Treatment plan complexity does not predict IROC Houston anthropomorphic head and neck phantom performance

Mallory C. Glenn, Victor Hernandez, Jordi Saez, David S. Followill, Rebecca M. Howell, Julianne M. Pollard-Larkin, Shouhao Zhou, Stephen F. Kry

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Previous works indicate that intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) plans that are highly complex may produce more errors in dose calculation and treatment delivery. Multiple complexity metrics have been proposed and associated with IMRT QA results, but their relationships with plan performance using in situ dose measurements have not been thoroughly investigated. This study aimed to evaluate the relationships between IMRT treatment plan complexity and anthropomorphic phantom performance in order to assess the extent to which plan complexity is related to dosimetric performance in the IROC phantom credentialing program. Sixteen complexity metrics, including the modulation complexity score (MCS), several modulation indices, and total monitor units (MU) delivered, were evaluated for 343 head and neck phantom irradiations, comprising both IMRT (step-and-shoot and sliding window techniques) and VMAT. Spearman's correlations were used to explore the relationship between complexity and plan performance, as measured by the dosimetric differences between the treatment planning system (TPS) and thermoluminescent dosimeter (TLD) measurement, as well as film gamma analysis. Relationships were likewise determined for several combinations of subpopulations, based on the linear accelerator model, TPS used, and delivery modality. Evaluation of the complexity metrics presented here yielded no significant relationships (p > 0.01, Bonferroni-corrected) and all correlations were weak (less than ±0.30). These results indicate that complexity metrics have limited predictive utility in assessing plan performance in multi-institutional comparisons of IMRT plans. Other factors affecting plan accuracy, such as dosimetric modeling or multileaf collimator (MLC) performance, should be investigated to determine a more probable cause for dose delivery errors.

Original languageEnglish (US)
Article number205015
JournalPhysics in Medicine and Biology
Volume63
Issue number20
DOIs
StatePublished - Oct 17 2018

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Intensity-Modulated Radiotherapy
Neck
Head
Therapeutics
Credentialing
Particle Accelerators
Linear Models

All Science Journal Classification (ASJC) codes

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging

Cite this

Glenn, M. C., Hernandez, V., Saez, J., Followill, D. S., Howell, R. M., Pollard-Larkin, J. M., ... Kry, S. F. (2018). Treatment plan complexity does not predict IROC Houston anthropomorphic head and neck phantom performance. Physics in Medicine and Biology, 63(20), [205015]. https://doi.org/10.1088/1361-6560/aae29e
Glenn, Mallory C. ; Hernandez, Victor ; Saez, Jordi ; Followill, David S. ; Howell, Rebecca M. ; Pollard-Larkin, Julianne M. ; Zhou, Shouhao ; Kry, Stephen F. / Treatment plan complexity does not predict IROC Houston anthropomorphic head and neck phantom performance. In: Physics in Medicine and Biology. 2018 ; Vol. 63, No. 20.
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abstract = "Previous works indicate that intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) plans that are highly complex may produce more errors in dose calculation and treatment delivery. Multiple complexity metrics have been proposed and associated with IMRT QA results, but their relationships with plan performance using in situ dose measurements have not been thoroughly investigated. This study aimed to evaluate the relationships between IMRT treatment plan complexity and anthropomorphic phantom performance in order to assess the extent to which plan complexity is related to dosimetric performance in the IROC phantom credentialing program. Sixteen complexity metrics, including the modulation complexity score (MCS), several modulation indices, and total monitor units (MU) delivered, were evaluated for 343 head and neck phantom irradiations, comprising both IMRT (step-and-shoot and sliding window techniques) and VMAT. Spearman's correlations were used to explore the relationship between complexity and plan performance, as measured by the dosimetric differences between the treatment planning system (TPS) and thermoluminescent dosimeter (TLD) measurement, as well as film gamma analysis. Relationships were likewise determined for several combinations of subpopulations, based on the linear accelerator model, TPS used, and delivery modality. Evaluation of the complexity metrics presented here yielded no significant relationships (p > 0.01, Bonferroni-corrected) and all correlations were weak (less than ±0.30). These results indicate that complexity metrics have limited predictive utility in assessing plan performance in multi-institutional comparisons of IMRT plans. Other factors affecting plan accuracy, such as dosimetric modeling or multileaf collimator (MLC) performance, should be investigated to determine a more probable cause for dose delivery errors.",
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Glenn, MC, Hernandez, V, Saez, J, Followill, DS, Howell, RM, Pollard-Larkin, JM, Zhou, S & Kry, SF 2018, 'Treatment plan complexity does not predict IROC Houston anthropomorphic head and neck phantom performance', Physics in Medicine and Biology, vol. 63, no. 20, 205015. https://doi.org/10.1088/1361-6560/aae29e

Treatment plan complexity does not predict IROC Houston anthropomorphic head and neck phantom performance. / Glenn, Mallory C.; Hernandez, Victor; Saez, Jordi; Followill, David S.; Howell, Rebecca M.; Pollard-Larkin, Julianne M.; Zhou, Shouhao; Kry, Stephen F.

In: Physics in Medicine and Biology, Vol. 63, No. 20, 205015, 17.10.2018.

Research output: Contribution to journalArticle

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AU - Glenn, Mallory C.

AU - Hernandez, Victor

AU - Saez, Jordi

AU - Followill, David S.

AU - Howell, Rebecca M.

AU - Pollard-Larkin, Julianne M.

AU - Zhou, Shouhao

AU - Kry, Stephen F.

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