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DOE OSTI2012

Evolving treatment plan quality criteria from institution-specific experience

Purpose: The dosimetric aspects of radiation therapy treatment plan quality are usually evaluated and reported with dose volume histogram (DVH) endpoints. For clinical practicality, a small number of representative quantities derived from the DVH are often used as dose endpoints to summarize the plan quality. National guidelines on reference values for such quantities for some standard treatment approaches are often used as acceptance criteria to trigger treatment plan review. On the other hand, treatment prescription and planning approaches specific to each institution warrants the need to report plan quality in terms of practice consistency and with respect to institution-specific experience. The purpose of this study is to investigate and develop a systematic approach to record and characterize the institution-specific plan experience and use such information to guide the design of plan quality criteria. In the clinical setting, this approach will assist in (1) improving overall plan quality and consistency and (2) detecting abnormal plan behavior for retrospective analysis. Methods: The authors propose a self-evolving methodology and have developed an in-house prototype software suite that (1) extracts the dose endpoints from a treatment plan and evaluates them against both national standard and institution-specific criteria and (2) evolves the statistics for the dose endpoints and updates institution-specific criteria. Results: The validity of the proposed methodology was demonstrated with a database of prostate stereotactic body radiotherapy cases. As more data sets are accumulated, the evolving institution-specific criteria can serve as a reliable and stable consistency measure for plan quality and reveals the potential use of the ''tighter'' criteria than national standards or projected criteria, leading to practice that may push to shrink the gap between plans deemed acceptable and the underlying unknown optimality. Conclusions: The authors have developed a rationale to improve plan quality and consistency, by evolving the plan quality criteria from institution-specific experience, complementary to national standards. The validity of the proposed method was demonstrated with a prototype system on prostate stereotactic body radiotherapy (SBRT) cases. The current study uses direct and indirect DVH endpoints for plan quality evaluation, but the infrastructure proposed here applies to general outcome data as well. The authors expect forward evaluation together with intelligent update based on evidence-based learning, which will evolve the clinical practice for improved efficiency, consistency, and ultimately better treatment outcome.

61 RADIATION PROTECTION AND DOSIMETRY↗

DOE OSTI2014

Independent calculation of dose distributions for helical tomotherapy using a conventional treatment planning system

Purpose: The dosimetric verification of treatment plans in helical tomotherapy usually is carried out via verification measurements. In this study, a method for independent dose calculation of tomotherapy treatment plans is presented, that uses a conventional treatment planning system with a pencil kernel dose calculation algorithm for generation of verification dose distributions based on patient CT data. Methods: A pencil beam algorithm that directly uses measured beam data was configured for dose calculation for a tomotherapy machine. Tomotherapy treatment plans were converted into a format readable by an in-house treatment planning system by assigning each projection to one static treatment field and shifting the calculation isocenter for each field in order to account for the couch movement. The modulation of the fluence for each projection is read out of the delivery sinogram, and with the kernel-based dose calculation, this information can directly be used for dose calculation without the need for decomposition of the sinogram. The sinogram values are only corrected for leaf output and leaf latency. Using the converted treatment plans, dose was recalculated with the independent treatment planning system. Multiple treatment plans ranging from simple static fields to real patient treatment plans were calculated using the new approach and either compared to actual measurements or the 3D dose distribution calculated by the tomotherapy treatment planning system. In addition, dose–volume histograms were calculated for the patient plans. Results: Except for minor deviations at the maximum field size, the pencil beam dose calculation for static beams agreed with measurements in a water tank within 2%/2 mm. A mean deviation to point dose measurements in the cheese phantom of 0.89% ± 0.81% was found for unmodulated helical plans. A mean voxel-based deviation of −0.67% ± 1.11% for all voxels in the respective high dose region (dose values >80%), and a mean local voxel-based deviation of −2.41% ± 0.75% for all voxels with dose values >20% were found for 11 modulated plans in the cheese phantom. Averaged over nine patient plans, the deviations amounted to −0.14% ± 1.97% (voxels >80%) and −0.95% ± 2.27% (>20%, local deviations). For a lung case, mean voxel-based deviations of more than 4% were found, while for all other patient plans, all mean voxel-based deviations were within ±2.4%. Conclusions: The presented method is suitable for independent dose calculation for helical tomotherapy within the known limitations of the pencil beam algorithm. It can serve as verification of the primary dose calculation and thereby reduce the need for time-consuming measurements. By using the patient anatomy and generating full 3D dose data, and combined with measurements of additional machine parameters, it can substantially contribute to overall patient safety.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-J-239: IMRT Planning of Prostate Cancer for a MRI-Linac Based On MRI Only

Purpose: : To investigate dosimetric differences between MRI- and CT-based IMRT planning for prostate cancer, the impact of a magnetic field in a MRI-Linac, and to explore the feasibility of IMRT planning based on MRI alone. Methods: IMRT plans were generated based on CT and MRI images acquired on two representative prostate-cancer patients using clinical dose volume constraints. A research planning system (Monaco, Elekta), which employs a Monte Carlo dose engine and includes a perpendicular magnetic field of 1.5T from an MRI-Linac, was used. Bulk electron density assignments based on organ-specific values from ICRU 46 were used to convert MRI (T2) to pseudo CT. With the same beam configuration as in the original CT plan, 5 additional plans were generated based on CT or MRI, with or without optimization (i.e., just recalculation) and with or without the magnetic field. The plan quality in terms of commonly used dose volume (DV) parameters for all plans was compared. The statistical uncertainty on dose was < 1%. Results: For plans with the same contour set but without re-optimization, the DV parameters were different from those for the original CT plan, mostly less than 5% with a few exceptions. These differences were reduced to mostly less than 3% when the plans were re-optimized. For plans with contours from MRI, the differences in the DV parameters varied depending on the difference in the contours as compared to CT. For the optimized plans with contours from MR, the differences for PTV were less than 3%. Conclusion: The prostate IMRT plans based on MRI-only for a MR-Linac were practically similar as compared to the CT plan under the same beam and optimization configuration if the difference on the structure delineation is excluded, indicating the feasibility of using MRI-only for prostate IMRT.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-T-337: Treatment Planning Study of Craniospinal Irradiation with Spot Scanning Proton Therapy

Purpose: To develop a treatment planning technique that achieves optimal robustness against systematic position and range uncertainties, and interfield position errors for craniospinal irradiation (CSI) using spot scanning proton radiotherapy. Methods: Eighteen CSI patients who had previously been treated using photon radiation were used for this study. Eight patients were less than 10 years old. The prescription dose was 23.4Gy in 1.8Gy fractions. Two different field arrangement types were investigated: 1 posterior field per isocenter and 2 posterior oblique fields per isocenter. For each field type, two delivery configurations were used: 5cm bolus attached to the treatment table and a 4.5cm range shifter located inside the nozzle. The target for each plan was the whole brain and thecal sac. For children under the age of 10, all plan types were repeated with an additional dose of 21Gy prescribed to the vertebral bodies. Treatment fields were matched by stepping down the dose in 10% increments over 9cm. Robustness against 3% and 3mm uncertainties, as well as a 3mm inter-field error was analyzed. Dose coverage of the target and critical structure sparing for each plan type will be considered. Ease of planning and treatment delivery was also considered for each plan type. Results: The mean dose volume histograms show that the bolus plan with posterior beams gave the best overall plan, and all proton plans were comparable to or better than the photon plans. The plan type that was the most robust against the imposed uncertainties was also the bolus plan with posterior beams. This is also the plan configuration that is the easiest to deliver and plan. Conclusion: The bolus plan with posterior beams achieved optimal robustness against systematic position and range uncertainties, as well as inter-field position errors.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

SU-E-T-353: Decoding the Beam Complexity in Intensity-Modulated Radiation Therapy Plans

Purpose: Modern IMRT relies on computers to generate treatment plans of varied complexity. A highly complex treatment plan may use a large number of small and irregular beam apertures in order to achieve high dose conformity. However, excessive beam complexity can increase dosimetric uncertainty, prolong treatment time, and increase susceptibility to target or organ motion. In this study we sought to develop metrics to assess the complexity of IMRT beams and plans. Methods: Based the information of leaf positions and MU for each beam segment, we calculated the following beam complexity metrics: aperture area, shape irregularity, and beam modulation. Then these beam complexity metrics were averaged to obtain the corresponding plan complexity metrics, using the beam MUs as weighting factors. We evaluated and compared the beam and plan complexity scores for 65 IMRT plans from 3 sites (prostate, head and neck, and spine). We also studied how the plan complexity scores were affected by adjusting inverse planning parameters. Results: For prostate IMRT, the lateral beams had large MUs and smaller shape irregularity, while the anterior or posterior beams had larger modulation values. On average, the prostate IMRT plans had the smallest shape irregularity and beam modulation; the HN IMRT plans had the largest aperture area, shape irregularity, and beam modulation; and the spine stereotactic IMRT plans often had small aperture area, which may be associated with relatively large discrepancies between calculated and measures doses. The plan complexity increased as the number of optimization iterations and the number of beam segments increased and as the minimum segment area decreased. Conclusion: Complexity of IMRT beams and plans were quantified in terms of aperture area, shape irregularity and beam modulation. The complexity metrics varied among IMRT plans for different disease sites and were affected when the planning parameters were adjusted.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

MO-C-17A-06: Online Adaptive Re-Planning to Account for Independent Motions Between Multiple Targets During Radiotherapy of Lung Cancer

Purpose: To quantify interfractional independent motions between multiple targets in radiotherapy (RT) of lung cancer, and to study the dosimetric benefits of an online adaptive replanning method to account for these variations. Methods: Ninety five diagnostic-quality daily CTs acquired for 9 lung cancer patients treated with IGRT using an in-room CT (CTVision, Siemens) were analyzed. On each daily CT set, contours of the targets (GTV, CTV, or involved nodes) and organs at risk were generated by populating the planning contours using an auto-segmentation tool (ABAS, Elekta) with manual editing. For each patient, an IMRT plan was generated based on the planning CT with a prescription dose of 60 Gy in 2Gy fractions. Three plans were generated and compared for each daily CT set: an IGRT (repositioning) plan by copying the original plan with the required shifts, an online adaptive plan by rapidly modifying the aperture shapes and segment weights of the original plan to conform to the daily anatomy, and a new fully re-optimized plan based on the daily CT using a planning system (Panther, Prowess). Results: The daily deviations of the distance between centers of masses of the targets from the plans varied daily from -10 to 8 mm with an average −0.9±4.1 mm (one standard deviation). The average CTV V100 are 99.0±0.7%, 97.9±2.8%, 99.0±0.6%, and 99.1±0.6%, and the lung V20 Gy 928±332 cc, 944±315 cc, 917±300 cc, and 891±295 cc for the original, repositioning, adaptive, and re-optimized plans, respectively. Wilcoxon signed-rank tests show that the adaptive plans are statistically significantly better than the repositioning plans and comparable with the reoptimized plans. Conclusion: There exist unpredictable, interfractional, relative volume changes and independent motions between multiple targets during lung cancer RT which cannot be accounted for by the current IGRT repositioning but can be corrected by the online adaptive replanning method.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-129: Are Knowledge-Based Planning Dose Estimates Valid for Distensible Organs?

Purpose: Knowledge-based planning programs have become available to assist treatment planning in radiation therapy. Such programs can be used to generate estimated DVHs and planning constraints for organs at risk (OARs), based upon a model generated from previous plans. These estimates are based upon the planning CT scan. However, for distensible OARs like the bladder and rectum, daily variations in volume may make the dose estimates invalid. The purpose of this study is to determine whether knowledge-based DVH dose estimates may be valid for distensible OARs. Methods: The Varian RapidPlan™ knowledge-based planning module was used to generate OAR dose estimates and planning objectives for 10 prostate cases previously planned with VMAT, and final plans were calculated for each. Five weekly setup CBCT scans of each patient were then downloaded and contoured (assuming no change in size and shape of the target volume), and rectum and bladder DVHs were recalculated for each scan. Dose volumes were then compared at 75, 60,and 40 Gy for the bladder and rectum between the planning scan and the CBCTs. Results: Plan doses and estimates matched well at all dose points., Volumes of the rectum and bladder varied widely between planning CT and the CBCTs, ranging from 0.46 to 2.42 for the bladder and 0.71 to 2.18 for the rectum, causing relative dose volumes to vary between planning CT and CBCT, but absolute dose volumes were more consistent. The overall ratio of CBCT/plan dose volumes was 1.02 ±0.27 for rectum and 0.98 ±0.20 for bladder in these patients. Conclusion: Knowledge-based planning dose volume estimates for distensible OARs are still valid, in absolute volume terms, between treatment planning scans and CBCT’s taken during daily treatment. Further analysis of the data is being undertaken to determine how differences depend upon rectum and bladder filling state. This work has been supported by Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-143: Automatic PBS Treatment Planning for Prostate Cancer

Purpose: This study presents a novel idea of using automated planning technique for parallel-opposed prostate plans with pencil beam scanning proton therapy. Methods: A random 5 clinical prostate patients treated with parallel-opposed modulated-scanning proton beam in our proton center were selected in this study. All of the 5 cases were re-planned with in-house developed python scripts integrated into RayStation 4.0 clinical version. This automatic tool was designed to perform patient DICOM data import, external structure contours, CT density assignment, prescription to PTV assignment, beam placement, optimization, and dose calculation. Results: The mean time to generate a complete treatment plan was 1 minute per plan. For the automatically generated plans, 5 out of 5 plans (100%) were deemed clinically acceptable by one experienced radiation oncologist. In addition, the automated plans were overall dosimetrically equivalent to the clinical plans when scored for target coverage, rectum and bladder dose. Mann-Whitney U tests did not show significant dosimetric differences for normal tissue structures between the clinical and automated plans. Conclusion: We have developed a robust and automated method for fully inversed planned paralleled-opposed prostate proton treatment planning. This efficient method can be readily integrated into clinical practice. The tool produces clinically acceptable plans using only manually contoured anatomic structures and simulation CT data set. We anticipate that this tool will not only improve patient access to high-quality proton treatment by simplifying the planning process and will also reduce the effort and cost of incorporating more advanced planning into clinical practice in the near future.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-E-T-151: Breathing Synchronized Delivery (BSD) Planning for RapicArc Treatment

Purpose: To propose a workflow for breathing synchronized delivery (BSD) planning for RapicArc treatment. Methods: The workflow includes three stages: screening/simulation, planning, and delivery. In the screening/simulation stage, a 4D CT with the corresponding breathing pattern is acquired for each of the selected patients, who are able to follow their own breathing pattern. In the planning stage, one breathing phase is chosen as the reference, and contours are delineated on the reference image. Deformation maps to other phases are performed along with contour propagation. Based on the control points of the initial 3D plan for the reference phase and the respiration trace, the correlation with respiration phases, the leaf sequence and gantry angles is determined. The beamlet matrices are calculated with the corresponding breathing phase and deformed to the reference phase. Using the 4D dose evaluation tool and the original 3D plan DVHs criteria, the leaf sequence is further optimized to meet the planning objectives and the machine constraints. In the delivery stage, the patients are instructed to follow the programmed breathing patterns of their own, and all other parts are the same as the conventional Rapid-Arc delivery. Results: Our plan analysis is based on comparison of the 3D plan with a static target (SD), 3D plan with motion delivery (MD), and the BSD plan. Cyclic motion of range 0 cm to 3 cm was simulated for phantoms and lung CT. The gain of the BSD plan over MD is significant and concordant for both simulation and lung 4DCT, indicating the benefits of 4D planning. Conclusion: Our study shows that the BSD plan can approach the SD plan quality. However, such BSD scheme relies on the patient being able to follow the same breathing curve that is used in the planning stage during radiation delivery. Funded by Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2015

SU-F-BRB-07: A Plan Comparison Tool to Ensure Robustness and Deliverability in Online-Adaptive Radiotherapy

Purpose: To develop a plan comparison tool that will ensure robustness and deliverability through analysis of baseline and online-adaptive radiotherapy plans using similarity metrics. Methods: The ViewRay MRIdian treatment planning system allows export of a plan file that contains plan and delivery information. A software tool was developed to read and compare two plans, providing information and metrics to assess their similarity. In addition to performing direct comparisons (e.g. demographics, ROI volumes, number of segments, total beam-on time), the tool computes and presents histograms of derived metrics (e.g. step-and-shoot segment field sizes, segment average leaf gaps). Such metrics were investigated for their ability to predict that an online-adapted plan reasonably similar to a baseline plan where deliverability has already been established. Results: In the realm of online-adaptive planning, comparing ROI volumes offers a sanity check to verify observations found during contouring. Beyond ROI analysis, it has been found that simply editing contours and re-optimizing to adapt treatment can produce a delivery that is substantially different than the baseline plan (e.g. number of segments increased by 31%), with no changes in optimization parameters and only minor changes in anatomy. Currently the tool can quickly identify large omissions or deviations from baseline expectations. As our online-adaptive patient population increases, we will continue to develop and refine quantitative acceptance criteria for adapted plans and relate them historical delivery QA measurements. Conclusion: The plan comparison tool is in clinical use and reports a wide range of comparison metrics, illustrating key differences between two plans. This independent check is accomplished in seconds and can be performed in parallel to other tasks in the online-adaptive workflow. Current use prevents large planning or delivery errors from occurring, and ongoing refinements will lead to increased assurance of plan quality.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-241: Reduction in Planning Errors Via a Process Control Developed Using the Eclipse Scripting API

Purpose: Errors found during initial physics plan checks frequently require replanning and reprinting, resulting decreased departmental efficiency. Additionally, errors may be missed during physics checks, resulting in potential treatment errors or interruption. This work presents a process control created using the Eclipse Scripting API (ESAPI) enabling dosimetrists and physicists to detect potential errors in the Eclipse treatment planning system prior to performing any plan approvals or printing. Methods: Potential failure modes for five categories were generated based on available ESAPI (v11) patient object properties: Images, Contours, Plans, Beams, and Dose. An Eclipse script plugin (PlanCheck) was written in C# to check errors most frequently observed clinically in each of the categories. The PlanCheck algorithms were devised to check technical aspects of plans, such as deliverability (e.g. minimum EDW MUs), in addition to ensuring that policy and procedures relating to planning were being followed. The effect on clinical workflow efficiency was measured by tracking the plan document error rate and plan revision/retirement rates in the Aria database over monthly intervals. Results: The number of potential failure modes the PlanCheck script is currently capable of checking for in the following categories: Images (6), Contours (7), Plans (8), Beams (17), and Dose (4). Prior to implementation of the PlanCheck plugin, the observed error rates in errored plan documents and revised/retired plans in the Aria database was 20% and 22%, respectively. Error rates were seen to decrease gradually over time as adoption of the script improved. Conclusion: A process control created using the Eclipse scripting API enabled plan checks to occur within the planning system, resulting in reduction in error rates and improved efficiency. Future work includes: initiating full FMEA for planning workflow, extending categories to include additional checks outside of ESAPI via Aria database queries, and eventual automated plan checks.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-284: The Effect of Linear Accelerator Output Variation On the Quality of Patient Specific Rapid Arc Verification Plans

Purpose: The aim of the current study is to investigate the effect of machine output variation on the delivery of the RapidArc verification plans. Methods: Three verification plans were generated using Eclipse™ treatment planning system (V11.031) with plan normalization value 100.0%. These plans were delivered on the linear accelerators using ArcCHECK− device, with machine output 1.000 cGy/MU at calibration point. These planned and delivered dose distributions were used as reference plans. Additional plans were created in Eclipse− with normalization values ranging 92.80%–102% to mimic the machine output ranging 1.072cGy/MU-0.980cGy/MU, at the calibration point. These plans were compared against the reference plans using gamma indices (3%, 3mm) and (2%, 2mm). Calculated gammas were studied for its dependence on machine output. Plans were considered passed if 90% of the points satisfy the defined gamma criteria. Results: The gamma index (3%, 3mm) was insensitive to output fluctuation within the output tolerance level (2% of calibration), and showed failures, when the machine output exceeds ≥3%. Gamma (2%, 2mm) was found to be more sensitive to the output variation compared to the gamma (3%, 3mm), and showed failures, when output exceeds ≥1.7%. The variation of the gamma indices with output variability also showed dependence upon the plan parameters (e.g. MLC movement and gantry rotation). The variation of the percentage points passing gamma criteria with output variation followed a non-linear decrease beyond the output tolerance level. Conclusion: Data from the limited plans and output conditions showed that gamma (2%, 2mm) is more sensitive to the output fluctuations compared to Gamma (3%,3mm). Work under progress, including detail data from a large number of plans and a wide range of output conditions, may be able to conclude the quantitative dependence of gammas on machine output, and hence the effect on the quality of delivered rapid arc plans.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-338: Flattening Filter Free Photon Beams Can Achieve the Same Plan Quality as Conventional Flattened Beams for Prostate Radiotherapy

Purpose: Some modern linear accelerators are equipped with one low energy flat beam and two flattening filter free (FFF) beams at high and low energies. The purpose of this study is to investigate whether the high energy FFF beam can produce the same plan quality as the conventional low energy flat beam, using a volumetric modulated arc (VMAT) technique for prostate patients. Methods: Ten prostate cancer patients were selected with a prescription of 78Gy. For each patient, three plans were created: (a) double arc flat 6MV plan used clinically; (b) double arc 10MV FFF plan; (c) single arc 10MV FFF plan. Each plan was prescribed so that at least 95% of the PTV received the prescription dose. The following dosimetric endpoints were evaluated: volume receiving 78Gy (V78) of the CTV and PTV, PTV conformality index (CI, ratio of prescription isodose volume to the PTV volume), bladder volume receiving 70Gy (V70) and 60Gy (V60), rectum volume receiving 70Gy (V70) and 50Gy (V50), dose to 10cc of the rectum, and volume of both femoral heads receiving 50Gy (V50). Total monitor units for each plan were recorded. Results: No significant difference was found for all dosimetric endpoints between all plans (p>0.05). Compared to the 6MV plans, monitor units were higher with the double arc 10MV FFF plans and lower with the single arc 10MV FFF plans, 29% and 4% respectively. Conclusion: Both single arc and double arc 10MV FFF VMAT can achieve equivalent plan quality as 6MV flat beam double arc treatment plans. With the gantry speed restriction, a high dose rate of 2400MU/min may allow the optimizer to use more MUs than actually needed. Single arc 10MV FFF VMAT plans are a reasonable alternative to double arc 6MV flat beam VMAT plans.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

SU-F-T-402: The Effect of Extremely Narrow MLC Leaf Width On the Plan Quality of VMAT for Prostate Cancer

Purpose: To investigate the effect of multi-leaf collimators (MLCs) with leaf width of 1.25 mm on the plan quality of volumetric modulated arc therapy (VMAT) for prostate cancer. Methods: A total of 20 patients with prostate cancer were retrospectively selected. Using a high definition MLC (HD MLC), primary and boost VMAT plans with two full arcs were generated for each patient (original plan). After that, by shifting patient CT images by 1.25 mm in the cranio-caudal direction between the 1st and the 2nd arc, we simulated fluences made with MLCs with leaf width of 1.25 mm. After shifting, primary and boost plans were generated for each patient (shifted plan). A sum plan was generated by summation of the primary and boost plan for each patient. Dose-volumetric parameters were calculated and compared. Results: Both homogeneity index (HI) and conformity index (CI) of the shifted plans were better than those of the original plans in primary plans (HI = 0.044 vs. 0.040 with p < 0.001 and CI = 1.056 vs. 1.044 with p = 0.006). Similarly, the shifted plans for boost target volume showed better homogeneity and conformity than did the original plans (HI = 0.042 vs. 0.037 with p = 0.006 and CI = 1.015 vs. 1.009 with p < 0.001). The total body volumes of the original plans irradiated by the prescription dose were larger than those of the shifted plans in sum plans (60.9 cc vs. 49.0 cc with p = 0.007). Conclusion: Use of extremely narrow MLCs could increase dose homogeneity and conformity of the target volume for prostate VMAT. This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (No. 2015R1C1A1A02036331).

60 APPLIED LIFE SCIENCES↗

NASA NTRS2010

Collective Intelligence and Three Aspects of Planning in Organizations: A NASA Example

For many complex sociotechnical systems, planning seems to require explicit coordination; certainly, in executing a plan the activities of different actors must be tightly coupled. However, distributing the needed planning information can be very burdensome and error prone, because different groups need different collections of information, updated or kept current on different time cycles. Further, the information needed to form successful plans is often highly distributed, and while feedback about the success of prior plans may exist, it may not be available to those in a position of using this to improve plans or to detect and resolve other problems in the system (Weick, 1995). Tools to support various aspects of planning have been developed, and can provide a huge benefit to the individuals working on that aspect. To be tractable, most solutions address a quite bounded slice of work, isolating it from the larger context. Prospective planning takes place over multiple, nested cycles of decision making. This builds a plan that specifies activities of different granularity. "Subplans" may specify multiple parallel activities by different groups and individuals, as well as sequential, nested actions by a single actor. Planning produces valuable, sharable, external, representations: in addition to prospective use, plans support retrospective assessment and also action in the present. Viewing planning in a larger context - both temporal and organizational -- enables noticing what one does not know and generating more systemic and effective solutions. Viewing a problem as one of collective intelligence invites thinking about the larger organizational context. Many approaches to supporting collective intelligence do not support execution of highly contingent actions, distributed across many players, and hence provide incomplete support for planning. However, CI technology maybe helpful in managing the processes of gathering information for decision making in planning and of distributing plan information to various actors, needed on various time cycles.

Billman, Dorrit↗

NASA NTRS2022

Balancing Predictive and Reactive Science Planning for Mars 2020 Perseverance

The design of the science planning process for a space science mission needs to find a balance between operational and resource constraints and scientific decision-making. Science planning has previously been characterized as either predictive or reactive. Predictive science planning is needed when constraints drive science activities to be planned far in advance. For example, a combination of long one-way light time plus high-stakes science decisions drove the Cassini-Huygens mission to Saturn to have an extremely predictive planning process. On the other extreme, reactive science planning is needed when constraints drive science activities to be planned based on the results of the previous plan. For example, the Mars Exploration Rover mission interacted with the surface of Mars, and so the planning team needed to know the state of the rover at the end of each planning cycle before starting the next cycle. Operational and resource constraints that require management on intermediate timescales has led to the development of a science planning process between these two extremes. For example, the Mars Science Laboratory is a technically complex rover and has a parallel predictive process that allows the operations team to manage engineering constraints several days in advance while maintaining the reactive tactical planning process similar to that of MER. The Mars 2020 Perseverance rover is a technically complex rover in the MSL style, but has an added layer of science complexity: it is tasked with collecting a returnable cache of scientifically valuable samples of Mars within prime mission. Thus, the science planning process also needs to accommodate high-stakes longer-term science decisions in the style of Cassini. In order to balance the push-pull of these constraints, we have developed a science campaign-focused operational paradigm for Mars 2020 Perseverance that allows for both predictive planning to accommodate technological complexity and high-stakes science decisions as well as reactive planning to accommodate the realities of interacting with the martian surface. This paradigm influenced the design of operational processes and operational tools.

Spanovich, Nicole↗

DOE OSTI2013

Whole breast and excision cavity radiotherapy plan comparison: Conformal radiotherapy with sequential boost versus intensity-modulated radiation therapy with a simultaneously integrated boost

A comparative study was conducted comparing the difference between (1) conformal radiotherapy (CRT) to the whole breast with sequential boost excision cavity plans and (2) intensity-modulated radiation therapy (IMRT) to the whole breast with simultaneously integrated boost to the excision cavity. The computed tomography (CT) data sets of 25 breast cancer patients were used and the results analysed to determine if either planning method produced superior plans. CT data sets from 25 past breast cancer patients were planned using (1) CRT prescribed to 50 Gy in 25 fractions (Fx) to the whole-breast planning target volume (PTV) and 10 Gy in 5Fx to the excision cavity and (2) IMRT prescribed to 60 Gy in 25Fx, with 60 Gy delivered to the excision cavity PTV and 50 Gy delivered to the whole-breast PTV, treated simultaneously. In total, 50 plans were created, with each plan evaluated by PTV coverage using conformity indices, plan maximum dose, lung dose, and heart maximum dose for patients with left-side lesions. CRT plans delivered the lowest plan maximum doses in 56% of cases (average CRT = 6314.34 cGy, IMRT = 6371.52 cGy). They also delivered the lowest mean lung dose in 68% of cases (average CRT = 1206.64 cGy, IMRT = 1288.37 cGy) and V20 in 88% of cases (average CRT = 20.03%, IMRT = 21.73%) and V30 doses in 92% of cases (average CRT = 16.82%, IMRT = 17.97%). IMRT created more conformal plans, using both conformity index and conformation number, in every instance, and lower heart maximum doses in 78.6% of cases (average CRT = 5295.26 cGy, IMRT = 5209.87 cGy). IMRT plans produced superior dose conformity and shorter treatment duration, but a slightly higher planning maximum and increased lung doses. IMRT plans are also faster to treat on a daily basis, with shorter fractionation.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2012

Preoperative treatment planning with intraoperative optimization can achieve consistent high-quality implants in prostate brachytherapy

Advances in brachytherapy treatment planning systems have allowed the opportunity for brachytherapy to be planned intraoperatively as well as preoperatively. The relative advantages and disadvantages of each approach have been the subject of extensive debate, and some contend that the intraoperative approach is vital to the delivery of optimal therapy. The purpose of this study was to determine whether high-quality permanent prostate implants can be achieved consistently using a preoperative planning approach that allows for, but does not necessitate, intraoperative optimization. To achieve this purpose, we reviewed the records of 100 men with intermediate-risk prostate cancer who had been prospectively treated with brachytherapy monotherapy between 2006 and 2009 at our institution. All patients were treated with iodine-125 stranded seeds; the planned target dose was 145 Gy. Only 8 patients required adjustments to the plan on the basis of intraoperative findings. Consistency and quality were assessed by calculating the correlation coefficient between the planned and implanted amounts of radioactivity and by examining the mean values of the dosimetric parameters obtained on preoperative and 30 days postoperative treatment planning. The amount of radioactivity implanted was essentially identical to that planned (mean planned radioactivity, 41.27 U vs. mean delivered radioactivity, 41.36 U; R{sup 2} = 0.99). The mean planned and day 30 prostate V100 values were 99.9% and 98.6%, respectively. The mean planned and day 30 prostate D90 values were 186.3 and 185.1 Gy, respectively. Consistent, high-quality prostate brachytherapy treatment plans can be achieved using a preoperative planning approach, mostly without the need for intraoperative optimization. Good quality assurance measures during simulation, treatment planning, implantation, and postimplant evaluation are paramount for achieving a high level of quality and consistency.

61 RADIATION PROTECTION AND DOSIMETRY↗