Bridging the Gap of Radiotherapy Planning Quality between a High-Income Countrie to a Middle-Income Country By the Dosimetric Validation of a KBP Model Vs Junior, Senior Dosimetrists and MCO Planning 📝

Author: Eduardo Florian, Hiram Gay, Geoffrey D. Hugo, Otto Hurtarte, Milton Ixquiac, Erick Orlando Montenegro, Franky Eduardo Reyes, Francisco Javier Reynoso, Edgar Aparicio Ruiz, Baozhou Sun, Jacaranda Van Rheenen, Kevin Vega, Angel Velarde, Vicky de Falla 👨‍🔬

Affiliation: WashU Medicine, Liga Nacional Contra el Cancer, Liga Nacional Contra el Cancer/INCAN, Liga Nacional Contra el Cancer / INCAN, Liga Nacional Contra el Cancer and Universidad de San Carlos de Guatemala, Washington Univ. in St. Louis, Liga Nacional Contra el Cáncer / INCAN, Washington University in St. Louis, Varian, Baylor College of Medicine 🌍

Abstract:

Purpose:
IMRT has become the standard of care in high-income countries (HICs) due to reduced toxicity and improved treatment outcomes.
The purpose of this work is validating the KBP model shared from a university from HICs with the manually created plans by junior and senior dosimetrists in our Radiotherapy Center; these were also compared with plans using MCO.
Methods:
The patients for validation were Pelvic Female Cases including 3 big groups, according to the shape of the PTV, first is a simple shape of volume including just the cervix and pelvic lymph nodes, second includes pelvic and inguinal nodes, third includes cervix, pelvic, inguinal and paraaortic nodes.
The KBP Model from the HIC University was modified according to the needs of our center. And this modified model was applied over the patients. The same group of patients was shared with our planners with different levels of experience, from 1 to 13 years. All cases were planned using MCO planning forcing the OAR´s constraints, without compromising the PTV coverage.
Results:
The coverage of the PTV is comparable in all cases. MCO plans are the best at OAR sparing followed by senior planners and KBP.
The highest variability in the metrics was for the MCO plans, followed by the junior dosimetrists. Comparisons between the senior planners with the KBP did not find a big difference. In terms of monitor units, the MCO has the higher value followed by the junior planners.
Conclusion:
The implementation of KBP is beneficial for the institution workflow because it can achieve the results of senior planners without human intervention using a fraction of the time required for the junior planners to achieve such results.
For challenging cases MCO can be used to reduce the dose to OARs considering the tradeoff with the resulting plan monitor units.