Department of Radiation Oncology Fully automated treatment plan generation in daily routine 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. 8th European Conference on Medical Physics, Athens, 2014 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 the dosimetrist (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 Erasmus-iCycle/Monaco Erasmus-iCycle: Med Phys. 2012; 39(2): 951-963. Monaco: Elekta AB, Stockholm, Sweden hard Prostate wishlist For each treatment site the wishlist is a priori established iterative procedure of Erasmus-iCycle plan generations/evaluations, followed by wishlist updates Institutions can generate their own wishlists main features of Erasmus-iCycle/Monaco: under the hood: lexicographic, multi-criterial optimization in Erasmus-iCycle, using priorities of objective functions as 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-iCycle has automated selection of beam angles (coplanar and non-coplanar beam arrangements) How good is automated planning compared to ‘manual’ planning? Head and Neck cancer Int J Radiat Oncol Biol Phys. 2013; 85(3): 866-72. Study design • On average 1 in 5 patients got an automatic plan next to the regular clinical plan made by dosimetrists • Dosimetrists and 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. differences between automatic and manual planning in mean OAR doses How good is automated planning compared to ‘manual’ planning? Prostate cancer 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 VMAT automatic vs. IMRT manual clinical VMAT automatic vs. VMAT manual expert planner no time pressure 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 Same conclusions for 44 cervical cancer patients 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.