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Atlas-based machine learning (ML) for radiation therapy (RT) treatment planning is effective at tailoring dose distributions to account for unique patient anatomies by selecting the most appropriate patients from the training database (atlases) to inform dose prediction for new patients. However, variations in clinical practice between the training dataset and a new patient to be planned may impact ML performance by confounding atlas selection. In this study, we simulated various contouring practices in prostate cancer RT to investigate the impact of changing input data on atlas-based ML treatment planning. We generated 225 ML plans for nine bespoke contouring protocol scenarios (reduced target margins, modified organ-at-risk (OAR) definitions, and inclusion of optional OARs less represented in the training database) on 25 patient datasets by applying a single, previously trained and validated ML model for prostate cancer followed by dose mimicking to create a final deliverable plan. ML treatment plans for each scenario were compared to base ML treatment plans that followed a contouring protocol consistent with the model training data. ML performance was evaluated based on atlas distance metrics that are calculated during ML dose prediction. There were significant changes between atlases selected for the base ML treatment plans and treatment plans when planning target volume margins were reduced and/or optional OARs were included. The deliverability of ML predicted dose distributions based on gamma analysis between predicted and mimicked final deliverable dose showed significant differences for seven out of eight scenarios compared with the base ML treatment plans. Overall, there were small but statistically significant dosimetric changes in predicted and mimicked dose with addition of optional OAR contours. This work presents a framework for benchmarking and performance monitoring of ML treatment planning algorithms in the context of evolving clinical practices.

Performance stability evaluation of atlas-based machine learning radiation therapy treatment planning in prostate cancer