{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T19:35:54Z","timestamp":1775849754794,"version":"3.50.1"},"reference-count":19,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,2,24]],"date-time":"2023-02-24T00:00:00Z","timestamp":1677196800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>There has been much research interest in automated head\u2010and\u2010neck (HN) planning with the goal of reducing planning time and inter\u2010planner variability while improving plan quality. However, clinical uses are still limited and institution\u2010dependent due to the plan complexity. This work aims to investigate whether the use of a novel semi\u2010automated two\u2010step optimization method (TSP) can improve the quality and efficiency of planning while providing a simple framework that other institutions can follow.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and materials<\/jats:title><jats:p>Forty patients (two and three prescription isodose levels) were retrospectively studied. Plans were generated by TSP which incorporates a knowledge\u2010based planning solution. Comparisons were performed for plan conformity and selected dose\u2010volume indices between clinical plan (CP) and TSP. Blind reviews were carried out by 15 clinicians to determine preference between the CP and TSP, as well as clinical suitability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For majority of patients studied, TSP had similar or slightly better conformity for the high\u2010dose PTV, and better conformity for the low\u2010dose PTV and 45\u00a0Gy isodose lines compared to CP. The only statistically significant difference observed for the serial organs was a reduction of the spinal cord maximum dose with TSP. Except for left parotid gland (<jats:italic>D<\/jats:italic><jats:sub>mean<\/jats:sub> and <jats:italic>V<\/jats:italic><jats:sub>30<\/jats:sub> for both 2R\u00d7 and 3R\u00d7 groups) and oral cavity (<jats:italic>D<\/jats:italic><jats:sub>mean<\/jats:sub> for 3R\u00d7 group), TSP had significant dose reductions for all parallel organs compared to CP. Blind reviewers either showed preference\/no preference for 57.2%\/21.7% (2R\u00d7) and 57.5%\/27.8% (3R\u00d7) of TSP compared with CP. Excluding no preference votes, 60% of TSP were preferred. TSP was selected majority of the time when looking at the vote distribution for each patient individually.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our TSP allows plans to be created within 90\u2010min time frame while offering improvements in plan quality and less inter\u2010planner variability as compared to traditional planning techniques.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.13939","type":"journal-article","created":{"date-parts":[[2023,2,24]],"date-time":"2023-02-24T16:41:14Z","timestamp":1677256874000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A two\u2010step treatment planning strategy incorporating knowledge\u2010based planning for head\u2010and\u2010neck radiotherapy"],"prefix":"10.1002","volume":"24","author":[{"given":"Han","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Cone Health Cancer Center  Greensboro North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Sintay","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Cone Health Cancer Center  Greensboro North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Wiant","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Cone Health Cancer Center  Greensboro North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,2,24]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.20378"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2014.12.045"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/40\/9\/004"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/56\/5\/R01"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748\u2010717X\u20108\u201026"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748\u2010717X\u20106\u201020"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2008.12.008"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2010.07.269"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2009.04.011"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2009.07.1754"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2011.11.012"},{"key":"e_1_2_9_13_1","unstructured":"Frontiers | Variations in head and neck treatment plan quality assessment among radiation oncologists and medical physicists in a single radiotherapy department | Oncology. 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