Purpose

Our purpose was to automate the treatment planning process for total body irradiation (TBI) with volumetric modulated arc therapy (VMAT).

Methods and Materials

Two scripts were developed to facilitate autoplanning: the binary plug-in script automating the creation of optimization structures, plan generation, beam placement, and setting of the optimization constraints and the stand-alone executable performing successive optimizations. Ten patients previously treated in our clinic with VMAT TBI were used to evaluate the efficacy of the proposed autoplanning process. Paired t tests were used to compare the dosimetric indices of the produced auto plans to the manually generated clinical plans. In addition, 3 physicians were asked to evaluate the manual and autoplans for each patient in a blinded retrospective review.

Results

No significant differences were observed between the manual and autoplan global D_max (P < .893), planning target volume V110% (P < .734), kidneys D_mean (P < .351), and bowel D_max (P < .473). Significant decreases in the D_mean to the lungs and lungs-1cm (ie, lungs with 1-cm inner margin) volumes of 5.4% ± 6.4% (P < .024) and 6.8% ± 7.4% (P < .017), respectively, were obtained with the autoplans compared with the manual plans. The autoplans were selected 77% of the time by the reviewing physicians as equivalent or superior to the manual plans. The required time for treatment planning was estimated to be 2 to 3 days for the manual plans compared with approximately 3 to 5 hours for the autoplans.

Conclusions

Large reductions in planning time without sacrificing plan quality were obtained using the developed autoplanning process compared with manual planning, thus reducing the required effort of the treatment planning team. Superior lung sparing with the same target coverage and similar global D_max were observed with the autoplans as compared with the manual treatment plans. The developed scripts have been made open-source to improve access to VMAT TBI at other institutions and clinics.

中文翻译：

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使 VMAT TBI 更普遍的一步：自动化治疗计划过程

目的

我们的目的是使用容积调制弧光疗法 (VMAT) 使全身照射 (TBI) 的治疗计划过程自动化。

方法和材料

开发了两个脚本来促进自动规划：二进制插件脚本自动创建优化结构、计划生成、梁放置和优化约束的设置，以及执行连续优化的独立可执行文件。之前在我们诊所接受过 VMAT TBI 治疗的 10 名患者被用来评估提议的自动计划过程的有效性。配对t检验用于比较生成的自动计划的剂量指标与手动生成的临床计划。此外，还要求 3 名医生在盲法回顾性审查中评估每位患者的手动和自动计划。

结果

手动和自动计划全局 D _max ( P < .893)、计划目标体积 V110% ( P < .734)、肾脏 D_平均值( P < .351) 和肠道 D _max ( P < .893)之间没有观察到显着差异。第473页。肺和肺的 D_均值显着降低- 1cm（即，具有 1cm 内缘的肺）体积分别为 5.4% ± 6.4% ( P < .024) 和 6.8% ± 7.4% ( P <.017) 分别是通过自动计划与手动计划获得的。审查医师在 77% 的时间内选择自动计划作为与手动计划相当或优于手动计划。手动计划所需的治疗计划时间估计为 2 到 3 天，而自动计划需要大约 3 到 5 小时。

结论

与手动计划相比，使用开发的自动计划流程可以在不牺牲计划质量的情况下大幅减少计划时间，从而减少治疗计划团队所需的工作量。与手动治疗计划相比，使用自动计划观察到具有相同目标覆盖率和相似全局 D _{max 的}优越肺保留。开发的脚本已经开源，以改善其他机构和诊所对 VMAT TBI 的访问。