Radiation Physics

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TU_14_3251 - The Analytical Hierarchy Process (AHP) to Score Plan Quality of Intact Prostate Treatment Plans

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

The Analytical Hierarchy Process (AHP) to Score Plan Quality of Intact Prostate Treatment Plans
A. Brito Delgado1, K. Rasmussen2, Z. Shi Jr2, T. Medrano Pesqueira3, K. Kauweloa4, D. R. Cohen1, T. Y. Eng1, N. Kirby2, D. Saenz2, S. Stathakis2, N. Papanikolaou2, and A. Gutierrez5; 1UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, 2University of Texas Health San Antonio Cancer Center, San Antonio, TX, 3Centro Oncologico del Estado de Sonora, Hermosillo, Mexico, 4Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, 5Miami Cancer Institute, Baptist Health South Florida, Miami, FL

Purpose/Objective(s): The purpose of this study is to assess the quality of intact prostate treatment plans using the Analytical Hierarchy Process (AHP) by considering different preferences from groups of professionals surveyed in cancer centers across the United States, Mexico and Brazil.

Materials/Methods: The AHP is a mathematical method used to select the best treatment plan from a set of options by quantifying subjective criteria through pairwise comparisons, generating ratio data that determine how much more important is one item being prioritized than another. To evaluate criteria preferences between two intact prostate treatment plans, eleven radiation oncologists, four dosimetrists, and one physicist were surveyed from the US, Mexico, and Brazil. Dosimetric criteria affecting plan quality were scored based on individual preferences. Both plans meet dosimetric tolerances based on QUANTEC data. The best plan alternative was determined for each respondent. The geometric mean of scored preferences was taken to group data by profession and country of practice.

Results: Criteria preference showed that all but one of the participants ranked the penile bulb as the least important treatment parameter by 6% on average [2%-10%] less than the next lowest ranked parameter. Dosimetrists’ difference in preference between PTV coverage and rectal constraint was only 1% in favor of the rectum whereas radiation oncologists prioritized the rectum over the PTV by 11%. United States’ radiation oncologists differed from Mexico’s by placing an 11% higher priority on the bladder constraints. All radiation oncologists chose plan 1 as preferred alternative whereas all dosimetrists and physicist chose plan 2 as the better-quality plan. Plan quality preference was also influenced by country of practice. The largest discrepancy was as follows: Mexican radiation oncologists placed a 17% higher importance on plan conformity than their US counterparts and the Brazilian cohort placed a much higher importance on the PTV Dmin (30% more important than US radiation oncologists, 47% more important than Mexican radiation oncologists).

Conclusion: There is a wide range of plan quality preferences and this can vary at the international, national, and even institutional level. As shown here, both country of practice and role in the treatment planning process can affect plan quality preferences. AHP appears to be a unique tool to quantify treatment plan quality preferences and determine the best plan alternative for intact prostate cases.
Radiation Oncologists Dosimetrists United States Radiation Oncologists United States Dosimetrists Mexico Radiation Oncologists Mexico Dosimetrists Brazil Physicist
PTV 38% 28% 34% 15% 40% 55% 61%
Bladder 14% 11% 21% 18% 10% 4% 4%
Rectum 27% 29% 19% 30% 34% 20% 15%
Penile Bulb 4% 7% 4% 5% 4% 9% 9%
Sigmoid 16% 24% 22% 32% 12% 12% 11%
Plan Preference
Plan 1 53% 44% 50.3% 45% 55% 40% 42%
Plan 2 47% 56% 49.7% 55% 45% 60% 58%

Author Disclosure: A. Brito Delgado: Scholarship funding; CONCYT. K. Rasmussen: None. Z. Shi: None. T. Medrano Pesqueira: None. K. Kauweloa: None. D.R. Cohen: None. T.Y. Eng: Stock; Amgen. N. Kirby: None. N. Papanikolaou: Research Grant; BrainLab. site visitor for ACR Radiation Oncology Practice Accreditation; ACR. Speaker's Bureau; BrainLab. treasurer/secretary; Texas Radiological Society. medical physics advisory committee member; Texas Medical Board.

Amy Brito Delgado, MS

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