Clinical application study of script-based Monaco automated planning in whole-brain radiation therapy
Fanrui Zeng1, Min Liu2, Wenguang Chen1
1Department of Radiation Oncology, Precision Radiation in Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Center, Sichuan Cancer Hospital & Institute, University of Electronic Science and Technology of China, Chengdu, China; Applied Nuclear Technology in Geosciences Key Laboratory of Sichuan Province, Chengdu University of Technology, Chengdu, China.
Abstract:
Elekta's Monaco (Elekta AB, Stockholm, Sweden) treatment planning system (TPS) introduces script-based automation functionality. This study developed and validated a fully script-based automated radiotherapy planning solution for whole-brain radiotherapy (WBRT) based on the Monaco TPS. This approach not only enables complete automation of the planning workflow but also effectively enhances plan quality while meeting clinical dose requirements. To systematically compare dosimetric, radiobiological, and operational performance between script-generated automated plans and clinically approved manual WBRT plans on the Monaco TPS. A retrospective analysis of 20 WBRT patients was conducted. A custom C# ASP.NET script was programmed in Visual Studio 2022 for end-to-end automated template optimization. Plan quality was assessed against clinical manual plans based on a RapidPlan scoring system. Paired t-tests or Wilcoxon signed-rank tests were used to compare planning target volume (PTV) and organ-at-risk (OAR) dosimetry, beam delivery parameters, equivalent uniform dose (EUD), tumor control probability (TCP), and normal tissue complication probability (NTCP). No statistically significant inter-group differences were detected for PTV coverage metrics, majority OAR dose-volume endpoints, beam delivery parameters, or total plan quality scores (p > 0.05). Manual plans yielded significantly lower optic nerve D0.03cc (2874.42 vs 3014.61 cGy, p < 0.05), while automated plans produced significantly reduced mean doses to bilateral parotid glands (566.84 vs 675.30 cGy, p < 0.001) and cochleae (2687.25 vs 2819.73 cGy, p < 0.05). PTV EUD and TCP were nearly identical between 2 planning strategies. For radiobiological indices, automated plans demonstrated statistically elevated NTCP for hippocampi, brainstem, eyes, and optic nerves (p < 0.05). Automated batch processing drastically reduced recorded planning workflow time, though retrospective manual timestamps carry inherent measurement bias. The proposed Monaco scripting workflow reliably generates WBRT plans meeting all institutional clinical dose criteria, with favorable automated sparing of parotid and cochlear tissues. This script tool delivers consistent baseline planning and batch-processing efficiency; multicenter large-cohort validation across variable cranial anatomy is required before universal routine clinical deployment.
