Toward Systematic Assessment and Improvement of Radiation Therapy Plan Quality of Cooperative Group Trial Submissions: A Report From the Children’s Oncology Group

Olch AJ, Gopalakrishnan M, Murphy ES, MacDonald SM, Hua CH. Toward Systematic Assessment and Improvement of Radiation Therapy Plan Quality of Cooperative Group Trial Submissions: A Report From the Children’s Oncology Group. Pract Radiat Oncol. 2023 Jul-Aug;13(4):e374-e382. doi: 10.1016/j.prro.2023.02.008. Epub 2023 Apr 9. PubMed PMID: 37037758; PubMed Central PMCID: PMC11163894.

This study evaluates the quality of plans used for treatment of patients on the Children’s Oncology Group (COG) study, ACNS1123. Plan quality is quantified based on a scoring system specific to the protocol. In this way, the distribution of plan quality scores is determined which can be used to identify plan quality issues for this study and for future plan quality improvement. ACNS1123 stratum 1 patients (70) were evaluated. This included 50 photon and 20 proton plans. DICOM structure and dose data was obtained from the COG. A commercially available plan quality scoring algorithm was used to create a scoring system we designed using the protocol dosimetric requirements. The whole ventricle and boost PTVs could earn a maximum of 70 points while the OARs could earn 30 points (total maximum score of 100 points). The scoring algorithm adjusted scores based on the difficulty in achieving the structure dose requirements which depended on the proximity of the PTVs and the dose gradients achieved relative to the organs at risk. The distribution of plan scores was used to determine the mean, median, and range of scores.