1

Improved planning efficiency in multi-lesion stereotactic radiosurgery (SRS) and

radiotherapy (SRT) volumetric modulated arc therapy (VMAT) cases using Eclipse
scripting
Rebecca Barrett, BA, CMD, Rob Hale, BS, CPhT, Courtney Williams, BS, RT(T), Nichelle
Lenards, PhD, CMD, RT(R)(T), FAAMD, Ashley Hunzeker, MS, CMD, Sabrina Zeiler, MS,
CMD, RT(T)
Medical Dosimetry Program at the University of Wisconsin – La Crosse
I. Abstract
II. Introduction
A. PI: Increased complexity of treatments creates a need for increased treatment
planning efficiency (Reference: Desai et al,1 Saw et al,2 Yoder et al,3 Fung et al,4)
B. PII: Eclipse scripting offers an opportunity to improve treatment planning efficiency
(Reference: Rusu et al,5 Wang et al,6 Teruel et al,7 Zhang et al,8)
C. PIII: Optimization process for multiple lesion SRS/SRT VMAT planning (Reference:
Bell et al,9)
D. PIV: Summarize introduction points
1. Problem: 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.
2. Purpose: The purpose of this study is to determine if scripting can
improve treatment planning efficiency for multiple lesion SRS/SRT
VMAT cases by reducing planning time commitment.
3. Hypotheses: Researchers tested the hypotheses that the use of
scripting will improve SRS/SRT VMAT treatment planning
efficiency by reducing the time to begin optimization (H1) and the
total planning time (H2). Researchers tested the null hypotheses that
the use of scripting will not improve SRS/SRT VMAT treatment
planning efficiency by reducing the time to begin optimization (H10)
or the total planning time to (H20).
III. Materials and Methods
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A. Scripting Development
1. PI: Eclipse script writing
a. Eclipse scripting application programming interface
(ESAPI) (Reference: Wang et al,6 Teruel et al,7)
2. PII: Script function
a. Script is applied at the beginning of the planning process
(Figure 1)
b. Script reads list of targets and OARs, planner uses script
dropdown boxes to select structures, and optimization
structures are created (Figures 2,3)
c. Created optimization structures (PTV minus GTV
structure, center of GTV structure, bridge avoidance
structure, wall structure around summed PTVs) (Figure 4)
B. Treatment Planning
1. PI: Study population
a. Study population is 8 medical dosimetrists and 1 medical
physicist, all with SRS planning experience
2. Patient selection
a. 3 patients with multiple brain lesions
b. Inclusion criteria (5-13 brain lesions, SRS/SRT VMAT
treatment plans)
c. Exclusion criteria (non-multiple lesion brain patients, non-
SRS/SRT VMAT treatment plans)
3. CT Simulation and patient immobilization
a. Patients were simulated in the supine position
b. Immobilization devices used include encompass mask with
stereotactic tolerance
4. PII: Contouring
a. Contours completed by script writer before the study
participants began treatment planning
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b. Target delineation in Eclipse treatment planning system

including GTV, CTV, PTV (Reference: Kruser et al,10)
c. OAR delineation in Eclipse treatment planning system
(Reference: Kruser et al,10)
d. Avoidance entry section delineation (avoid entry through
lens, retina)
5. Planning process
a. PIII: General planning details (Eclipse treatment planning
system, version 16.01.10, with AAA_13623 algorithm;
Varian TrueBeam linear accelerator with micro-MLCs
(0.25 cm and 0.5 cm leaf size); single-isocenter SRS/SRT
VMAT, 0.1cm dose grid)
b. PIV: Optimization process completed WITH and
WITHOUT the script
c. The number of optimization structures created for each
patient WITH the use of the script
d. PV: Medical dosimetrists have control over assigning
clinical goal priorities
e. Each dosimetrist completes 6 plans total. There are 3
patients plans. Each patient plan is completed 2 times by
the medical dosimetrist (once WITH and once WITHOUT
the use of the script)
f. At least 7 days between each patient’s plan 1 (WITH script)
and plan 2 (WITHOUT script) to prevent memorized plan 1
process from being used to make plan 2 process easier
g. Screen record planning process using Zoom
C. PI: Plan comparison
1. Time comparison
a. Start and stop times for plan 1 planning process (WITH
script) and plan 2 planning process (WITHOUT script) are
recorded and compared
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D. PI: Statistical analysis

1. Wilcoxon test
2. T-test
a. Statistical significance: P < 0.05 is statistically significant
IV. Results
A. PI: Scripting and Optimization Time
1. Time from optimizer opening time to start of first optimization WITH
and WITHOUT the script
a. Population results for optimizer setup time (Figure 5; Table 1)
b. Wilcoxon difference in optimizer setup time
i. Case 1: Padj = 0.046 (Padj < 0.05 statistically significant)
1. Reject null hypothesis (H10)
ii. Case 2: Padj = 0.000 (Padj < 0.05 statistically significant)
1. Reject null hypothesis (H10)
iii. Case 3: Padj =0.000 (Padj < 0.05 statistically significant)
1. Reject null hypothesis (H10)
2. Total contouring time and script running time vs total contouring time
WITH and WITHOUT the script
a. Population results for total contouring/script running time
(Figures 6,7,8,9; Table 2)
b. T-test difference in Total contouring time/script running time
i. Case 1: Padj = 0.354 (Padj < 0.05 statistically significant)
1. Fail to reject null hypothesis (H10)
ii. Case 2: Padj = 0.000 (Padj < 0.05 statistically significant)
1. Reject null hypothesis (H10)
iii. Case 3: Padj =0.000 (Padj < 0.05 statistically significant)
1. Reject null hypothesis (H10)
3. PII: Total number of optimizations WITH and WITHOUT the script
a. Population results for number of optimizations (Figure 10;
Table 3)
b. Wilcoxon difference in optimizer setup time
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i. Case 1: Padj = 0.002 (Padj < 0.05 statistically significant)

1. Reject null hypothesis
ii. Case 2: Padj = 0.094 (Padj < 0.05 statistically significant)
1. Fail to reject null hypothesis
iii. Case 3: Padj =0.133 (Padj < 0.05 statistically significant)
1. Fail to reject null hypothesis
4. PIII: Total optimization setup time WITH and WITHOUT the script
a. Population results for total planning time (Figure 11; Table 4)
b. T-test difference in total optimization setup time
i. Case 1: Padj = 0.075 (Padj < 0.05 statistically significant)
1. Fail to reject null hypothesis
ii. Case 2: Padj = 0.000 (Padj < 0.05 statistically significant)
1. Reject null hypothesis
iii. Case 3: Padj =0.000 (Padj < 0.05 statistically significant)
1. Reject null hypothesis
B. PIV: Scripting and Total Plan Time
1. Population results for total planning time (Figure 12; Table 5)
2. Wilcoxon difference in total planning time
a. Case 1: Padj = 0.029 (Padj < 0.05 statistically significant)
i. Reject null hypothesis (H20)
b. Case 2: 0.001 (Padj < 0.05 statistically significant)
i. Reject null hypothesis (H20)
c. Case 3: 0.000 (Padj < 0.05 statistically significant)
i. Reject null hypothesis (H20)
V. Discussion
VI. Conclusion
A. PI: Summarize the study
1. Problem: 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.
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2. Purpose: The purpose of this study was to determine if scripting can

improve treatment planning efficiency for multiple lesion SRS/SRT
VMAT cases by reducing planning time commitment.
B. PII: Limitations and future research
1. Limitations: Limited sample size at a single institution, patients with a
specified range of lesions per plan
2. Future research: Larger sample size, multiple institutions, larger range of
specified lesions per plan
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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
10. Kruser TJ, Bosch WR, Badiyan SN, et al. NRG brain tumor specialists consensus guidelines
for glioblastoma contouring. J Neurooncol. 2019;143(1):157-166. doi:10.1007/s11060-019-
03152-9
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Figures 

 
Figure 1. The script allows users to select the correct course and prescription. It then prompted
the user to continue the script process, provided updates for each step, and the script function
was complete when all optimization structures were generated. 

 
Figure 2. The script used the list of contoured structures to generate optimization structures. 
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Figure 3. Structures that were generated by the script are listed. This includes bridge, GTV,
PTV, and summed PTV wall optimization structures.  

 
Figure 4. Bridge structures were used to reduce dose to the normal tissue in between target
volumes. PTV and GTV optimization structures were used to provide dose coverage and dose
falloff. 
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Figure 5. A chart tracks the time taken to setup the optimizer with and without the use of the
script.  

Figure 6. A chart shows the comparison of time, in minutes, dedicated to contouring

optimization strictures with and without the use of the script.  
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Figure 7. A chart shows the difference, with and without the use of the script, in the combined
time taken to run the script and perform any extra contouring for Case 1. 

 
Figure 8. A chart shows the difference, with and without the use of the script, in the combined
time taken to run the script and perform any extra contouring for Case 2.  
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Figure 9. A chart shows the difference, with and without the use of the script, in the combined
time taken to run the script and perform any extra contouring for Case 3.
 

Figure 10. A comparison chart tracks the number of optimizations for each case with and
without the use of the script. 
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Figure 11. A comparison chart tracks the total time, in minutes, taken for optimization setup in
each case with and without the use of the script. 

Figure 12. A comparison chart tracks the total planning time with and without the use of the
script. 
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Tables

Table 1. Standard deviation and mean value for optimizer setup times with and without the use
of the script.
Optimizer Setup Time

script case Standard Deviation Mean

with 1 2.24814814814815 1.427299423

without 1 6.89074074074074 3.893915402

with 2 1.80185185185185 1.560947995

without 2 6.83703703703704 1.988295225

with 3 2.31111111111111 1.957428869

without 3 9.24814814814815 3.440874046

Table 2. Standard deviation and mean value for contouring time and script running time with
and without the use of the script.
Contouring Time/Contouring plus Script running time

script case Standard Deviation Mean

with 1 1.977777778 1.756219108

without 1 6.42962963 4.521029395

with 2 2.872222222 2.370580684

without 2 11.53518519 5.816746922

with 3 3.611111111 3.50656131

without 3 15.97222222 7.978330026

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Table 3. Standard deviation and mean value for the number of optimizations during planning
with and without the use of the script.
Number of optimizations

script case Standard Deviation Mean

with 1 2.222222222 1.301708279

without 1 2.333333333 1.58113883

with 2 2.888888889 2.088327348

without 2 3.666666667 2.179449472

with 3 2.888888889 2.315407332

without 3 3.222222222 1.922093766

Table 4. Standard deviation and mean value for total optimization setup times with and without
the use of the script.
Total Optimization Setup Time

script case Standard Deviation Mean

with 1 5.97407407407407 2.986231264

without 1 13.6981481481481 6.169568261

with 2 6.57962962962963 4.400818877

without 2 18.3722222222222 7.165232415

with 3 5.49074074074074 2.263188372

without 3 21.637037037037 7.941809975

Table 5. Standard deviation and mean value for total planning time with and without the use of
the script.
Total Planning Time

script case Standard Deviation Mean

with 1 66.1351851851852 24.55227904

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without 1 75.4166666666667 35.16701915

with 2 76.3981481481482 38.9747162

without 2 115.833333333333 55.71395634

with 3 91.312962962963 63.02795609

without 3 124.198148148148 54.01843592

*Raw data
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Total Planning Time

C1 C2 C3
Dosimetrist C1 W/O C2 W/O C3 W/O
WITH WITH WITH

1 0:45:36 1:05:39 1:30:23 2:04:00 0:49:28 1:38:26

2 0:56:29 1:02:30 0:52:31 1:16:41 1:04:00 2:56:04

3 0:35:35 0:51:44 0:41:01 0:55:18 0:51:49 1:14:07

4 1:07:48 1:31:20 1:16:46 1:36:32 0:55:28 1:36:22

5 1:08:20 1:02:38 1:15:23 1:44:50 1:20:38 1:32:05

6 1:39:11 2:27:16 1:59:49 3:44:52 2:37:13 3:22:39

7 0:41:26 0:38:12 0:42:24 0:51:29 0:52:16 0:50:37

8 1:14:48 0:47:33 0:37:58 2:28:26 1:17:18 2:21:34

9 1:46:00 1:51:53 2:31:20 2:40:22 3:53:39 3:05:53

Total Optimization Setup Time

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C1 C2 C3
Dosimetrist C1 W/O C2 W/O C3 W/O
WITH WITH WITH

1 0:07:26 0:16:41 0:04:07 0:10:23 0:03:56 0:17:50

2 0:11:51 0:20:09 0:06:17 0:23:39 0:03:31 0:13:01

3 0:01:52 0:22:29 0:04:33 0:18:21 0:05:45 0:29:10

4 0:05:45 0:16:11 0:09:38 0:18:57 0:06:52 0:32:14

5 0:04:04 0:03:44 0:16:56 0:32:06 0:09:45 0:17:09

6 0:04:44 0:06:03 0:03:08 0:09:58 0:04:28 0:14:36

7 0:08:08 0:15:12 0:06:25 0:13:28 0:05:47 0:14:07

8 0:03:15 0:11:21 0:02:43 0:23:22 0:02:13 0:32:17

9 0:06:41 0:11:27 0:05:26 0:15:07 0:07:08 0:24:20

Contouring Time/Contouring plus Script running time

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C1 C2 C3
Dosimetrist C1 W/O C2 W/O C3 W/O
WITH WITH WITH

1 0:01:00 0:13:14 0:03:57 0:10:56 0:01:46 0:13:02

2 0:03:38 0:08:11 0:01:24 0:18:03 0:03:31 0:26:26

3 0:00:35 0:07:20 0:01:28 0:12:26 0:01:55 0:21:43

4 0:05:17 0:11:15 0:07:01 0:18:00 0:08:06 0:23:12

5 0:00:55 0:00:00 0:01:20 0:04:36 0:01:29 0:09:52

6 0:00:49 0:00:00 0:01:20 0:04:01 0:01:42 0:06:59

7 0:01:08 0:04:33 0:01:34 0:04:37 0:01:30 0:03:17

8 0:00:40 0:08:02 0:01:15 0:15:38 0:01:30 0:19:59

9 0:03:46 0:05:17 0:06:32 0:15:32 0:02:01 0:19:15

Optimizer Setup Time

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C1 C2 C3
Dosimetrist C1 W/O C2 W/O C3 W/O
WITH WITH WITH

1 0:04:30 0:04:45 0:01:39 0:04:29 0:01:53 0:04:23

2 0:01:05 0:11:59 0:00:56 0:10:02 0:00:32 0:11:46

3 0:00:13 0:13:30 0:01:16 0:09:27 0:01:06 0:13:04

4 0:03:22 0:06:21 0:03:13 0:06:51 0:04:00 0:13:12

5 0:01:57 0:03:36 0:05:27 0:06:40 0:06:20 0:08:58

6 0:02:31 0:05:29 0:00:58 0:05:30 0:01:41 0:06:37

7 0:02:25 0:09:32 0:01:01 0:07:26 0:01:26 0:10:06

8 0:00:38 0:02:14 0:00:45 0:06:54 0:00:17 0:10:49

9 0:03:33 0:04:35 0:00:58 0:04:13 0:03:33 0:04:19

Number of Optimizations
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C1 C2 C3
Dosimetrist C1 W/O C2 W/O C3 W/O
WITH WITH WITH

1 1 2 4 5 1 2

2 2 2 2 2 2 6

3 1 1 1 1 1 1

4 3 4 6 6 3 3

5 1 1 1 3 2 2

6 4 5 5 7 5 4

7 1 1 1 1 1 1

8 3 1 1 3 3 4

9 4 4 5 5 8 6