TY - JOUR
T1 - Automation of radiation treatment planning for rectal cancer
AU - Huang, Kai
AU - Das, Prajnan
AU - Olanrewaju, Adenike M.
AU - Cardenas, Carlos
AU - Fuentes, David
AU - Zhang, Lifei
AU - Hancock, Donald
AU - Simonds, Hannah
AU - Rhee, Dong Joo
AU - Beddar, Sam
AU - Briere, Tina M.
AU - Court, Laurence
N1 - Publisher Copyright:
© 2022 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine.
PY - 2022/9
Y1 - 2022/9
N2 - Purpose: To develop an automated workflow for rectal cancer three-dimensional conformal radiotherapy (3DCRT) treatment planning that combines deep learning (DL) aperture predictions and forward-planning algorithms. Methods: We designed an algorithm to automate the clinical workflow for 3DCRT planning with field aperture creations and field-in-field (FIF) planning. DL models (DeepLabV3+ architecture) were trained, validated, and tested on 555 patients to automatically generate aperture shapes for primary (posterior–anterior [PA] and opposed laterals) and boost fields. Network inputs were digitally reconstructed radiographs, gross tumor volume (GTV), and nodal GTV. A physician scored each aperture for 20 patients on a 5-point scale (>3 is acceptable). A planning algorithm was then developed to create a homogeneous dose using a combination of wedges and subfields. The algorithm iteratively identifies a hotspot volume, creates a subfield, calculates dose, and optimizes beam weight all without user intervention. The algorithm was tested on 20 patients using clinical apertures with varying wedge angles and definitions of hotspots, and the resulting plans were scored by a physician. The end-to-end workflow was tested and scored by a physician on another 39 patients. Results: The predicted apertures had Dice scores of 0.95, 0.94, and 0.90 for PA, laterals, and boost fields, respectively. Overall, 100%, 95%, and 87.5% of the PA, laterals, and boost apertures were scored as clinically acceptable, respectively. At least one auto-plan was clinically acceptable for all patients. Wedged and non-wedged plans were clinically acceptable for 85% and 50% of patients, respectively. The hotspot dose percentage was reduced from 121% (σ = 14%) to 109% (σ = 5%) of prescription dose for all plans. The integrated end-to-end workflow of automatically generated apertures and optimized FIF planning gave clinically acceptable plans for 38/39 (97%) of patients. Conclusion: We have successfully automated the clinical workflow for generating radiotherapy plans for rectal cancer for our institution.
AB - Purpose: To develop an automated workflow for rectal cancer three-dimensional conformal radiotherapy (3DCRT) treatment planning that combines deep learning (DL) aperture predictions and forward-planning algorithms. Methods: We designed an algorithm to automate the clinical workflow for 3DCRT planning with field aperture creations and field-in-field (FIF) planning. DL models (DeepLabV3+ architecture) were trained, validated, and tested on 555 patients to automatically generate aperture shapes for primary (posterior–anterior [PA] and opposed laterals) and boost fields. Network inputs were digitally reconstructed radiographs, gross tumor volume (GTV), and nodal GTV. A physician scored each aperture for 20 patients on a 5-point scale (>3 is acceptable). A planning algorithm was then developed to create a homogeneous dose using a combination of wedges and subfields. The algorithm iteratively identifies a hotspot volume, creates a subfield, calculates dose, and optimizes beam weight all without user intervention. The algorithm was tested on 20 patients using clinical apertures with varying wedge angles and definitions of hotspots, and the resulting plans were scored by a physician. The end-to-end workflow was tested and scored by a physician on another 39 patients. Results: The predicted apertures had Dice scores of 0.95, 0.94, and 0.90 for PA, laterals, and boost fields, respectively. Overall, 100%, 95%, and 87.5% of the PA, laterals, and boost apertures were scored as clinically acceptable, respectively. At least one auto-plan was clinically acceptable for all patients. Wedged and non-wedged plans were clinically acceptable for 85% and 50% of patients, respectively. The hotspot dose percentage was reduced from 121% (σ = 14%) to 109% (σ = 5%) of prescription dose for all plans. The integrated end-to-end workflow of automatically generated apertures and optimized FIF planning gave clinically acceptable plans for 38/39 (97%) of patients. Conclusion: We have successfully automated the clinical workflow for generating radiotherapy plans for rectal cancer for our institution.
KW - automation
KW - deep learning
KW - field-in-field
KW - radiotherapy
KW - rectal cancer
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U2 - 10.1002/acm2.13712
DO - 10.1002/acm2.13712
M3 - Article
C2 - 35808871
AN - SCOPUS:85133628263
SN - 1526-9914
VL - 23
JO - Journal of applied clinical medical physics
JF - Journal of applied clinical medical physics
IS - 9
M1 - e13712
ER -