Development and clinical deployment of an automated planning tool for prostate only and male whole pelvis plans based...

Multi-criteria optimization (MCO) is an advanced optimization technique that can be applied to any problem with multiple objectives that may be conflicting. MCO has been available in commercial treatment planning systems (TPS) for several years now and has been applied to treatment planning of many anatomical locations in a variety of ways. The MCO optimization method is based on the Pareto plans generation and is very powerful, but there are significant hurdles in terms of clinical implementation due to long computing times, lack of dosimetrists training and plan degradation after the optimized fluence is converted to deliverable. While some authors have studied the use of MCO in automation, no clinical implementation of an MCO-based auto-planning technique has been reported.

This study aims to develop and clinically deploy an automated planning tool based on MCO for prostate and whole-pelvis radiotherapy.

A Python script based on a commercial treatment planning system was developed to automate MCO, including Pareto plan generation, fluence plan selection, dose conversion, and post-processing. The tool underwent retrospective validation on 10 prostate patients with the input of four dosimetrists and a 10-month prospective pilot involving another three senior dosimetrists across different community sites. Dosimetrists evaluated plan quality and provided quantitative and qualitative feedback for iterative improvements of the tool. The study reports on the plan comparisons between the clinical and the MCO generated plans for retrospective patients. The study also reports the prospective use cases and the qualitative and quantitative evaluations from dosimetrists.

Retrospective evaluations showed 82.5% of MCO prostate plans were clinically acceptable. The tool generated prostate plans in approximately 10.1 min and whole pelvis plans in 27.2 min. Dosimetric analysis revealed comparable plan quality to clinical plans, with MCO plans achieving lower organ-at-risk doses. In the pilot phase, the MCO tool was used for 41 prospective patients, producing plans that dosimetrists could refine to achieve clinical acceptability within a median of 10 min.

This study demonstrates the successful development and clinical implementation of an MCO-based automated planning tool for generating acceptable VMAT plans for prostate and whole pelvis radiotherapy. The extensive pilot phase showcases an effective strategy for integrating automated planning solutions into routine clinical practice.