Interobserver Variability in Radiotherapy Plan Output: Results of a Single-Institution Study

Publication date: Available online 8 May 2016
Source:Practical Radiation Oncology
Author(s): Sean L. Berry, Amanda Boczkowski, Rongtao Ma, James Mechalakos, Margie Hunt
PurposeTo investigate the sources of variability in radiotherapy treatment plan output between planners within a single institution.Materials/Methods40 treatment planners across 5 campuses of the same institution created a plan on copies of the same thoracic esophagus patient CT and structure set. Plans were scored and ranked based on the planner's adherence to ordered list of target dose coverage and normal tissue evaluation criteria. A runs test was used to identify whether any of the studied planner qualities influenced the ranking. Spearman's rank correlation was used to investigate whether plan score correlated with years of experience or planned MU.ResultsThe distribution of scores, ranging from 80.24 to 135.89, was negatively skewed (mean = 128.7, median = 131.5). No statistically significant relationship between plan score and campus (p=0.193), job title (p=0.174), previous outside experience (p=0.611), or number of gantry angles (p=0.156) exists. No statistical correlation between plan score and MU or years of experience was found.ConclusionDespite clear and established critical organ dose criteria and well documented planning guidelines, planning variation still occurs, even among members of the same institution. As plan consistency does not seem to significantly correlate with experience, career path, or campus, investigation into alternate methods beyond additional education and training to reduce this variation, such as knowledge based planning or advanced optimization techniques, is necessary.



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