Single Click Automated Breast Planning With Iterative Optimization

Purpose To present the development of an in-house coded solution for treatment planning of tangential breast radiotherapy that creates single click plans by emulating the iterative optimization process of human dosimetrists. Method One hundred clinical breast cancer patients were retrospectively planned with an automated planning (AP) code incorporating the hybrid intensity-modulated radiotherapy (IMRT) approach. The code automates all planning processes including plan generation, beam generation, gantry and collimator angle determination, open segments and dynamic IMRT fluence and calculations. Thirty-nine dose volume histogram (DVH) metrics taken from three international recommendations were compared between the automated and clinical plans (CP), along with median interquartile analysis of the DVH distributions. Total planning time and delivery QA were also compared between the plan sets. Results Of the 39 planning metrics analyzed 23 showed no significant difference between clinical and automated planning techniques. Of the 16 metrics with statistically significant variations, 2 were improved in the clinical plans in comparison to 14 improved in the AP plans. Automated plans produced a greater number of ideal plans against international guidelines as per EviQ (AP:77%, CP:68%), RTOG 1005 (AP:80%, CP:71%), and London Cancer references (AP:80%, CP:75%). Delivery QA results for both techniques were equivalent. Automated planning techniques resulted in an average reduction in planning time from 23 to 5 minutes. Conclusion We have introduced an automated planning code with iterative optimization that produces equivalent quality plans to manual clinical planning. The resultant change in workflow results in a reduction in treatment planning times.