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An Initial Plan Check Procedure Specifically Designed for Fully-Automated Treatment Planning

L Court

L Court1*, R McCarroll1 , K Kisling1 , L Zhang1 , J Yang1 , H Simonds2 , M du Toit2 , A Jhingran1 , P Balter1 , B Beadle1 , (1) UT MD Anderson Cancer Center, Houston, TX,(2) Stellenbosch University, Stellenbosch, Western Cape, South Africa


SU-I-GPD-T-232 (Sunday, July 30, 2017) 3:00 PM - 6:00 PM Room: Exhibit Hall

Purpose: To design and test an illustrated procedure for checking plans that are created by a fully automated treatment planning system. We focused on initial checks of some of the vital automated planning tasks, and designing the procedure such that it could be delegated to less experienced staff when resources are limited.

Methods: An illustrated procedure was designed that leads the user through checks of marked isocenter and body contour identification, consistency of patient orientation/laterality/treatment site, accuracy of CT couch removal, appropriateness of field apertures (for a 4-field box example), and presence of image or dose calculation artifacts. Each step of the procedure has simple instructions and library examples to which the user can refer. To evaluate the procedure in different environments, the final version was tested by staff in the USA and South Africa. After training, the users were asked to check 16 plans, 12 of which included intentional errors.

Results: Iterative testing of the procedure allowed improved definition of all questions/check lists, including all necessary (but not superfluous) information in figures, and improvements to the training materials to include more examples of good and bad situations. The final version required ~30minutes of training. Plan checks required ~8minutes per plan. The testers (n=4) were able to find all errors in the body contours, isocenter (based on fiducial markers) and dose calculation artifacts. In many cases they were not able to reliably determine whether field apertures were correct or spot errors that were not examined with a specific check-list item.

Conclusion: Initial checking of some vital features of radiotherapy plans created by automated processes may be assigned to staff with limited radiotherapy experience, allowing any need for remedial action to be identified before physician review. Physician and physics review is still required.

Funding Support, Disclosures, and Conflict of Interest: This work is funded by the NIH (UH2CA202665). Additional support from Varian Medical Systems and Mobius Medical Systems.

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