Pre-review Items

Problems of plan

 Settings of gantry angle

Fields did not follow the principle of parallel to the longest side of target volumes.

The angle between adjacent fields too small.
Fields did not follow the principle of nearby target volumes.

The opposite fields set up.
For the thorax tumor, the field not limited to a certain angle range in the anterior-posterior direction.

Settings of optimization condition

Optimization conditions omitted.

Improper settings of optimization conditions.

The pseudo organs missed.

Pseudo organs drawn wrongly or unreasonably.

Dose distribution

Unmet target prescription dose.

Dose to OAR too high.

Improper conformity of target volumes.

Improper homogeneity of target volumes.

Improper maximum dose.

Slow dose fall-off outside target volumes.

Control point

Improper position of opening control point.

Improper size of opening control point.

Other items

Please give detail problems.

Pre-review Items

Problems of plan

Settings of gantry angle

Unreasonable range of arc.

Unreasonable number of arc.

Round-trip arcs not used.

Settings of optimization condition

Optimization conditions omitted.

Improper settings of optimization conditions.

The pseudo organs missed.

Pseudo organs drawn wrongly or unreasonably.

Dose distribution

Unmet target prescription dose.

Dose to OAR too high.

Improper conformity of target volumes.

Improper homogeneity of target volumes.

The position of maximum dose was improper.

Slow dose fall-off outside target volumes.

Control point

 The position of opening control point improper.

 The size of opening control point improper.

Other items

Please give detail problems.

Pre-review Items

Problems of plan

Settings of optimization parameter

Unreasonable field width.

Unreasonable modulation factor.

Settings of optimization condition

Optimization conditions omitted.

Improper settings of optimization conditions.

The pseudo organs missed.

Pseudo organs drawn wrongly or unreasonably.

Dose distribution

Unmet target prescription dose.

The dose to OAR was too high.

Improper conformity of target volumes.

Improper homogeneity of target volumes.

Improper maximum dose.

Slow dose fall-off outside target volumes.

Other items

Please give detail problems.

Pre-review Items

Problems of plan

Settings of gantry angle

Unreasonable range of arc.

Unreasonable number of arc.

Round-trip arcs not used.

Dose distribution

Unmet target prescription dose.

Dose to OAR was too high.

Improper conformity of target volumes.

Improper homogeneity of target volumes.

Improper maximum dose.

Slow dose fall-off outside target volumes.

Other items

Please give detail problems.

Pre-review Items

Problems of plan

Settings of gantry angle

Fields did not follow the principle of parallel to the longest side of target volumes.
Small angle between adjacent fields.
Fields did not follow the principle of nearby target volumes.

Dose distribution

Unmet target prescription dose.

Dose to OAR was too high.

Improper conformity of target volumes.

Improper homogeneity of target volumes.

Improper maximum dose..

Slow dose fall-off outside target volumes.

Other items

Please give detail problems.

Pre-review Items

Problems of plan

Settings of field

Improper energy used.

Improper angle of field.

Dose distribution

Unmet target prescription dose.

Dose to OAR was too high.

Improper conformity of target volumes.

Improper homogeneity of target volumes.

Improper maximum dose.

Slow dose fall-off outside target volumes.

Other items

Please give detail problems.

Disease species

First recommended treatment technique

Second recommended treatment technique

Brain oligo-metastatic tumor

VMAT

IMRT

Multiple brain metastasis

TOMO

VMAT

Whole brain irradiation

VMAT

IMRT

Whole-brain irradiation and Hippocampus protection

TOMO

VMAT

Whole-brain irradiation and simultaneous integrated boost brain metastasis

TOMO

VMAT

Whole brain and spinal cord

TOMO

VMAT

Nasopharyngeal carcinoma（T1T2）

VMAT

IMRT

Nasopharyngeal carcinoma（T3T4）

TOMO

VMAT

Oropharynx cancer

VMAT

IMRT

Paranasal sinus tumor

VMAT

IMRT

Lung cancer

VMAT

IMRT

Esophageal cancer

VMAT

IMRT

Sarcoma tumor

VMAT

IMRT

Whole breast irradiation

IMRT

CRT

Whole breast and supraclavicular irradiation

VMAT

IMRT

Chest wall and supraclavicular irradiation

VMAT

VMAT/IMRT+E

Liver cancer

VMAT

IMRT

Stomach cancer

VMAT

IMRT

Prostate cancer

VMAT

IMRT

Bladder cancer

VMAT

IMRT

Gynecological tumor

VMAT

IMRT

Lymphoma cancer

VMAT

IMRT

Limb tumor

VMAT

IMRT

Bone metastasis

VMAT

IMRT

Radiotherapy
Technique

Number of problem plans found by independent physics pre-review

Number of total plans by independent physics pre-review

Proportion

IMRT

2

138

1.45%

VMAT

59

1233

4.79%

TOMO

5

53

9.43%

CA

0

3

0.00%

CRT

0

10

0.00%

Electron

0

10

0.00%

Total

66

1447

4.56%

Parameters

Disapproval plan

Approved plan

P-value

HI

0.23±0.08

0.23±0.08

0.824

CI

0.76±0.08

0.74±0.06

0.171

Dmax(Cord)

32.10±11.80

31.29±12.01

0.224

Dmax(Cord PRV)

37.07±13.21

37.55±13.34

0.468

V5(%)(Lung all)

31.16%±13.26%

29.11%±13.29%

0.006

V20(%)(Lung all)

15.85%±6.83%

15.24%±6.91%

0.049

V30(%)(Lung all)

12.05%±5.35%

11.81%±6.83%

0.064

Dmean(Lung all)

9.22±3.67%

8.87±3.72%

0.013

V30(%)(Heart)

17.39%±15.51%

16.06%±15.31%

0.298

V40(%)(Heart)

10.57%±9.18%

10.66%±10.44%

0.925

Dmean(Gy)(Heart)

11.48 ±9.10

11.26±9.30

0.526

MU

811.71±178.30

823.14±200.94

0.428