title: Treatment plan comparison using grading analysis based on clinical judgment.
abstract: OBJECTIVE
  In this work we explore a method named clinical grading analysis (CGA) which is based on clinical assessments performed by radiation oncologists (ROs). The purpose is to investigate how useful the method is for treatment plan comparisons, and how the CGA results correlate with dosimetric evaluation parameters, traditionally used for treatment plan comparisons.
  
  
  METHODS
  Helical tomotherapy (HTT) and seven-beam step-and-shoot intensity modulated radiation therapy (SS-IMRT) plans were compared and assessed by 10 experienced ROs for 23 patient cases. A CGA was performed where the plans were graded based on how the ROs thought they compared to each other. The resulting grades from the CGA were analyzed and compared to dose-volume statistics and equivalent uniform dose (EUD) data.
  
  
  RESULTS
  For eight of the 23 cases the CGA revealed a significant difference between the HTT and the SS-IMRT plans, five cases were in favor of HTT, and three in favor of SS-IMRT. Comparing the dose-volume statistics and EUD-data with the result from the CGA showed that CGA results correlated well with dose-volume statistics for cases regarding difference in target coverage or doses to organs at risk. The CGA results also correlated well with EUD-data for cases with difference in clinical target volume (CTV) coverage but the correlation for cases with difference in planning target volume (PTV) coverage was not as clear.
  
  
  CONCLUSIONS
  This study presents CGA as a useful method of comparing radiotherapy treatment plans. The proposed method offers a formalized way of introducing and evaluating the implementation of new radiotherapy techniques in a clinical setting. The CGA identify patients that have a clinical benefit of one or the other of the advanced treatment techniques available to them, i.e. in this study HTT and SS-IMRT, which facilitates a more optimal use of a clinics' advanced treatment resources.
authors.affiliation: Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden. Kristoffer.petersson@med.lu.se
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Petersson
authors.forename: Jacob
authors.initials: J
authors.lastname: Engellau
authors.forename: Per
authors.initials: P
authors.lastname: Nilsson
authors.forename: Per
authors.initials: P
authors.lastname: Engström
authors.forename: Tommy
authors.initials: T
authors.lastname: Knöös
authors.forename: Crister
authors.initials: C
authors.lastname: Ceberg
mesh_terms: D006801:Humans; D007600:Judgment; D008962:Models, Theoretical; D060787:Neoplasm Grading / Q000379:methods*; D009369:Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy; D010820:Physicians; D013902:Radiography, Thoracic; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D047368:Tumor Burden