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Medical Physics
Article . 2024 . Peer-reviewed
License: CC BY NC
Data sources: Crossref
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PubMed Central
Article . 2024
License: CC BY NC
Data sources: PubMed Central
Medical Physics
Article . 2025
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An automated treatment planning portfolio for whole breast radiotherapy

Authors: Baroudi, Hana; Che Fru, Leonard; Schofield, Deborah; Roniger, Dominique L.; Nguyen, Callistus; Hancock, Donald; Chung, Christine; +16 Authors

An automated treatment planning portfolio for whole breast radiotherapy

Abstract

Abstract Background Automation in radiotherapy presents a promising solution to the increasing cancer burden and workforce shortages. However, existing automated methods for breast radiotherapy lack a comprehensive, end‐to‐end solution that meets varying standards of care. Purpose This study aims to develop a complete portfolio of automated radiotherapy treatment planning for intact breasts, tailored to individual patient factors, clinical approaches, and available resources. Methods We developed five automated conventional treatment approaches and utilized an established RapidPlan model for volumetric arc therapy. These approaches include conventional tangents for whole breast treatment, two variants for supraclavicular nodes (SCLV) treatment with/without axillary nodes, and two options for comprehensive regional lymph nodes treatment. The latter consists of wide tangents photon fields with a SCLV field, and a photon tangents field with a matched electron field to treat the internal mammary nodes (IMNs), and a SCLV field. Each approach offers the choice of a single or two isocenter setup (with couch rotation) to accommodate a wide range of patient sizes. All algorithms start by automatically generating contours for breast clinical target volume, regional lymph nodes, and organs at risk using an in‐house nnU‐net deep learning models. Gantry angles and field shapes are then automatically generated and optimized to ensure target coverage while limiting the dose to nearby organs. The dose is optimized using field weighting for the lymph nodes fields and an automated field‐in‐field approach for the tangents. These algorithms were integrated into the RayStation treatment planning system and tested for clinical acceptability on 15 internal whole breast patients (150 plans) and 40 external patients from four different institutions in Switzerland, Argentina, Iran, and the USA (360 plans). Evaluation criteria included ensuring adequate coverage of targets and adherence to dose constraints for normal structures. A breast radiation oncologist reviewed the single institution dataset for clinical acceptability (5‐point scale) and a physicist evaluated the multi‐institutional dataset (use as is or edit). Results The dosimetric evaluation across all datasets (510 plans) showed that 100% of the automated plans met the dose coverage requirements for the breast, 99% for the SCLV, 98% for the axillary nodes, and 91% for the IMN. As expected, hot spots were more prevalent when multiple fields were combined. For the heart, ipsilateral lung, and contralateral breast, automated plans met constraints for 95%, 92%, and 95% of the plans, respectively. Physician evaluation of the 15 internal patients indicated that all automated plans were clinically acceptable with minor edits. Notably, the use of automated contours with the RapidPlan model resulted in plans that were immediately ready for use in 73% of cases (95% confidence interval, 95% CI [51‐ 96]) of patients, with the remaining cases requiring minor stylistic edits. Similarly, the physicist's review of the 40 multi‐institution patients showed that the auto‐plans were ready for use 79% (95% CI [73,85]) of the time (95% CI [73,85]), with edits needed for the remaining cases. Conclusion This study demonstrates the feasibility of a comprehensive automated treatment planning model for whole breast radiotherapy, effectively accommodating diverse treatment paradigms.

Keywords

Organs at Risk, Automation, EMERGING IMAGING AND THERAPY MODALITIES, Radiotherapy Planning, Computer-Assisted, Humans, Breast Neoplasms, Female, Radiotherapy Dosage

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    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
5
Top 10%
Average
Top 10%
Green
hybrid
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