Standardisation initiative for plan complexity in radiotherapy: from metrics to clinical practice
18 – 19 October 2024 | Krakow, Poland

Chairs: Victor Hernandez (Spain), Alessandro Scaggion (Italy)

The Standardisation Initiative for Plan Complexity in Radiotherapy: from Metrics to Clinical Practice track at last year’s physics workshop was joined by 42 participants, including two invited speakers and six vendor representatives. The event was marked by active discussions and productive exchanges, which set the stage for critical advancements in the field. Chaired by Victor Hernandez (Spain) and Alessandro Scaggion (Italy), and with the collaboration of Jeroen van de Kamer (The Netherlands) and Eduard Gershkevitsh (Estonia) as invited speakers, the workshop was intended to develop a standardised framework for the management of plan complexity in radiotherapy.

_{Picture 1: Workshop delegates}

The relationship between complexity metrics and dose uncertainties was a central focus. These issues arise from various factors and steps within the radiotherapy process. Participants emphasised the need to balance dose improvements against the uncertainties that are introduced during treatment planning, particularly by using class solutions to mitigate variability in the treatment planning process.

The necessity for platform-specific complexity metrics was also discussed, and the diverse range of delivery systems was considered. These include not only C-arm linacs but also other ring-based, tomotherapy and CyberKnife™ platforms. The importance of establishing a minimum set of metrics by which to evaluate and optimise treatment plans was underscored; a consensus on this topic will be formalised in an upcoming positioning paper. A key highlight of the workshop was the launch of the standardisation initiative for metrics of plan complexity (SIMPLY), through which we intend to define clear metrics and set reference benchmarks.

The relationship between plan complexity metrics and patient-specific quality assurance (PSQA) was another significant focus. Participants emphasised the need to quantify plan complexity, particularly to minimise uncertainties, to ensure safe treatments on older or lower-performing linacs, and to optimise PSQA workflows.

Vendor representatives demonstrated current implementations and discussed potential future developments in commercial products. They adopted an open and collaborative approach that attendees highly appreciated. The workshop concluded with a discussion on the role of plan complexity metrics in large clinical trials and credentialling procedures. Attendees recognised the potential for their inclusion to control and standardise planning approaches and to establish complexity ranges that are deemed clinically representative.

Victor Hernandez

Medical Physicist, Hospital Universitari Sant Joan de Reus, Tarragona, Spain

 

Alessandro Scaggion

Medical Physicist, Veneto Institute of Oncology, Padova, Italy