What is plan quality in radiotherapy? The importance of evaluating dose metrics, complexity, and robustness of treatment plans
Por:
Hernandez, V, Hansen, CR, Widesott, L, Back, A, Canters, R, Fusella, M, Gotstedt, J, Jurado-Bruggeman, D, Mukumoto, N, Kaplan, LP, Koniarova, I, Piotrowski, T, Placidi, L, Vaniqui, A, Jornet, N
Publicada:
1 dic 2020
Resumen:
Plan evaluation is a key step in the radiotherapy treatment workflow. Central to this step is the assessment of treatment plan quality. Hence, it is important to agree on what we mean by plan quality and to be fully aware of which parameters it depends on. We understand plan quality in radiotherapy as the clinical suitability of the delivered dose distribution that can be realistically expected from a treatment plan. Plan quality is commonly assessed by evaluating the dose distribution calculated by the treatment planning system (TPS). Evaluating the 3D dose distribution is not easy, however; it is hard to fully evaluate its spatial characteristics and we still lack the knowledge for personalising the prediction of the clinical outcome based on individual patient characteristics. This advocates for standardisation and systematic collection of clinical data and outcomes after radiotherapy. Additionally, the calculated dose distribution is not exactly the dose delivered to the patient due to uncertainties in the dose calculation and the treatment delivery, including variations in the patient set-up and anatomy. Consequently, plan quality also depends on the robustness and complexity of the treatment plan. We believe that future work and consensus on the best metrics for quality indices are required. Better tools are needed in TPSs for the evaluation of dose distributions, for the robust evaluation and optimisation of treatment plans, and for controlling and reporting plan complexity. Implementation of such tools and a better understanding of these concepts will facilitate the handling of these characteristics in clinical practice and be helpful to increase the overall quality of treatment plans in radiotherapy. (C) 2020 The Authors. Published by Elsevier B.V.
Filiaciones:
Hernandez, V:
Hosp St Joan de Reus, IISPV, Dept Med Phys, Tarragona, Spain
Hansen, CR:
Odense Univ Hosp, Lab Radiat Phys, Odense, Denmark
Univ Southern Denmark, Inst Clin Res, Odense, Denmark
Aarhus Univ Hosp, Danish Ctr Particle Therapy, Aarhus, Denmark
Widesott, L:
APSS, Ctr Protonterapia, Trento, Italy
Back, A:
Sahlgrens Univ Hosp, Dept Therapeut Radiat Phys Med Phys & Biomed Engn, Gothenburg, Sweden
Univ Gothenburg, Inst Clin Sci, Dept Radiat Phys, Sahlgrenska Acad, Gothenburg, Sweden
Canters, R:
Maastricht Univ, GROW Sch Oncol, Dept Radiat Oncol Maastro, Med Ctr, Maastricht, Netherlands
Fusella, M:
Veneto Inst Oncol IOV IRCCS, Med Phys Dept, Padua, Italy
Gotstedt, J:
Univ Gothenburg, Dept Radiat Phys, Gothenburg, Sweden
Jurado-Bruggeman, D:
Inst Catala Oncol, Med Phys & Radiat Protect Dept, Girona, Spain
Mukumoto, N:
Kyoto Univ, Grad Sch Med, Dept Radiat Oncol & Image Appl Therapy, Kyoto, Japan
Kaplan, LP:
Aarhus Univ Hosp, Dept Oncol, Aarhus, Denmark
Koniarova, I:
Natl Radiat Protect Inst, Prague, Czech Republic
Piotrowski, T:
Poznan Univ Med Sci, Dept Electroradiol, Poznan, Poland
Greater Poland Canc Ctr, Dept Med Phys, Poznan, Poland
Placidi, L:
Fdn Policlin Univ A Gemelli IRCCS, Dipartimento Diagnost Immagini Radioterapia Oncol, UOC Radioterapia Oncol, Rome, Italy
Vaniqui, A:
Maastricht Univ, GROW Sch Oncol, Dept Radiat Oncol Maastro, Med Ctr, Maastricht, Netherlands
Jornet, N:
Hosp Santa Creu & Sant Pau, Serv Radiofis & Radioproteccio, Barcelona, Spain
Green Published, Hybrid Gold
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