Group #8

Rebecca Barrett
Rob Hale
Courtney Williams

Working Title
Improved planning efficiency in multi-lesion SRS/SRT VMAT cases using Eclipse scripting

Problem Statement
The problem is that multiple lesion SRS/SRT VMAT cases require an extensive time
commitment to create structures and multiple objectives to the optimizer, leading to decreased
treatment planning efficiency.

Purpose Statement
The purpose of this study is to determine if scripting improves treatment planning efficiency for
multiple lesion SRS/SRT VMAT cases by reducing planning time commitment.

Hypotheses Statements or Research Questions

H1A: The first research hypothesis (H1) is that using scripting will improve treatment planning
efficiency by reducing the time to begin optimization for SRS/SRT cases.
H10: The first null hypothesis (H10) is that using scripting will not improve treatment planning
efficiency by reducing the time to begin optimization for SRS/SRT cases.
H2A: The second research hypothesis (H2) is that using scripting will improve treatment planning
efficiency by reducing the total planning time for SRS/SRT cases.
H20: The second null hypothesis (H20) is that using scripting will not improve treatment
planning efficiency by reducing the total planning time for SRS/SRT cases.

Summary
Radiation has been used as a form of cancer therapy since the beginning of the twentieth
century and has since consistently progressed to improve patient treatment. With such increased
complexities over the years, medical dosimetrists have been required to adapt and improve
treatment planning efficiency on a multitude of levels. For example, stereotactic treatments, such
as radiosurgery (SRS) and radiotherapy (SRT), were originally limited to single lesion treatments
but are now commonly used to treat multi-lesion cases with a single isocenter. As these plans
allow for high dose deliverance with accurate precision, complexity of the treatment planning
process has become ever more complicated.1 Many new technologies, such as HyperArc and
RapidPlan, are available for clinics to purchase to improve the efficiency of the dosimetrist’s
daily tasks, making for a more automated and proficient treatment planning procedure.2, 3 Fung et
al, for example, found a decrease in overall planning time when using OAR auto-contouring
versus manual contouring for head and neck cases.4 Though these technologies are useful tools
that simplify dosimetry tasks, many are still being studied, are not available to all clinics, and
require multiple rounds of QA to implement in the radiation oncology workflow.
Eclipse scripting offers planning automation with the flexibility of direct editing at the
hands of individual clinics. Scripts can be shared through online portals allowing clinics to
utilize them without a designated on-site coder. Additionally, these scripts can be as simple or
complex as planners find useful and run directly through Eclipse, offering an opportunity to
effectively improve planning efficiency.5 Given that dosimetrists have many tedious
responsibilities, they are required to dedicate time and energy on tasks that don’t necessarily put
their skills to work. The more time-consuming tasks that a dosimetrist needs to complete in a day
could overall limit the number of patients that they can plan in a week.6 With Eclipse scripting,
Teruel et al saved an estimated one day’s work using a TBI planning script that generated multi-
isocenter VMAT treatment plans.7 Scripting is thought to be an especially useful tool for
complex cases like multiple lesion SRS/SRT, where monotonous tasks are exceptionally time-
consuming given the numerous target volumes.8 
For multiple lesion SRS/SRT cases, optimization structures are a useful tool to ensure a
hot target center, a reduction of hotspots in the GTV to PTV margin, and a uniform, sharp dose
fall-off. Though using only targets, OARs, and normal tissue objectives in the optimizer can
yield acceptable plans, dosimetrists tend to find optimization structures useful in all cases,
especially SRS/SRT where there are multiple lesions to treat. Creating these additional structures
requires the dosimetrist to dedicate more time to the planning process to create a clinically
acceptable plan.9 The problem is that multiple lesion SRS/SRT VMAT cases require an
extensive time commitment to create optimization structures and add multiple objectives to the
optimizer, leading to decreased treatment planning efficiency. Implementing a script that creates
these optimization structures and adds them, as well as targets and OARs, to the optimizer offers
a time-reducing solution to the tedious tasks that dosimetrists are required to complete. The
purpose of this study is to determine if scripting improves treatment planning efficiency for
multiple lesion SRS/SRT VMAT cases by reducing planning time commitment. Researchers
tested the hypotheses that using scripting will improve treatment planning efficiency by reducing
the time to begin optimization for SRS/SRT cases and the total planning time for SRS/SRT
cases.
References
1. Desai DD, Cordrey IL, Johnson EL. Efficient optimization of R50% when planning multiple
cranial metastases simultaneously in single isocenter SRS/SRT. J Appl Clin Med Phys.
2021;22(6):71-82. https://doi.org/10.1016/j.meddos.2019.05.005
2. Saw CB, Li S, Battin F, McKeague J, Peters CA. External beam planning module of Eclipse
for external beam radiation therapy. Med Dosim. 2018;43(2):195-204.
https://doi.org/10.1016/j.meddos.2018.03.003
3. Yoder T, Hsai AT, Xu Z, Stessin A, Ryu S. Usefulness of EZFluence Software for
radiotherapy planning of breast cancer treatment. Med Dosim. 2019;44(4):339-343.
https://doi.org/10.1016/j.meddos.2018.12.001
4. Fung NTC, Hung WM, Sze CK, Lee MCH, Ng WT. Automatic segmentation for adaptive
planning in nasopharyngeal carcinoma IMRT: Time, geometrical, and dosimetric
analysis. Med Dosim. 2020;45(1):60-65. https://doi.org/10.1016/j.meddos.2019.06.002
5. Rusu I, Roeske J, Solanki A, Kang H. Fully automated planning and delivery of
hippocampal-sparing whole brain irradiation. Med Dosim. 2022;47(1):8-13.
https://doi.org/10.1016/j.meddos.2021.06.004
6. Wang H, Rea A, Rudek B, Chen T, McCarthy A, Barbee D. Automatic couch position
calculation using eclipse scripting for external beam radiotherapy. J Appl Clin Med Phys.
2021;22(2):77-84. https://doi.org/10.1002/acm2.13159
7. Teruel JR, Taneja Sameer, et al. Automatic treatment planning for VMAT-based total body
irradiation using Eclipse scripting. J Appl Clin Med Phys. 2021;22(3);119-130.
https://doi.org/10.1002/acm2.13189
8. Zhang Q, Peng Y, Song X, Yu H, Wang L, Zhang S. Dosimetric evaluation of automatic and
manual plans for early nasopharyngeal carcinoma for radiotherapy. Med Dosim.
2019;45(1):13-20. https://doi.org/10.1016/j.meddos.2019.05.005
9. Bell JP, Patel P, Higgins, K, McDonald MW, Roper J. Fine-tuning the normal tissue
objective in eclipse for lung stereotactic body radiation therapy. Med Dosim. 2017;43(4):344-
350. https://doi.org/10.1016/j.meddos.2017.11.004