title: Prostate intensity-modulated radiotherapy planning in seven mouse clicks: Development of a class solution for cancer.
abstract: OBJECTIVE
  The aim of the retrospective study was to develop a planning class solution for prostate intensity-modulated radiotherapy (IMRT) that achieved target and organs-at-risk (OAR) doses within acceptable departmental protocol criteria using the Monaco treatment planning system (Elekta-CMS Software, MO, USA).
  
  
  BACKGROUND
  Advances in radiation therapy technology have led to a re-evaluation of work practices. Class solutions have the potential to produce highly conformal plans in a time-efficient manner.
  
  
  METHODS
  Using data from intermediate and high risk prostate cancer patients, a stepwise quality improvement model was employed. Stage 1 involved the development of a broadly based treatment template developed across 10 patients. Stage 2 involved template refinement and clinical audit (n= 20); Stage 3, template review (n= 50) and Stage 4 an assessment of a revised template against the actual treatment plan involving 72 patients.
  
  
  RESULTS
  The computer algorithm that comprised the Stage 4 template met clinical treatment criteria for 82% of patients. Minor template changes were required for a further 13% of patients. Major changes were required in 4%; one patient could not be assessed. The average calculation time was 13 min and involved seven mouse clicks by the planner. Thus, the new template met treatment criteria or required only minor changes in 95% of prostate patients; this is an encouraging result suggesting improvements in planning efficiency and consistency.
  
  
  CONCLUSIONS
  It is feasible to develop a class solution for prostate IMRT using a stepwise quality improvement model which delivers clinically acceptable plans in the great majority of prostate cases.
authors.affiliation: Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales 2450, Australia.
authors.forename: Maree
authors.initials: M
authors.lastname: Wood
authors.affiliation: Department of Radiation Oncology, North Coast Cancer Institute, Lismore, New South Wales 2480, Australia.
authors.forename: Amara
authors.initials: A
authors.lastname: Fonseca
authors.affiliation: Department of Radiation Oncology, North Coast Cancer Institute, Lismore, New South Wales 2480, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Sampson
authors.affiliation: Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales 2450, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kovendy
authors.affiliation: Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales 2450, Australia.
authors.forename: Justin
authors.initials: J
authors.lastname: Westhuyzen
authors.affiliation: Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales 2450, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Shakespeare
authors.affiliation: Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales 2450, Australia.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Turnbull
keywords: Computer assisted; Diagnostic imaging; Prostate; Radiotherapy planning