S2323
Physics - Quality assurance and auditing
ESTRO 2026
References: 1Sterpin E, Widesott L, Poels K, Hoogeman M, Korevaar EW, Lowe M, Molinelli S, Fracchiolla F. Robustness evaluation of pencil beam scanning proton therapy treatment planning: A systematic
review. Radiother Oncol. 2024 Aug;197 Keywords: Robusteness plan evaluation
Digital Poster 147 Development and clinical implementation of an automated plan check and documentation application to improve patient safety and planning efficiency Wei Jie Ang, Ming Long Melvin Chew, Xue Jing Ong, Wen Xin Jolene Phua, Jing Hu Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore Purpose/Objective: The increasing complexity of modern radiotherapy elevates the risk of human error during manual quality assurance checks, potentially impacting patient safety. Recognizing this, the American Association of Physicists in Medicine Task Group 275 (TG-275) provided evidence-based recommendations for plan review, encouraging automation to bolster the quality assurance process [1]. This study aimed to develop, validate, and implement an automated plan checking application, called PlanGuardian, to improve the safety and efficiency of our treatment plan quality assurance workflow. Material/Methods: PlanGuardian was developed with C# and integrated as a binary plugin within the Eclipse™ Treatment Planning System (v17.0, Varian Medical Systems, Palo Alto, CA) using the Eclipse Scripting Application Programming Interface (ESAPI). A comprehensive review of the manual plan checking workflow was conducted to identify automatable checks and documentation. PlanGuardian was validated following a formal software development lifecycle, including integration testing, end-to-end testing, and user acceptance testing. To quantify the tool's impact, a prospective, comparative study was performed. The time taken to perform the designated checks by dosimetrists was recorded for 60 randomly sampled treatment plans, one-sided t-test was used for comparing the manual process with the automated tool. The plans were stratified by dosimetrists’ role (n=30 primary dosimetrist, n=30 secondary checker). Results: PlanGuardian was successfully developed and clinically implemented. Eighteen plan checks were programmed that check parameters such as field naming, deliverability of MLCs, dose grid resolution,
Conclusion: This ESTRO Delphi consensus highlights key areas of agreement and provides insights for clinical practice and future technology development. The study's key conclusion is a strong consensus against the PTV concept, advocating instead for CTV-based robust optimization and evaluation. The expert panel also unanimously agreed that the current robustness evaluation is insufficient and requires significant improvements, such as probabilistic evaluation and motion management technologies. Finally, the consensus supports necessity for evaluating the impact of variable RBE, emphasizing the need for standardizing methodologies and aligning software developments with clinical needs.
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