What is plan quality in radiotherapy? The importance of evaluating dose metrics, complexity, and robustness of treatment plans
What is plan quality in radiotherapy? The importance of evaluating dose metrics, complexity, and robustness of treatment plans
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DOI：
10.1016/j.radonc.2020.09.038
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发表时间：
2020-12-01
影响因子：
5.7
通讯作者：
Jornet, Nuria
中科院分区：
文献类型：
--
作者：
Hernandez, Victor;Hansen, Christian Ronn;Jornet, Nuria
计划评估是放射治疗工作流程中的关键步骤。此步骤的核心是评估治疗计划的质量。因此，重要的是要就计划质量的含义达成一致，并充分了解它取决于哪些参数。我们将放射治疗中的计划质量理解为可以从治疗计划中实际预期的所交付剂量分布的临床适用性。通常通过评估治疗计划系统 (TPS) 计算的剂量分布来评估计划质量。然而，评估 3D 剂量分布并不容易；很难全面评估其空间特征，我们仍然缺乏根据个体患者特征个性化预测临床结果的知识。这主张放射治疗后临床数据和结果的标准化和系统收集。此外，由于剂量计算和治疗实施的不确定性，包括患者设置和解剖结构的变化，计算出的剂量分布并不完全是输送给患者的剂量。因此，计划质量还取决于治疗计划的稳健性和复杂性。我们认为，未来需要就质量指数的最佳指标开展工作并达成共识。 TPS 需要更好的工具来评估剂量分布、稳健评估和优化治疗计划以及控制和报告计划复杂性。这些工具的实施以及对这些概念的更好理解将有助于在临床实践中处理这些特征，并有助于提高放射治疗治疗计划的整体质量。 (C) 2020 作者。由 Elsevier B.V. 出版
Plan evaluation is a key step in the radiotherapy treatment workflow. Central to this step is the assessment of treatment plan quality. Hence, it is important to agree on what we mean by plan quality and to be fully aware of which parameters it depends on. We understand plan quality in radiotherapy as the clinical suitability of the delivered dose distribution that can be realistically expected from a treatment plan. Plan quality is commonly assessed by evaluating the dose distribution calculated by the treatment planning system (TPS). Evaluating the 3D dose distribution is not easy, however; it is hard to fully evaluate its spatial characteristics and we still lack the knowledge for personalising the prediction of the clinical outcome based on individual patient characteristics. This advocates for standardisation and systematic collection of clinical data and outcomes after radiotherapy. Additionally, the calculated dose distribution is not exactly the dose delivered to the patient due to uncertainties in the dose calculation and the treatment delivery, including variations in the patient set-up and anatomy. Consequently, plan quality also depends on the robustness and complexity of the treatment plan. We believe that future work and consensus on the best metrics for quality indices are required. Better tools are needed in TPSs for the evaluation of dose distributions, for the robust evaluation and optimisation of treatment plans, and for controlling and reporting plan complexity. Implementation of such tools and a better understanding of these concepts will facilitate the handling of these characteristics in clinical practice and be helpful to increase the overall quality of treatment plans in radiotherapy. (C) 2020 The Authors. Published by Elsevier B.V.