Differences between professionals in treatment planning for patients with stage III lung cancer using treatment-planning QA software

Daisuke Sato; Motoharu Sasaki; Yuji Nakaguchi; Takeshi Kamomae; Takashi Kawanaka; Akiko Kubo; Chisato Tonoiso; Yuki Kanazawa; Masataka Oita; Akimi Kajino; Akira Tsuzuki; Hitoshi Ikushima

doi:10.5603/rpor.97511

Differences between professionals in treatment planning for patients with stage III lung cancer using treatment-planning QA software

Rep Pract Oncol Radiother. 2023 Nov 16;28(5):671-680. doi: 10.5603/rpor.97511. eCollection 2023.

Authors

Affiliations

¹ Graduate School of Health Sciences, Tokushima University, Tokushima, Japan.
² Department of Therapeutic Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
³ Toyo Medic Co., Ltd, Tokyo, Japan.
⁴ Department of Radiology, Graduate School of Medicine, Nagoya University Nagoya, Japan.
⁵ Department of Radiology and Radiation Oncology, Institute of Biomedical Sciences, Graduate School, Tokushima University Tokushima, Japan.
⁶ Department of Medical Image Informatics, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima, Japan.
⁷ Division of Radiological Technology, Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan.
⁸ Department of Radiological Technology, Kakogawa Central City Hospital, Kakogawa, Japan.

Abstract

Background: The quality of treatment planning for stage III non-small cell lung cancer varies within and between facilities due to the different professions involved in planning. Dose estimation parameters were calculated using a feasibility dose-volume histogram (FDVH) implemented in the treatment planning quality assurance software PlanIQ. This study aimed to evaluate differences in treatment planning between occupations using manual FDVH-referenced treatment planning to identify their characteristics.

Materials and methods: The study included ten patients with stage III non-small cell lung cancer, and volumetric-modulated arc therapy was used as the treatment planning technique. Fifteen planners, comprising five radiation oncologists, five medical physicists, and five radiological technologists, developed treatment strategies after referring to the FDVH.

Results: Medical physicists had a higher mean dose at D98% of the planning target volume (PTV) and a lower mean dose at D2% of the PTV than those in other occupations. Medical physicists had the lowest irradiation lung volumes (V5 Gy and V13 Gy) compared to other professions, and radiation oncologists had the lowest V20 Gy and mean lung dose. Radiological technologists had the highest irradiation volumes for dose constraints at all indexes on the normal lung volume.

Conclusions: The quality of the treatment plans developed in this study differed between occupations due to their background expertise, even when an FDVH was used as a reference. Therefore, discussing and sharing knowledge and treatment planning techniques among professionals is essential to determine the optimal treatment plan for each facility and patient.

Keywords: PlanIQ; stage III non-small cell lung cancer; treatment planning quality; volumetric-modulated arc therapy.