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©2019. VARIAN MEDICAL SYSTEMS, INC. For immediate recipient’s use only©2019. VARIAN MEDICAL SYSTEMS, INC. For immediate recipient’s use only
Anthony Magliari MS, CMD
Sr Research Scientist – Medical Affairs
2019 PlanChallengeMan Vs MachineRapidPlan:Esophagus
2019 Varian Plan Challenge: Man vs Machine
Goals
• Identify and recognize top Eclipse planners
• Increase awareness of and increase utilization of RapidPlan
• Create a very high quality and finely tuned RapidPlan model
for the community
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How to crowd source a RapidPlan model• Create a score card from superset dose constraints from popular
protocol
• Collect CT, structure, plan and dose from users who attempt to get the
highest score possible for their patient
• Use submitted cases to create RapidPlan model(s) and tune
automatically generated optimization objectives for max score• Optional: use RapidPlan created plans as training set cases for final
model
• Replan all submitted cases using final RapidPlan and a defined beam geometry (4arc Halcyon or TrueBeam)
• User’s plan that outscores the RapidPlan model by the largest margin wins
• Explain results and where to download final model
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The Protocol: RTOG1010 (esophagus)
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Scorecard: RTOG1010 superset to 50.4Gy
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Scorecard: closer look
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Scorecard: Many Nonlinear Score Functions 1
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Scorecard: Many Nonlinear Score Functions 2
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Scorecard: Many Nonlinear Score Functions 3
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Scorecard: Many Nonlinear Score Functions 4
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Scorecard: Many Nonlinear Score Functions 5
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What is RapidPlan?
A method for estimating DVHs which utilizes Machine Learning
Based on patient geometry
Previous knowledge contained in a set of existing patient cases
Optimization objectives that are agood starting point for the optimization
Based on the estimated DVH and plan prescription
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DVH Prediction and Optimization Objectives
DVH prediction is straightforward
• If you have consistently planned, high quality cases: simply eliminate
outliers.
• However, with very careful tuning of the auto-created optimization objectives, RapidPlan can create really high
quality plans—directly.
• One method (used here) to tune auto-created optimization objectives: the Scorecard
The priorities for auto-created Optimization Objectives are not
• Most people create a “good guess” set of auto-created optimization
objectives when they package a RapidPlan model for “a good starting
point”.
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Recursive Model creation also improves quality
• After creating the initial RapidPlan model
and guessing at an initial set of auto-
created optimizations objectives,
priorities will be modified and the process
will iterate.
• The single highest scoring plan from
each patient created by one of the initial
RapidPlan models, while tuning priorities,
can be used as the training set for a final
RapidPlan model.
• The result is a next generation RapidPlan
model created from plans created by an
initial RapidPlan model.
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RapidPlan Optimization Example
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Example: Esophagus clinical IMRT(45Gy)
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Example: Esophagus manual VMAT 4arc
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Example: Esophagus InitalRP1.0 VMAT 4arc
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Example: Esophagus InitalRP1.0a VMAT 4arc
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Example: Esophagus Score Cards
122.83 (manual) 133.66 (RPinital1.0) 134.64 (RPinital1.0a) […]
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Score spreadsheet: Training set for FinalRP
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Score spreadsheet: Final Result
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The winner and honorable mentions
Frank Simac (21st century Oncology)
• Beat the Final RapidPlan model by 11.34
points!
Honorable mentions:
• Nathan Wu (3.04 points)
• Justin Hayes (1.04 points)
• Thomas Costantino (.47 points)
Submitted noncoplanar plans (against the rules):
• Shaomin Zhang (3.41 points)
• Kirby DeLozier (2.13 points)
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RapidPlan vs winning plan (Dose)
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RapidPlan vs winning plan (Score)121.41 132.49
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Where to download the Esophagus Model
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Preferred location: Varian MarketPlace
Alternate location: Varian Medical Affairs
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Where get more informationOn this Esophagus RapidPlan model
• Clinical Description included with model
On creating RapidPlan models
• AAMD website Meetings>Archives>2016In the Knowledge Based Planning Era: The Role of the
Dosimetrist as a Predictive Model Creator/Administrator
Anthony Magliari, MS, CMD
On your submission and how it compares
• https://varian.proknow.com Browse>(new)Dose
On RapidPlan in general and much more
• www.myvarian.com
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Conclusion
Special Thanks:
Belinda Thibodaux(!), Lesley Rosa, Ben Nelms, Drew Bullock, Karen Kigin,
Theodore Hong, MD and Andy Su, MD
RapidPlan can perform as well or better than humans
• In this example, only four valid human planners were able to outperform the final
model.
• 39 cases in used in final Esophagus model
You can use a model you helped create in your clinic
• Take pride in knowing some of your knowledge is contained in this model which will
help patients all over the world get great esophagus plans with superior lung and
heart sparing.
©2019. VARIAN MEDICAL SYSTEMS, INC. For immediate recipient’s use only
©2019. VARIAN MEDICAL SYSTEMS, INC. For immediate recipient’s use only