Journal of Radiation Oncology

, Volume 8, Issue 2, pp 233–238 | Cite as

Quantitative assessment of the efficacy of two different treatment plan optimization algorithms in treating tumors in locations of high heterogeneity

  • E. Ishmael ParsaiEmail author
  • Vincent Ulizio
  • Jacob M. Eckstein
  • Krishna Reddy
Original Research



The purpose of this study is to evaluate the differences in treatment optimization algorithms in two leading treatment planning systems, Pinnacle v9.8 (Philips Healthcare, Amsterdam, Netherlands) and Raystation 8A (Raysearch Americas Inc., Garden City, USA). The aim is to compare and contrast between planning systems in terms of sparing of vital organs (SVO) using several gradient and conformity indices, as well as vital organ dose limits.


The study includes patients (N = 18) presenting with lung (10), liver (4), and head and neck (4) tumors and treated with intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) planned using the same objectives and weights, number of iterations, beam angles, and planning target volume (PTV) coverage. Both plans were analyzed for Radiation Therapy Oncology Group (RTOG) conformity index, Paddick conformity index, gradient index (GI), dose gradient index, and sparing of vital organs. This study utilized both segmented and dynamic approaches to multileaf collimation (SMLC and DMLC, respectively) in the Raystation planning system in lung IMRT plans, as some plans could not be optimized in Raystation with SMLC (7).


It was determined that in lung plans, Pinnacle demonstrated better sparing of the right lung and the spinal cord, but Raystation more effectively spared the heart and esophagus. In liver plans, Raystation demonstrated a superior GI, indicating faster dose falloff; this correlated with lower volumes of the liver receiving 24 Gy. In head and neck (H&N) plans, Pinnacle demonstrated superior sparing of the parotid but inferior GI, indicating more rapid dose falloff in Raystation beyond the PTV.


The analysis for the lung, liver, and H&N cases indicated that both planning systems are equivocal for the majority of parameters measured, with a few differentiating trends. In H&N plans, Pinnacle showed improved parotid sparing but inferior performance in calculated GI values. Liver plans showed superiority of Raystation in GI computations, but the most notable differences were in the lung plans where Pinnacle spared the spinal cord significantly more in contrast to Raystation’s performance but also delivered significantly more dose to the esophagus.


Treatment planning system TPS Dosimetry Conformity 



Paddick conformity index


RTOG conformity index


conformation number


central nervous system


computed tomography


clinical target volume


isodose line


dose gradient index


dose-volume histogram


dynamic multileaf collimator


gradient index


gross tumor volume


intensity modulated radiation therapy


left lung


left parotid


multileaf collimator


organ at risk


prescription isodose


prescription isodose volume


volume of the 50% prescription isodose


planning target volume


effective radius of the 50% prescription isodose


effective radius of the prescription isodose


right lung


right parotid


region of interest


Radiation Therapy Oncology Group


segmented multileaf collimator


stereotactic radiosurgery


sparing of vital organs


treatment planning system


target volume, defined as the PTV for this study


volume of prescription isodose located within the target volume


volume of organ at risk


Compliance with ethical standards


No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Statement of informed consent was not applicable since the manuscript does not contain any patient data.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiation OncologyUniversity of Toledo Medical CenterToledoUSA

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