Automatic field-in-field treatment planning function for deep inspiration breath hold left breast radiotherapy using...

Breast radiotherapy treatment planning can be time consuming for the medical dosimetrist due to the manual creation of field-in-field control points to achieve dose homogeneity. RayStation 2023b includes an automatic field-in-field (AFIF) feature to assist in planning three-dimensional conformal radiation therapy (3D-CRT) treatment plans. Although AFIF is extensively researched for tools such as EZFluence, there is limited research that examines RayStation 2023b's AFIF feature on planning 3D-CRT treatments to the breast. The purpose of this study was to examine if the use of RayStation 2023b's AFIF feature reduced treatment planning time while maintaining planning metrics for left breast deep inspiration breath-hold (DIBH) radiotherapy, compared with manual field-in-field (MFIF) planning. Ten patients with histologically confirmed left sided breast cancer were retrospectively planned with both MFIF and AFIF techniques with a prescription of 4256 cGy delivered in 16 fractions. All patients had undergone breast conserving surgery and were patients from one institution. Time to plan for each MFIF and AFIF plans were recorded along with dose to the surrounding organs at risk (OAR) and monitor units (MU) for each field. The AFIF treatment plans were significantly more efficient than the MFIF plans (p = 0.000) but were associated with higher maximum doses (p = 0.000). All other planning metrics had no significant differences, suggesting that RayStation 2023b's AFIF tool was more efficient at planning left sided breast radiotherapy treatments without compromising the clinical target volume (CTV) coverage and OAR sparing.