Author: Ryan Clark, Anthony Magliari, Luis Felipe Oliveira E Silva, Yang Sheng, Jason R Vickress, Qingrong Jackie Wu, Giulianne Rivelli Rodrigues Zaratim 👨🔬
Affiliation: Verspeeten Family Cancer Center, Office of Medical Affairs, Varian, A Siemens Healthineers Company, Confiar Radioterapia, Duke University Medical Center 🌍
Purpose: Develop a toolset to replace several of the tedious steps required to manually generate 3D breast treatment plans using static gantry forward planned tangent beams.
Methods: Eclipse Scripting Application Programming Interface (ESAPI) and Visual Studio 2022 C# .net framework 4.X were used to create a toolset which can: automatically create sliding window Breast tangent treatment plans for a single energy on C-arm linacs and automatically extend and visualize beam fluence (skin flash). The planning process begins with the user’s tangent open fields to generate a PTV. Nearby OARs and skin surfaces are subtracted to define a PTV volume, which is used by Eclipse to generate a homogeneous dose distribution. Hotspots are minimized and maintained within the user’s predefined limits. The skin flash algorithm uses user-defined depths from the fluence map to determine fluence values and extension size, which are applied perpendicularly to the body outline, mimicking standard TPS tools.
Results: The toolset allows users to create clinically viable 3D sliding window MLC plans with skin flash often requiring no normalization or correction. This toolset is in clinical use in both North and South America and creates plans in 2-3 minutes.
Conclusion: BreastPlan-helper is designed to provide easy-to-use and automated breast tangent planning, which can improve efficiency in dosimetry and deliver high-quality plans to centers with limited resources. BreastPlan-helper is currently under active development and the source code is shared publicly at the Varian Medical Affairs Applied Siolutions GitHub code repository with releases including easily adopted precompiled binaries for several popular Eclipse versions. While this toolset can help relieve some treatment planning burden for patients with favorable anatomy, development continues for future support of: multiple energies; O-Ring linacs; optionally auto-placing one, two or three tangent beam pairs; along with a separate step and shoot (field-in-field) mode.