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J Appl Clin Med Phys. 2018 Sep;19(5):491-498. doi: 10.1002/acm2.12403. Epub 2018 Jul 8.

An interactive plan and model evolution method for knowledge-based pelvic VMAT planning.

Author information

Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Beijing Cancer Hospital & Institute, Peking University Cancer Hospital & Institute, Beijing, China.
Department of Medical Physics, Institute of Medical Humanities, Peking University, Beijing, China.
Beijing City Key Lab for Medical Physics and Engineering, School of Physics, Institute of Heavy Ion Physics, Peking University, Beijing, China.



To test if a RapidPlan DVH estimation model and its training plans can be improved interactively through a closed-loop evolution process.


Eighty-one manual plans (P0 ) that were used to configure an initial rectal RapidPlan model (M0 ) were reoptimized using M0 (closed-loop), yielding 81 P1 plans. The 75 improved P1 (P1+ ) and the remaining 6 P0 were used to configure model M1 . The 81 training plans were reoptimized again using M1 , producing 23 P2 plans that were superior to both their P0 and P1 forms (P2+ ). Hence, the knowledge base of model M2 composed of 6 P0 , 52 P1+ , and 23 P2+ . Models were tested dosimetrically on 30 VMAT validation cases (Pv ) that were not used for training, yielding Pv (M0 ), Pv (M1 ), and Pv (M2 ) respectively. The 30 Pv were also optimized by M2_new as trained by the library of M2 and 30 Pv (M0 ).


Based on comparable target dose coverage, the first closed-loop reoptimization significantly (P < 0.01) reduced the 81 training plans' mean dose to femoral head, urinary bladder, and small bowel by 2.65 Gy/15.63%, 2.06 Gy/8.11%, and 1.47 Gy/6.31% respectively, which were further reduced significantly (P < 0.01) in the second closed-loop reoptimization by 0.04 Gy/0.28%, 0.18 Gy/0.77%, 0.22 Gy/1.01% respectively. However, open-loop VMAT validations displayed more complex and intertwined plan quality changes: mean dose to urinary bladder and small bowel decreased monotonically using M1 (by 0.34 Gy/1.47%, 0.25 Gy/1.13%) and M2 (by 0.36 Gy/1.56%, 0.30 Gy/1.36%) than using M0 . However, mean dose to femoral head increased by 0.81 Gy/6.64% (M1 ) and 0.91 Gy/7.46% (M2 ) than using M0 . The overfitting problem was relieved by applying model M2_new .


The RapidPlan model and its constituent plans can improve each other interactively through a closed-loop evolution process. Incorporating new patients into the original training library can improve the RapidPlan model and the upcoming plans interactively.


RapidPlan; knowledge-based planning; model improvement; rectal cancer

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