Performance assessment of a new optimization system for robotic SBRT MLC-based plans

PurposeTo assess the performance of a new optimization system, VOLO, for CyberKnife MLC-based SBRT plans in comparison with the existing Sequential optimizer.MethodsMLC-plans were created for 25 SBRT cases (liver, prostate, pancreas and spine) using both VOLO and Sequential. Monitor units (MU), delivery time (DT), PTV coverage, conformity (nCI), dose gradient (R50%) and OAR doses were used for comparison and combined to obtain a mathematical score (MS) of plan quality for each solution. MS strength was validated by changing parameter weights and by a blinded clinical plan evaluation. The optimization times (OT) and the average segment areas (SA) were also compared.ResultsVOLO solutions offered significantly lower mean DT (−19%) and MU (−13%). OT were below 15 min for VOLO, whereas for Sequential, values spanned from 8 to 160 min. SAs were significantly larger for VOLO: on average 10 cm² versus 7 cm². VOLO optimized plans achieved a higher MS than Sequential for all tested parameter combinations. PTV coverage and OAR sparing were comparable for both groups of solutions. Although slight differences in R50% and nCI were found, the parameters most affecting MS were MU and DT. VOLO solutions were selected in 80% of cases by both physicians with 88% inter-observer agreement.ConclusionsThe good performance of the VOLO optimization system, together with the large reduction in OT, make it a useful tool to improve the efficiency of CK SBRT planning and delivery. The proposed methodology for comparing different planning solutions can be applied in other contexts.     

An Application of Renewal Theory to Contraceptive Follow-up Studies,Exemplified by an Intrauterine Device Study

Contraceptive practice consists of a series of recurrent events of use and nonuse. Application of the life table technique for analysis of multiple-segment contraceptive usage is not entirely satisfactory. In this paper the renewal process approach is applied to the results of contraceptive follow-up studies involving all segments of use. By means of this model, it is possible to estimate the proportion of current users, the average duration of actual use, and the average number of segments used by the acceptors. The practical importance of these parameters for the evaluation of family planning programs is considered.