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What is plan quality in radiotherapy? The importance of evaluating dose metrics, complexity, and robustness of treatment plans
V. Hernandez, CR. Hansen, L. Widesott, A. Bäck, R. Canters, M. Fusella, J. Götstedt, D. Jurado-Bruggeman, N. Mukumoto, LP. Kaplan, I. Koniarová, T. Piotrowski, L. Placidi, A. Vaniqui, N. Jornet
Language English Country Ireland
Document type Journal Article, Review
- MeSH
- Algorithms MeSH
- Benchmarking MeSH
- Radiotherapy Dosage MeSH
- Humans MeSH
- Radiotherapy Planning, Computer-Assisted MeSH
- Radiation Oncology * MeSH
- Radiotherapy, Intensity-Modulated * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
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.
Centro di protonterapia APSS Trento Italy
Danish Centre for Particle Therapy Aarhus University Hospital Denmark
Department of Electroradiology Poznań University of Medical Sciences Poznań Poland
Department of Medical Physics Greater Poland Cancer Centre Poznań Poland
Department of Medical Physics Hospital Sant Joan de Reus IISPV Spain
Department of Oncology Aarhus University Hospital Denmark
Department of Radiation Physics University of Gothenburg Göteborg Sweden
Institute of Clinical Research University of Southern Denmark Denmark
Laboratory of Radiation Physics Odense University Hospital Denmark
Medical Physics and Radiation Protection Department Institut Català d'Oncologia Girona Spain
Medical Physics Department Veneto Institute of Oncology IOV IRCCS Padua Italy
National Radiation Protection Institute Prague Czech Republic
Servei de Radiofísica i Radioprotecció Hospital de la Santa Creu i Sant Pau Barcelona Spain
References provided by Crossref.org
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- $a Hernandez, Victor $u Department of Medical Physics, Hospital Sant Joan de Reus, IISPV, Spain. Electronic address: vhernandezmasgrau@gmail.com
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- $a 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.
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