Figure 1: The statistics of pre-review plans by medical physicists for three months
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. |
|
The opposite fields set up. |
|
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. |
Table A1 Independent physics pre-review items of IMRT treatment plan
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. |
Table A2 Independent physics pre-review items of VMAT treatment plan
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. |
Table A3 Independent physics pre-review items of TOMO treatment plan
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. |
Table A4 Independent physics pre-review items of CA treatment plan
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. |
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. |
Table A5 Independent physics pre-review items of CRT treatment plan
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. |
Table A6 Independent physics pre-review items of Electron treatment plan
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 |
Table A7 Clinical treatment techniques for different sites
Radiotherapy |
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% |
Table 1: The statistics of problem plans found by independent physics pre-review
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 |
Table 2: The dosimetric statistics between disapproval and approved plans of lung cancer by independent physics pre-review
Figure 1: The statistics of pre-review plans by medical physicists for three months
Figure 2: Percentage of problem plans classified by diseases
Figure 3: Percentage of problem for VMAT plans found by independent physics pre-review
Figure 4: Example dose distribution of independent physics pre-review planning for sarcoma tumor. (a) Disapproval dose distribution; (b) Approved dose distribution
Figure 5: Example setting of gantry angle by independent physics pre-review planning for lung cancer. (a) Disapproval setting of gantry angle; (b) Approved setting of gantry angles
Figure 6: Problem percentages of unreasonable dose distribution
Figure 7: Percentage of causes leading to VMAT problem plans found by independent physics pre-review
Figure 8: Statistics of planning time of modifying disapproval plans
Tables at a glance
Figures at a glance