Wide-Scale Clinical Implementation of Knowledge-Based Planning: An Investigation of Workforce Efficiency, Need for Post-automation Refinement, and Data-Driven Model Maintenance
| Autor: | Victoria Bry, James D. Murphy, Mariel Cornell, Robert Kaderka, Todd F. Atwood, Kevin L. Moore, Sebastian J. Hild, Xenia Ray |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Lung Diseases
Male Organs at Risk Cancer Research Knowledge based planning Knowledge Bases viruses genetic processes information science Data-driven Automation Humans Medicine Radiology Nuclear Medicine and imaging Operations management Head and neck Radiation business.industry Radiotherapy Planning Computer-Assisted Radiotherapy Dosage biochemical phenomena metabolism and nutrition Workflow Oncology Lung disease Scale (social sciences) Workforce bacteria Radiotherapy Intensity-Modulated business |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 111:705-715 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/j.ijrobp.2021.06.028 |
| Popis: | Our purpose was to investigate the effect of automated knowledge-based planning (KBP) on real-world clinical workflow efficiency, assess whether manual refinement of KBP plans improves plan quality across multiple disease sites, and develop a data-driven method to periodically improve KBP automated planning routines.Using clinical knowledge-based automated planning routines for prostate, prostatic fossa, head and neck, and hypofractionated lung disease sites in a commercial KBP solution, workflow efficiency was compared in terms of planning time in a pre-KBP (n = 145 plans) and post-KBP (n = 503) patient cohort. Post-KBP, planning was initialized with KBP (KBP-only) and subsequently manually refined (KBP +human). Differences in planning time were tested for significance using a 2-tailed Mann-Whitney U test (P.05, null hypothesis: planning time unchanged). Post-refinement plan quality was assessed using site-specific dosimetric parameters of the original KBP-only plan versus KBP +human; 2-tailed paired t test quantified statistical significance (Bonferroni-corrected P.05, null hypothesis: no dosimetric difference after refinement). If KBP +human significantly improved plans across the cohort, optimization objectives were changed to create an updated KBP routine (KBP'). Patients were replanned with KBP' and plan quality was compared with KBP +human as described previously.KBP significantly reduced planning time in all disease sites: prostate (median: 7.6 hrs → 2.1 hrs; P.001), prostatic fossa (11.1 hrs → 3.7 hrs; P = .001), lung (9.9 hrs → 2.0 hrs; P.001), and head and neck (12.9 hrs → 3.5 hrs; P.001). In prostate, prostatic fossa, and lung disease sites, organ-at-risk dose changes in KBP +human versus KBP-only were minimal (1% prescription dose). In head and neck, KBP +human did achieve clinically relevant dose reductions in some parameters. The head and neck routine was updated (KBP'KBP increased clinical efficiency by significantly reducing planning time. On average, human refinement offered minimal dose improvements over KBP-only plans. In the single disease site where KBP +human was superior to KBP-only, differences were eliminated by adjusting optimization parameters in a revised KBP routine. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|