title: A knowledge-based approach to improving and homogenizing intensity modulated radiation therapy planning quality among treatment centers: an example application to prostate cancer planning.
abstract: OBJECTIVE
  Intensity modulated radiation therapy (IMRT) treatment planning can have wide variation among different treatment centers. We propose a system to leverage the IMRT planning experience of larger institutions to automatically create high-quality plans for outside clinics. We explore feasibility by generating plans for patient datasets from an outside institution by adapting plans from our institution.
  
  
  METHODS
  A knowledge database was created from 132 IMRT treatment plans for prostate cancer at our institution. The outside institution, a community hospital, provided the datasets for 55 prostate cancer cases, including their original treatment plans. For each "query" case from the outside institution, a similar "match" case was identified in the knowledge database, and the match case's plan parameters were then adapted and optimized to the query case by use of a semiautomated approach that required no expert planning knowledge. The plans generated with this knowledge-based approach were compared with the original treatment plans at several dose cutpoints.
  
  
  RESULTS
  Compared with the original plan, the knowledge-based plan had a significantly more homogeneous dose to the planning target volume and a significantly lower maximum dose. The volumes of the rectum, bladder, and femoral heads above all cutpoints were nominally lower for the knowledge-based plan; the reductions were significantly lower for the rectum. In 40% of cases, the knowledge-based plan had overall superior (lower) dose-volume histograms for rectum and bladder; in 54% of cases, the comparison was equivocal; in 6% of cases, the knowledge-based plan was inferior for both bladder and rectum.
  
  
  CONCLUSIONS
  Knowledge-based planning was superior or equivalent to the original plan in 95% of cases. The knowledge-based approach shows promise for homogenizing plan quality by transferring planning expertise from more experienced to less experienced institutions.
authors.affiliation: Medical Physics Graduate Program, Duke University, Durham, North Carolina, USA.
authors.forename: David
authors.initials: D
authors.lastname: Good
authors.forename: Joseph
authors.initials: J
authors.lastname: Lo
authors.forename: W Robert
authors.initials: WR
authors.lastname: Lee
authors.forename: Q Jackie
authors.initials: QJ
authors.lastname: Wu
authors.forename: Fang-Fang
authors.initials: FF
authors.lastname: Yin
authors.forename: Shiva K
authors.initials: SK
authors.lastname: Das
mesh_terms: D002173:Cancer Care Facilities / Q000592:standards*; D005240:Feasibility Studies; D005270:Femur Head / Q000528:radiation effects; D006764:Hospitals, Community; D006801:Humans; D051188:Knowledge Bases; D008297:Male; D058958:Organs at Risk / Q000528:radiation effects; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D058996:Quality Improvement / Q000592:standards*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods / Q000592:standards*; D020266:Radiotherapy, Conformal; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods / Q000592:standards*; D012007:Rectum / Q000528:radiation effects; D018581:Technology Transfer; D001743:Urinary Bladder / Q000528:radiation effects