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Dosimetry and efficiency comparison of knowledge-based and manual planning using volumetric modulated arc therapy for craniospinal irradiation

Wei-Ta Tsai

Wei-Ta Tsai

  • Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung UniversityTaipei, Taiwan
  • Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical FoundationChiayi, Taiwan
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Tsai, Wei-Ta
, 
Hui-Ling Hsieh

Hui-Ling Hsieh

Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical FoundationChiayi, Taiwan
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Hsieh, Hui-Ling
, 
Shih-Kai Hung

Shih-Kai Hung

  • Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical FoundationChiayi, Taiwan
  • School of Medicine, Tzu Chi UniversityHualien, Taiwan
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Hung, Shih-Kai
, 
Chi-Fu Zeng

Chi-Fu Zeng

Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical FoundationChiayi, Taiwan
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Zeng, Chi-Fu
, 
Ming-Fen Lee

Ming-Fen Lee

Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical FoundationChiayi, Taiwan
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Lee, Ming-Fen
, 
Po-Hao Lin

Po-Hao Lin

Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical FoundationChiayi, Taiwan
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Lin, Po-Hao
, 
Chia-Yi Lin

Chia-Yi Lin

Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical FoundationChiayi, Taiwan
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Lin, Chia-Yi
, 
Wei-Chih Li

Wei-Chih Li

Departments of Radiation Oncology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical FoundationTaichung, Taiwan
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Li, Wei-Chih
, 
Wen-Yen Chiou

Wen-Yen Chiou

  • Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical FoundationChiayi, Taiwan
  • School of Medicine, Tzu Chi UniversityHualien, Taiwan
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Chiou, Wen-Yen
 and 
Tung-Hsin Wu

Tung-Hsin Wu

Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung UniversityTaipei, Taiwan
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Wu, Tung-Hsin
  
Mar 07, 2024
Dosimetry and efficiency comparison of knowledge-based and manual planning using volumetric modulated arc therapy for craniospinal irradiation's Cover Image
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Article Category: Research Article
Published Online: Mar 07, 2024
Page range: 289 - 299
Received: Nov 04, 2023
Accepted: Jan 03, 2024
DOI: https://doi.org/10.2478/raon-2024-0018
Keywords
© 2024 Wei-Ta Tsai et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

Flowchart of the study design.CSI = craniospinal irradiation; CT = computed tomography; KBP = knowledge-based planning; VMAT = volumetric modulated arc therapy
Flowchart of the study design.CSI = craniospinal irradiation; CT = computed tomography; KBP = knowledge-based planning; VMAT = volumetric modulated arc therapy

FIGURE 2.

Example of the target and field setup. (A) The arrangement of the brain field (dotted lines), spine-superior field (solid lines), spine-inferior field (dashed lines), and their isocenters. Each field overlaps at least 5 cm for the low-dose gradient junction. (B) Full arc was used on the brain field. (C) Partial arc was used in the spinal fields for arm sparing.
Example of the target and field setup. (A) The arrangement of the brain field (dotted lines), spine-superior field (solid lines), spine-inferior field (dashed lines), and their isocenters. Each field overlaps at least 5 cm for the low-dose gradient junction. (B) Full arc was used on the brain field. (C) Partial arc was used in the spinal fields for arm sparing.

FIGURE 3.

(A) Population-averaged dose-volume histogram (DVH) for all organs at risk and targets. (B) The population-averaged DVH for targets only.CTV = clinical target volume; MP = manual optimization plan; PTV = planning target volumes; RPI = RapidPlan initial; RPF = final RapidPlan after manual re-optimization
(A) Population-averaged dose-volume histogram (DVH) for all organs at risk and targets. (B) The population-averaged DVH for targets only.CTV = clinical target volume; MP = manual optimization plan; PTV = planning target volumes; RPI = RapidPlan initial; RPF = final RapidPlan after manual re-optimization

FIGURE 4.

Comparison of the planning time for MP, RPI, and RPF. The error bar represents one standard deviation.MP = manual optimization plan; RPI = RapidPlan initial; RPF = final RapidPlan after manual re-optimization
Comparison of the planning time for MP, RPI, and RPF. The error bar represents one standard deviation.MP = manual optimization plan; RPI = RapidPlan initial; RPF = final RapidPlan after manual re-optimization

Dosimetric goals and results for organs at risk

OAR parameters Goals Results P value
MP RPI RPF MP vs. RPF MP vs. RPF RPI vs. RPI
Brain
  Dmax [Gy] < 60 39.34 ± 0.39 40.24 ± 0.61 39.28 ± 0.37 < 0.01** 0.46 < 0.01**
Brain stem
  Dmax [Gy] < 54 38.48 ± 0.41 39.03 ± 0.46 38.51 ± 0.28 < 0.01** 0.91 < 0.01**
Chiasm
  Dmean [Gy] < 50 37.15 ± 0.35 37.10 ± 0.32 36.95 ± 0.32 0.69 0.07 0.06
  Dmax [Gy] < 55 38.13 ± 0.40 38.73 ± 0.55 38.20 ± 0.26 0.01* 0.46 < 0.01**
Optic nerves
  Dmean [Gy] < 50 27.61 ± 3.40 22.90 ± 2.39 22.42 ± 2.29 < 0.01** < 0.01** 0.05
  Dmax [Gy] < 55 37.13 ± 0.69 36.36 ± 1.72 36.15 ± 1.39 0.13 0.02* 0.13
Eyes
  Dmax [Gy] < 50 25.55 ± 3.57 22.52 ± 3.83 21.60 ± 3.86 0.02* 0.01* 0.01*
Lens
  Dmax [Gy] < 10 8.40 ± 0.68 8.87 ± 1.00 8.10 ± 0.55 0.11 0.21 < 0.01**
Parotid glands
  Dmean [Gy] < 25 7.38 ± 2.52 5.16 ± 0.39 4.95 ± 0.39 < 0.01** < 0.01** < 0.01**
Spinal cord
  Dmax [Gy] < 50 38.93 ± 0.51 39.81 ± 0.67 39.04 ± 0.56 < 0.01** < 0.01** < 0.01**
Thyroid
  Dmax [Gy] < 45 17.23 ± 4.04 16.68 ± 2.13 16.38 ± 2.04 0.59 0.36 0.07
Lungs
  Dmean [Gy] < 13 4.63 ± 0.30 4.95 ± 0.43 4.63 ± 0.24 0.03* 0.73 < 0.01**
  V20Gy [%] < 22 0.06 ± 0.11 0.04 ± 0.08 0.03 ± 0.04 0.64 0.44 0.33
  V5Gy [%] < 42 36.48 ± 2.88 42.77 ± 5.62 37.11 ± 2.87 0.01* 0.69 < 0.01**
Heart
  Dmean [Gy] < 10 6.76 ± 1.47 5.53 ± 0.82 5.70 ± 0.93 0.01* 0.02* 0.33
  V40Gy [%] < 3 0.00 ± 0.00 0.00 ± 0.00 0.00 ± 0.00 - - -
  V18Gy [%] < 5 0.04 ± 0.10 0.01 ± 0.03 0.01 ± 0.02 0.31 0.23 0.41
Esophagus
  Dmean [Gy] < 34 14.34 ± 1.62 13.23 ± 1.63 13.30 ± 1.74 0.01* < 0.01** 0.96
Liver
  Dmean [Gy] < 30 4.82 ± 0.94 4.57 ± 0.73 4.45 ± 0.70 0.61 0.33 < 0.01**
Kidneys
  Dmean [Gy] < 18 2.81 ± 1.17 2.47 ± 0.46 2.38 ± 0.43 0.96 0.73 < 0.01**

The mean dose of the OARs outside the targets contours

Organ Mean dose P value
MP RPI RPF MP vs. RPI MP vs. RPF RPI vs. RPF
Optic nerves 27.61 ± 3.40 22.90 ± 2.39 22.42 ± 2.29 < 0.01** < 0.01** 0.05
Eyes 12.11 ± 1.99 10.16 ± 0.55 9.83 ± 0.74 0.01* 0.01* 0.02*
Lens 7.09 ± 0.67 7.21 ± 0.52 6.78 ± 0.39 0.43 0.16 < 0.01**
Parotid glands 7.38 ± 2.52 5.16 ± 0.39 4.95 ± 0.39 < 0.01** < 0.01** < 0.01**
Thyroid 10.41 ± 3.37 9.00 ± 1.94 8.51 ± 2.07 0.06 0.04* < 0.01**
Lungs 4.63 ± 0.30 4.95 ± 0.43 4.63 ± 0.24 0.03* 0.73 < 0.01**
Heart 6.76 ± 1.47 5.53 ± 0.82 5.70 ± 0.93 0.01* 0.02* 0.33
Liver 4.82 ± 0.94 4.57 ± 0.73 4.45 ± 0.70 0.61 0.33 < 0.01**
Kidneys 2.81 ± 1.17 2.47 ± 0.46 2.38 ± 0.43 0.96 0.73 < 0.01**

Dosimetric comparison between manual plans, RapidPlan initial, and RapidPlan final

Parameters Goals Results P value
MP RPI RPF MP vs. RPI MP vs. RPF RPI vs. RPF
CTV
  V95 [%] > 99 99.99 ± 0.03 99.98 ± 0.03 99.97 ± 0.03 0.36 0.03* 0.09
  V100 [%] > 99 99.20 ± 0.17 98.37 ± 0.33 99.37 ± 0.23 < 0.01** 0.07 < 0.01**
  V107 [%] Minimize 0.62 ± 0.59 2.94 ± 4.33 0.46 ± 0.66 < 0.01** 0.16 < 0.01**
  Dmean [Gy] 36 37.23 ± 0.18 37.31 ± 0.21 37.22 ± 0.24 0.07 0.87 0.13
  Dmax [Gy] Minimize 39.38 ± 0.40 40.38 ± 0.57 39.42 ± 0.41 < 0.01** 0.78 < 0.01**
  D2 [%] < 107 106.12 ± 0.73 106.95 ± 0.96 105.72 ± 0.84 < 0.01** 0.19 < 0.01**
PTV
  V95 [%] > 98 99.68 ± 0.15 99.55 ± 0.23 99.24 ± 0.32 0.03* < 0.01** < 0.01**
  V100 [%] = 95 95.00 ± 0.00 95.00 ± 0.00 95.00 ± 0.00 - - -
  V107 [%] Minimize 0.62 ± 0.57 3.01 ± 4.12 0.44 ± 0.61 < 0.01** 0.17 < 0.01**
  Dmean [Gy] 36 37.10 ± 0.16 37.22 ± 0.18 37.08 ± 0.20 0.05 0.73 0.01*
  Dmax [%] < 112 109.99 ± 1.17 112.89 ± 1.78 110.17 ± 1.14 < 0.01** 0.57 < 0.01**
  D2 [%] < 107 106.09 ± 0.73 107.00 ± 0.93 105.71 ± 0.80 < 0.01** 0.21 < 0.01**
  CI 1 0.98 ± 0.01 1.01 ± 0.01 1.00 ± 0.01 < 0.01** < 0.01** 0.01*
  HI 1 1.10 ± 0.01 1.13 ± 0.02 1.10 ± 0.01 < 0.01** 0.57 < 0.01**
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