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Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy

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Published on: June 7, 2015

Comprehensive geometry-based plan quality score for lung VMAT.

Johann Brand¹, Juliane Szkitsak¹, Rafael Lobao¹

¹Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany; Bavarian Cancer Research Center (BZKF), Erlangen, Germany.

Zeitschrift Fur Medizinische Physik

|April 4, 2026

Summary

This summary is machine-generated.

A new Comprehensive Plan Score (CPS) objectively measures lung cancer radiotherapy quality. This score, using geometry-based metrics, helps standardize plan evaluation and improve treatment consistency.

Keywords:

Comprehensive plan score Geometry-based score Lung cancer Plan quality VMAT

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Area of Science:

Radiation Oncology
Medical Physics
Radiotherapy Planning

Background:

Lung cancer radiotherapy planning using Volumetric-modulated arc therapy (VMAT) faces challenges in balancing target coverage and organ-at-risk (OAR) sparing.
Plan quality is inconsistent due to variations in planner expertise, preferences, and patient-specific anatomy.

Purpose of the Study:

To introduce and validate a Comprehensive Plan Score (CPS) for objective and standardized evaluation of lung VMAT plans.
To integrate geometry-based OAR quality indices into a unified scoring system.

Main Methods:

Developed CPS by combining normalized target and OAR scores, incorporating geometry-based metrics from overlap volume histograms (OVH) and overlap-z-histograms (OZH).
Learned relative weights for CPS components through blinded pairwise plan comparisons by senior radiation oncologists (ROs).
Evaluated 35 manual vs. automated lung VMAT plan pairs, with 20 for training and 15 for independent testing.

Main Results:

Radiation oncologists showed clear preference in 81% of comparisons, with fair inter-observer agreement (Fleiss' κ = 0.36).
The CPS, using preference-trained weights, matched RO consensus in 11/15 (73%) of independent test cases.
Applying an equivalence threshold (ΔCPS = 0.01) improved CPS agreement to 13/15 (86%) cases.

Conclusions:

The Comprehensive Plan Score (CPS) offers an objective, geometry-based measure for lung VMAT plan quality.
CPS quantifies achievable OAR sparing, supporting consistent and standardized radiotherapy plan evaluation.
This approach has the potential to enhance the reproducibility and overall quality of radiotherapy planning.