit, University of Turin, Turin, Italy. 7. A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy. 8. Medical Physics Department, Humanitas C.C.O., Catania, Italy. 9. UOC Fisica Sanitaria, Azienda ULSS2 Marca Trevigiana, Treviso, Italy. 10. Medical Physics Complex Unit, Azienda USL Toscana Centro, Via dell'Antella 58, 50012, Bagno a Ripoli, Italy. 11. Department of Medical Physics, Azienda Ospedaliera Ordine Mauriziano di Torino, Turin, Italy. 12. Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer, Institute IFO, Rome, Italy. 13. S.C. Fisica Sanitaria, Azienda Unità Sanitaria Locale (AUSL) Piacenza, Piacenza, Italy. 14. Medical Physics Unit of Radiotherapy Dept., Humanitas Clinical and Research Hospital, Rozzano, Italy.
Abstract
BACKGROUND: The dosimetric variability in spine stereotactic body radiation therapy (SBRT) planning was investigated in a large number of centres to identify crowd knowledge-based solutions. METHODS: Two spinal cases were planned by 48 planners (38 centres). The required prescription dose (PD) was 3 × 10 Gy and the planning target volume (PTV) coverage request was: VPD > 90% (minimum request: VPD > 80%). The dose constraints were: planning risk volume (PRV) spinal cord: V18Gy < 0.35 cm3, V21.9 Gy < 0.03 cm3; oesophagus: V17.7 Gy < 5 cm3, V25.2 Gy < 0.03 cm3. Planners who did not fulfil the protocol requirements were asked to re-optimize the plans, using the results of planners with the same technology. Statistical analysis was performed to assess correlations between dosimetric results and planning parameters. A quality index (QI) was defined for scoring plans. RESULTS: In all, 12.5% of plans did not meet the protocol requirements. After re-optimization, 98% of plans fulfilled the constraints, showing the positive impact of knowledge sharing. Statistical analysis showed a significant correlation (p < 0.05) between the homogeneity index (HI) and PTV coverage for both cases, while the correlation between HI and spinal cord sparing was significant only for the single dorsal PTV case. Moreover, the multileaf collimator leaf thickness correlated with the spinal cord sparing. Planners using comparable delivery/planning system techniques produced different QI, highlighting the impact of the planner's skills in the optimization process. CONCLUSION: Both the technology and the planner's skills are fundamentally important in spine SBRT planning optimization. Knowledge sharing helped to follow the plan objectives.
BACKGROUND: The dosimetric variability in spine stereotactic body radiation therapy (SBRT) planning was investigated in a large number of centres to identify crowd knowledge-based solutions. METHODS: Two spinal cases were planned by 48 planners (38 centres). The required prescription dose (PD) was 3 × 10 Gy and the planning target volume (PTV) coverage request was: VPD > 90% (minimum request: VPD > 80%). The dose constraints were: planning risk volume (PRV) spinal cord: V18Gy < 0.35 cm3, V21.9 Gy < 0.03 cm3; oesophagus: V17.7 Gy < 5 cm3, V25.2 Gy < 0.03 cm3. Planners who did not fulfil the protocol requirements were asked to re-optimize the plans, using the results of planners with the same technology. Statistical analysis was performed to assess correlations between dosimetric results and planning parameters. A quality index (QI) was defined for scoring plans. RESULTS: In all, 12.5% of plans did not meet the protocol requirements. After re-optimization, 98% of plans fulfilled the constraints, showing the positive impact of knowledge sharing. Statistical analysis showed a significant correlation (p < 0.05) between the homogeneity index (HI) and PTV coverage for both cases, while the correlation between HI and spinal cord sparing was significant only for the single dorsal PTV case. Moreover, the multileaf collimator leaf thickness correlated with the spinal cord sparing. Planners using comparable delivery/planning system techniques produced different QI, highlighting the impact of the planner's skills in the optimization process. CONCLUSION: Both the technology and the planner's skills are fundamentally important in spine SBRT planning optimization. Knowledge sharing helped to follow the plan objectives.
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