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Lauren Brandl, Marc Anderson, Renee Jackson

DOS 711: Research Methodology in Medical Dosimetry I

05/01/2019

Research Proposal

Title: Survey of implementation and satisfaction with RapidPlan™ knowledge-based planning

software in the clinical setting.

Problem Statement: RapidPlan™ is a newly emerging knowledge-based planning system that

has caught the attention of the radiation oncology community. However, there are some
departments with access to this technology that are not utilizing the program. Currently, there is
little information known about the adoption and usage levels of RapidPlan™ in radiation
oncology departments despite multiple publications demonstrating its efficiency and
capabilities.1,2

Literature Review: RapidPlan™ is a knowledge-based planning system produced by Varian

Medical Systems Inc. that provides clinicians with models based on clinical practices from
leading institutions. This program was released in 2015 with the goal to provide consistent,
efficient, and higher quality plans for individualized treatment plans with less variability.
RapidPlan™ applies its knowledge by looking at the data set of a new patient’s anatomy and
compares the geometric proportions to those from the model it has already learned from. By
reviewing the dose distributions of past plans with similar anatomy, the software is able to
predict a reasonable dose volume histogram (DVH) for nearby critical structures. The predictions
are then used to develop an Intensity-modulated radiation therapy (IMRT) or volumetric
modulated arc therapy (VMAT) plan.3

Previous studies have been conducted to determine if Knowledge-based Planning (KBP)

systems such as RapidPlan™ are viable options. For example, Hussein et al1 reported
RapidPlan™ was able to produce comparable or better conformity IMRT & VMAT treatment
plans in the pelvis than the original clinically accepted plans, in one optimization. They
concluded the system offered better consistency and efficiency in the treatment planning
process.1 In another example, Kaderka2 reports the KBP system proved to be noninferior
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compared to manual planning. They also demonstrated better dose constraints on multiple organs
at risk (OAR).

A survey of IMRT used in the United States was conducted by Loren Mell, John Roeske
and Arno Mundt.4 Their goal was to assess the current level of IMRT usage in 2003, not long
after the release of IMRT technology. Similar to our pursuit, the purpose of their survey was also
to gauge adoption of a new technology amongst radiation oncology departments as well as
expected usage going forward. Mell, Roeske, and Mundt emphasized in their conclusion the
importance of safe and appropriate implementation of new technology in the world of treatment
planning.4

Plan efficiency is continually discussed when looking at turnover rate from a patient CT
simulation to their treatment start date. KBP has had a huge impact on dosimetrist’s
performance. Reducing planning time has allowed the ability to extend the capabilities of each
dosimetrist. Artificial intelligence in healthcare can greatly improve quality of care if used
correctly. Improved decision making and reducing the knowledge gap between experts and non-
experts is extremely important to ensure the best patient care.5

Hypothesis: In this study, we believe that a majority of the clinics that have RapidPlan™
licenses and software are utilizing this technology. We hypothesize that the clinics utilizing the
RapidPlan™ program are satisfied with its performance in their clinic, with the speed of plan
generation being the most advantageous feature of RapidPlanTM. We also hypothesize
“Insufficient time to learn and adapt new technology” will be the most common answer as to
why departments with access are not using RapidPlanTM.

Materials and Methods: We plan to create an 11-question survey using the survey tool,
Qualtrics, to assess the implementation of and satisfaction with RapidPlan™ automated planning
system. We are currently in contact with Varian in search of contact information for clinics with
RapidPlan™ software and licenses. The goal of our study is to contact these facilities to
determine their satisfaction with the program and usage level. Specifically, we will question the
departments not using RapidPlan™ on their rationale behind not implementing the program into
their department. For departments currently using RapidPlan™ we would like to know their
constructive criticism of the software and what they find to be the most advantageous features.
We will also question these facilities on their expected usage of RapidPlan™ going forward.
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Data analysis will then be performed to give greater understanding of perceived adequacy and
adoption.

Below are screen captures of proposed survey questions. We expect the survey to take no longer
than 5 minutes. Here is also a link to the survey if preferred.

https://uwlax.ca1.qualtrics.com/jfe/form/SV_cOaH8GFNdoJp8EJ?fbclid=IwAR2MKhQbw461T
yUnEvRv_U9lHb9QpNRD5Mhe6f3VAlHf836HvHMKe6inefY
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References

1. Hussein M, South C, Barry M, et al. Clinical validation and benchmarking of knowledge-

based IMRT and VMAT treatment planning in pelvic anatomy. Radiation Therapy and
Oncology. 2016;120(3):473-479. https://doi.org/10.1016/j.radonc.2016.06.022
2. Kaderka R, Mundt R, Li N, Automated Closed- and Open-Loop Validation of
Knowledge-Based Planning Routines Across Multiple Disease Sites. 2019;
https://doi.org/10.1016/j.prro.2019.02.010
3. RapidPlan Knowledge Based Planning Software Varian Medical Systems
https://www.varian.com/oncology/products/software/treatment-planning/rapidplan-
knowledge-based-planning Accessed April 20, 2019
4. Mell L, Roeske J, Mundt A. A survey of intensity modulated radiation therapy in the
United States. Cancer. 2003;98(1):204-211 https://doi.org/10.1002/cncr.11489
5. Thompson R, Valdes G, Fuller C et al. Artificial intelligence in Radiation Oncology: A
specialty-wide disruptive transformation? Radiation Therapy and Oncology.
2018;129(3):421-426. doi:10.1016/j.radonc.2018.05.030