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With many variables to adjust, conventional manual forward planning for GammaKnife (GK) radiosurgery is very complicated and cumbersome. The resulting planquality heavily depends on planners skills, experiences and devoted efforts,and varies significantly among cases, planners, and institutions. Qualitycontrol for GK planning is desired to consistently provide high-quality plan toeach patient. In this study, we proposed a quality control method for GKplanning by building a database of high-quality GK plans. Patient anatomy wasdescribed by target volume, target shape complexity, and spatial relationshipbetween target and nearby organs, which determine GK planning difficulty level.Plan quality was evaluated using target coverage, selectivity, intermediatedose spillage, maximum dose to 0.1 cc of brainstem, mean dose of ipsilateralcochlea, and beam-on time. When a new plan is created, a high-quality plan thathas the most similar target volume size and shape complexity will be identifiedfrom the database. A model has also been built to predict the dose to brainstemand cochlea based on their overlap volume histograms. The identified referenceplan and the predicted organ dose will help planners to make quality controldecisions accordingly. To validate this method, we have built a database forvestibular schwannoma, which are considered to be challenging for GK planningdue to the irregularly-shaped target and its proximity to brainstem andcochlea. Five cases were tested, among which one case was considered to be ofhigh quality and four cases had a lower plan quality than prediction. Thesefour cases were replanned and got substantially improved. Our results havedemonstrated the efficacy of our proposed quality control method. This methodmay also be used as a plan quality prediction method to facilitate thedevelopment of automatic treatment planning for GK radiosurgery.

A plan quality control method of treatment planning for Gamma Knife radiosurgery