What is plan quality in radiotherapy? The importance of evaluating dose metrics, complexity, and robustness of treatment plans

Victor Hernandez, Christian Rønn Hansen, Lamberto Widesott, Anna Bäck, Richard Canters, Marco Fusella, Julia Götstedt, Diego Jurado-Bruggeman, Nobutaka Mukumoto, Laura Patricia Kaplan, Irena Koniarová, Tomasz Piotrowski, Lorenzo Placidi, Ana Vaniqui, Nuria Jornet

Research output: Contribution to journalReview articlepeer-review

Abstract

Plan evaluation is a key step in the radiotherapy treatment workflow. Central to this step is the assessment of treatment plan quality. Hence, it is important to agree on what we mean by plan quality and to be fully aware of which parameters it depends on. We understand plan quality in radiotherapy as the clinical suitability of the delivered dose distribution that can be realistically expected from a treatment plan. Plan quality is commonly assessed by evaluating the dose distribution calculated by the treatment planning system (TPS). Evaluating the 3D dose distribution is not easy, however; it is hard to fully evaluate its spatial characteristics and we still lack the knowledge for personalising the prediction of the clinical outcome based on individual patient characteristics. This advocates for standardisation and systematic collection of clinical data and outcomes after radiotherapy. Additionally, the calculated dose distribution is not exactly the dose delivered to the patient due to uncertainties in the dose calculation and the treatment delivery, including variations in the patient set-up and anatomy. Consequently, plan quality also depends on the robustness and complexity of the treatment plan. We believe that future work and consensus on the best metrics for quality indices are required. Better tools are needed in TPSs for the evaluation of dose distributions, for the robust evaluation and optimisation of treatment plans, and for controlling and reporting plan complexity. Implementation of such tools and a better understanding of these concepts will facilitate the handling of these characteristics in clinical practice and be helpful to increase the overall quality of treatment plans in radiotherapy.

Original languageEnglish
Pages (from-to)26-33
Number of pages8
JournalRadiotherapy and Oncology
Volume153
DOIs
Publication statusPublished - Dec 2020

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