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Objective@#To design and implement an automatic independent check software (AutoReview) for the radiotherapy treatment plan and improve the efficiency of independent check.@*Methods@#The patient′s electronic treatment plan chart in the record and verify (R&V) system database accessed by the SQL language was read and parsed. Based on the treatment plan information obtained from the chart, AutoReview extracted all parameters related to the treatment plan from the treatment planning system and the R&V system, and saved the structured data into a local database. For different check items, corresponding check logic was designed and the program was written to realize the automatic independent check. In total, 664 clinical treatment plans for one month were selected as a sample to evaluate the clinical application effect.@*Results@#Compared with manual check, AutoReview improved the check efficiency by nearly 60 times and the problem detection rate was elevated by 19.2%. In the two-year clinical application, the software operation was stable, and 14509 treatment plans were automatically checked and identified 588 cases with problems, accounting for 4.05%.@*Conclusion@#AutoReview can effectively improve the efficiency and accuracy of independent check in radiotherapy treatment plan.
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Purpose/Objective(s): In India > 1 million new cases of cancer diagnosed every year. 40-50% of these cases are of head and neck cancer because of tobacco overuse. In our institute we have almost 1000-1300 new cases of Carcinoma Buccal Mucosa reported every year. From which 70-75% are surgically operable. For post-operative Radiotherapy treatment, we treat most of our patients by 2 Dimensional conventional treatments. Purpose of this study is to assess toxicity & long term results of postoperative carcinoma buccal mucosa cases treated by 2 Dimensional conventional treatment planning. Materials/Methods: From January 2009 to January 2012, almost 1980 postoperative cases of Carcinoma Buccal mucosa were referred for radiotherapy treatment. From which 1584 cases were suitable for postoperative 2 Dimensional Conventional planning. In selected cases, 71%, 18%, 11% cases were of Stage IV, III, II (close margin) respectively. Postoperative chemotherapy and radiotherapy was indicated in 475 patients. For all patients Plaster of Paris cast was prepared & X-ray was taken on Simulator machine. Target volume was drawn on x-ray & treatment plan generated on contour drawn with 90-95% isodose line covering the target, with hot spot of +10% on 2D Plato treatment planning system. All patients were treated with unilateral Anterior Posterior Lateral wedge pair technique for buccal mucosa and unilateral lower neck was given in indicated patients. Dose prescribed was 60 Gy/30#, 2Gy/#, 5 days a week, total 6 weeks treatment. Treatment plan verified on day 2 and treatment started. In patients where postoperative chemotherapy and radiotherapy was used, chemotherapy was given Cisplatin 30mg/m2 every weekly for 6 weeks. In most of the patients, treatment break was not required. All patients completed treatment successfully. Patients were assessed for locoregional control, acute & late toxicity and followed up for 3 years for disease free survival and overall survival. Results: Grade II & III acute mucositis was 82% & 18% respectively in 1109 patients who received only postoperative radiotherapy. For patients who received postoperative radiotherapy and chemotherapy Grade II and Grade III acute mucositis was seen in 75% & 25% respectively and side effects related to Cisplatin were managed conservatively. Almost all patients had Grade II skin reactions. Grade III skin reactions were observed in 8% of patients on post operative radiotherapy alone and 19% of patients on postoperative radiotherapy and chemotherapy but were manageable. All patients tolerated treatment well. For 1584 patients, follow up dropout rate was 20%. None of the patients developed significant late toxicity. As opposite parotid spared, no late complication of xerostomia observed. For 1268 patients, 1-, 2-, 3- year locoregional control rates were 82%, 75%, 68% respectively. Disease free survival rate was 63% (799 patients) & overall survival was almost 55% (697 patients) at median follow up for 40 months. Conclusion: 2D Conventional Radiotherapy Treatment Planning in our set up has shown very good results with almost 50% survival rates. It is less toxic treatment with fewer complications & less time consuming. It is highly cost effective treatment approach & results are very much encouraging.
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Objective To use clustering analysis to help physicians detect abnormal parameters in radiotherapy treatment plans and improve the efficiency of plan verification. Methods From 2010 to 2015, 835 breast cancer treatment plans for using 4?field hybrid intensity?modulated radiotherapy from MOSAIQ were collectted. Fractional dose, beam angle, and monitor unit were used as featured parameters of a treatment plan to generate a dataset. The K?means clustering algorithm based on principal component analysis was used to perform a clustering analysis of the dataset and divide the dataset into different clusters. The outliers of clusters were automatically detected based on the distance threshold. The outlier?contained treatment plans were manually verified by physicians to determine the accuracy of clustering analysis in detection of abnormal plans. Results In the clustering analysis, the sample space composed by parameters of treatment plans for breast cancer was divided into 4 clusters, 3 of which had outliers detected. In the targeted treatment plans, 3 plans became outliers because of special target volume and the other 4 plans needed improvement. Conclusions Clustering analysis is effective to help physicians to independently verify treatment plans.
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Objective Using Eclipse and Pinnacle3 V 7.4f treatment planning sytems (TPS) for dose calculation of the CT images of simulation phantom,patients and homogeneous organization phantom,to compare the differences between the two TPS for the calculation of non-uniform organizations.Methods For the CT images of simulation phantom,patients and homogeneous organization phantom,the calculating results between the two TPS were compared,including the common used clinical indexes of V20 and V30 of the lung,D95 of the planning target volume,the doses of the ISO and eight points of interest inside ISO slice.Resuits For simulation phantom and patients,although the calculating differences of the isocenter doses between the two TPS were small,the differences of other indicators were large.For example,when using secondary collimator irradiation,the maximal D95 difference of planning target volume reached 10.17%for patients and 4.64%for simulation phantom.When using muhileaf collimator irradiation,the maximal D95 difference reached 10.74%for patients and 5.66%for simulation phantom.Sometimes the dose differences of points 1-4 at the edge of planning target volume were more than 10%.In addition,the V30 differences of the lung were large too.But for the homogeneous organization phantom,the calculating differences were small.Conclusions The calculating differences between the two TPS are less for simulation phantom than for patients,and more for simulation phantom and patients than for homogeneous organization phantom.
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purpose:This paper is to provide the gerneral principle and method of using the wedge filter. Materials and Methods:A concept of the irradiation angle and a equation to calculate it were introduced. The radiation angle and the given dose for each field were derived from this equation.The wedge angles of each field were got.Results: By means of the examples of laryngocarcinoma and carcinoma of maxillary sinus,the isodose graphs from the TPS using the radiation angles of the equations comfirmed this method.Conclusion: The way introduced is brief and raliable. It may help to optimize the treatment plan.
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The ultimate goal of radiotherapy is to result in complete local control of tumor while sparing the surrounding normal tissues as much as possible. Since the development of CT in 1970s, patient's anatomical normal tissues and the site and extent of infiltration of tumor were identified almost accurately. In addition, the isodose distribution of delivered radiation to target tumor was shown in each cross-section. In the treatment planning of head and neck cancers, CT-reconstruction provided almost 3-dimensinonal inter-relationship between tumor and normal tissues. The utilization of imaging system of the CT scanner made it possible to illustrate in superposition the patient structure image, the radiation beams, and the isodose distributions. Thus it was possible to deliver radiation enough to control the local disease, and to avoid unnecessary administration of radiation to normal tissue such as spinal cord. CT-reconstructed image in axial, sagittal, and coronal planes suggested 3-dimensional radiotherapy treatment planning be possible and practical instead of conventional 2-dimensional planning at coronal plane.