Inter-planner Variability in Expert Driven Pareto-guided Automated Planning Solutions

An intra-planner study has been carried out to compare planning choices among qualified professionals when utilising Pareto-guided automated planning (PGAP) navigation. PGAP was used to calibrate planning goal weights of a protocol-based automatic iterative optimisation automated planning system. Four qualified professionals (Participant A-D) navigated solutions for eight prostate seminal vesicle (PSV) patient cases using PGAP. Plans were based on an existing clinically approved planning protocol containing seven planning goals (PGs). Three PG weights were navigated per plan (rectum Dmean, bladder Dmean and PTV conformality) with all other weights held constant at a value assigned in the original clinically approved protocol. Statistically significant differences were observed between participants for all PG groups except bladder Dmean. However, dosimetrically the PGAP system mitigated the majority of discrepancies in deviations at the calibration stage with few statistically significant dose-volume metric differences observed, none of which were clinically significant.