Exploring plan quality: using plan complexity to quantitatively analyse the tradeoff between clinical suitability and dosimetric accuracy

IF 2.7 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Physica Medica-European Journal of Medical Physics Pub Date : 2025-06-21 DOI:10.1016/j.ejmp.2025.105026

S. Cavinato , A.G. Amico , A. Bettinelli , P. Caricato , P. Ceroni , B. El Khouzai , F. Guida , M. Paiusco , C. Paronetto , N. Pivato , M.A. Rossato , S. Sapignoli , M. Sepulcri , A. Scaggion

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引用次数: 0

Abstract

Purpose

This study investigates how controlling the complexity of Volumetric Modulated Arc Therapy (VMAT) plans can quantitatively balance clinical suitability and dosimetric accuracy.

Materials and Methods

Thirty clinical cases treated with VMAT plans were re-optimized to limit plan complexity to varying degrees using Monitor Units (MU) objective and the Aperture Shape Controller (ASC) in the Eclipse TPS. The resulting plans were evaluated based on surrogate measures of plan complexity (single and aggregate complexity metrics), dosimetric accuracy (γ-index passing rate), and clinical suitability (Adjusted Plan Quality Metric).

Results

Stricter MU limits and higher ASC penalties resulted in beam’s-eye-view regularization and reduced leaf travel while increasing modulation of gantry speed and dose rate. Limiting plan complexity enhanced dosimetric accuracy, as shown by a higher γ-index passing rate. However, this was accompanied by a moderate reduction in clinical suitability, reflected by a lower Adjusted Plan Quality Metric (APQM%), with variations across treatment sites. Complexity metrics related to MLC apertures were the most significant indicators for characterizing dosimetric accuracy and clinical suitability. An aggregate complexity score was established, demonstrating a monotonic relationship with both dosimetric accuracy and clinical suitability, enabling the assessment of their trade-off.

Conclusion

By defining appropriate proxies, clinical suitability and deliverability can be quantitatively balanced through managing plan complexity in VMAT plans. While tailored to this study’s clinical routine, the method holds potential for standardizing plan quality assessment and improving VMAT treatment outcomes across diverse clinical settings. Insights gained could contribute to greater consistency and effectiveness in evaluating the overall plan quality in radiation therapy.

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探索计划质量：利用计划复杂性定量分析临床适用性和剂量学准确性之间的权衡

目的探讨如何控制体积调制弧线治疗（VMAT）计划的复杂性，以定量地平衡临床适用性和剂量学准确性。材料与方法应用Eclipse TPS中的Monitor Units （MU）物镜和Aperture Shape Controller （ASC）对30例采用VMAT计划治疗的临床病例进行再优化，以不同程度地限制计划复杂性。根据计划复杂性（单一和总体复杂性度量）、剂量学准确度（γ指数合格率）和临床适用性（调整计划质量度量）的替代度量来评估最终的计划。结果更严格的MU限制和更高的ASC惩罚导致光束视界正则化和叶片行程减少，同时增加了龙门速度和剂量率的调制。限制方案的复杂性提高了剂量测定的准确性，这体现在更高的γ-指数通过率上。然而，这伴随着临床适宜性的中度降低，反映在较低的调整计划质量度量（APQM%）上，不同治疗地点存在差异。与MLC孔径相关的复杂性指标是表征剂量学准确性和临床适用性的最重要指标。建立了一个综合复杂性评分，显示了剂量学准确性和临床适用性之间的单调关系，从而能够评估它们之间的权衡。结论通过确定合适的代理，通过管理VMAT计划的复杂性，可以定量地平衡临床适宜性和可交付性。虽然该方法是为本研究的临床常规量身定制的，但它具有标准化计划质量评估和改善不同临床环境下VMAT治疗结果的潜力。所获得的见解有助于在评估放射治疗总体计划质量方面取得更大的一致性和有效性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Physica Medica-European Journal of Medical Physics 生物-生物物理

CiteScore

6.80

自引率

14.70%

发文量

493

审稿时长

78 days

期刊介绍： Physica Medica, European Journal of Medical Physics, publishing with Elsevier from 2007, provides an international forum for research and reviews on the following main topics: Medical Imaging Radiation Therapy Radiation Protection Measuring Systems and Signal Processing Education and training in Medical Physics Professional issues in Medical Physics.