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Updated: May 8, 2025
Author Spotlight: Improving Radiation Therapy Access with Radiation Planning Assistant
Published on: October 6, 2023
Automated contouring and radiotherapy treatment planning of spine metastases using atlas-based auto-segmentation and
Emma-Louise Jones1, Porsher Oppong1, Caroline Sisodia1
1Department of Medical Physics and Clinical Engineering, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London SE1 7EH, United Kingdom.
Objectives:
Spine metastases are routinely treated with conventional external beam radiotherapy (cEBRT) where there is no delineation of target volumes (TV) or organs at risk (OAR), or attempt to optimize dose distribution. Automated contouring and treatment planning could facilitate conformal planning of spine metastases in the clinical environment.
Methods:
Atlas-based auto-segmentation (ABAS) using SmartSegmentation was developed for delineation of thoracic and lumbar vertebrae, and OAR; knowledge-based planning (KBP) using RapidPlan was developed for conformal volumetric-modulated arc therapy treatment planning. Plans produced using this automated approach were compared to the equivalent cEBRT plans.
Results:
TV coverage for automated ABAS/KBP conformal treatment plans were superior to cEBRT. The planning target volume (PTV) Dmean = 7.86 ± 0.16 Gy, Dmin = 3.46 ± 1.79 Gy, Dmax = 8.56 ± 0.05 Gy compared to PTV Dmean = 7.78 ± 0.24 Gy, Dmin = 1.83 ± 1.08 Gy, Dmax = 10.46 ± 0.41 Gy, with homogeneity index and conformity index 0.236 ± 0.215 and 1.201 ± 0.121, respectively, for ABAS/KBP compared to 0.508 ± 0.137 and 1.789 ± 0.437 for cEBRT. Dose to dose-limiting spinal cord and cauda equina was reduced in ABAS/KBP plans, with Dmax of 7.91 ± 0.16 Gy and 7.94 ± 0.13 Gy, respectively, compared to 8.67 ± 0.13 Gy and 8.90 ± 0.16 Gy for cEBRT.
Conclusions:
Automated conformal treatment planning was achievable, with improved sparing of dose-limiting OAR and superior plan quality compared to cEBRT. Automation of the planning process makes this feasible for implementation in the clinical environment.
Advances In Knowledge:
Automated contouring and treatment planning are feasible in the clinical environment using this approach. We describe the first use of ABAS and KBP for radiotherapy treatment of spine metastases that would allow patients to receive conformal as opposed to the widely used approach of cEBRT.
