Plan quality improvement by DVH sharing and planner's experience: Results of a SBRT multicentric planning study on prostate

Elena Villaggi, Victor Hernandez, Marco Fusella, Eugenia Moretti, Serenella Russo, Elena Maria Luisa Vaccara, Barbara Nardiello, Marco Esposito, Jordi Saez, Savino Cilla, Carmelo Marino, Michele Stasi, Pietro Mancosu

Research output: Contribution to journalArticlepeer-review


Purpose: To evaluate, in a multi-institutional context, the role of Dose Volume Histogram (DVH) sharing in order to achieve higher plan quality, to harmonize prostate Stereotactic Body Radiation Therapy (SBRT) plans and to assess if the planner's experience in SBRT could lead to lower dose at organs at risk (OARs). Methods: During the first phase five patients enrolled for prostate SBRT were planned by multiple physicists according to common protocol. The prescription dose was 35 Gy in 5 fractions. Dosimetric parameters, modulation index (MIt), plan parameters, and planner experience level (EL) were statistically analyzed. During the second phase median DVHs from all centers were shared and physicists replanned one patient of the five, aiming at inter-planner harmonization and further OARs sparing. Data were summarized by Spearman-correlogram (p < 0.05) and boxplots. The Kruskal-Wallis test was used to compare the re-plans to the original plans. Results: Seventy-eight SBRT plans from 13 centers were evaluated. EL correlated with modulation of plan parameters and reduction of OARs doses, such as volume receiving 28 Gy of rectum (rectum-V28Gy), rectum-V32Gy, and bladder-V30Gy. The re-plans showed significant reduced variability in rectum-V28Gy and increased PTV dose homogeneity. No significant difference in plan complexity metrics and plan parameters between plans and re-plans were obtained. Conclusions: Planner's experience in prostate SBRT was correlated with dosimetric parameters. Sharing median DVHs reduced variability among centers whilst keeping the same level of plan complexity. SBRT planning skills can benefit from a replanning phase after sharing DVHs from multiple centers, improving plan quality and concordance among centers.

Original languageEnglish
Pages (from-to)73-82
Number of pages10
JournalPhysica Medica
Publication statusPublished - Jun 1 2019


  • Crowd knowledge-based optimization
  • Multicentric planning
  • Plan quality
  • Prostate SBRT

ASJC Scopus subject areas

  • Biophysics
  • Radiology Nuclear Medicine and imaging
  • Physics and Astronomy(all)


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