IntuitivePlan inverse planning performance evaluation for Gamma Knife radiosurgery of AVMs

Purpose To compare planning indices achieved using manual and inverse planning approaches for Gamma Knife radiosurgery of arterio-venous malformations (AVMs). Methods and materials For a series of consecutive AVM patients, treatment plans were manually created by expert planners using Leksell GammaPlan (LGP). Patients were re-planned using a new commercially released inverse planning system, IntuitivePlan. Plan quality metrics were calculated for both groups of plans and compared. Results Overall, IntuitivePlan created treatment plans of similar quality to expert planners. For some plan quality metrics statistically significant higher scores were achieved for the inversely generated plans (Coverage 96.8% vs 96.3%,P = 0.027; PCI 0.855 vs 0.824,P = 0.042), but others did not show statistically significant differences (Selectivity 0.884 vs 0.856,P = 0.071; GI 2.85 vs 2.76,P = 0.096; Efficiency Index 47.0% vs 48.1%,P = 0.242; Normal Brain V-12(cc) 5.81 vs 5.79,P = 0.497). Automatic inverse planning demonstrated significantly shorter planning times over manual planning (3.79 vs 11.58 min,P < 10(-6)) and greater numbers of isocentres (40.4 vs 10.8,P < 10(-6)), with an associated cost of longer treatment times (57.97 vs 49.52 min,P = 0.009). When planning and treatment time were combined, there was no significant difference in the overall time between the two methods (61.76 vs 61.10,P = 0.433). Conclusions IntuitivePlan can offer savings on the labor of treatment planning. In many cases, it achieves higher quality indices than those achieved by an "expert planner".