Enhancing SABR Workflow Efficiency with Automated VMAT Planning: Operational Impact of Tpas for Liver and Spine Sarb Treatments
Abstract
Purpose
Stereotactic Ablative Radiotherapy (SABR) requires highly complex treatment planning, often consuming many hours of manual effort. The Treatment Planning Automation System (TPAS) was developed to improve efficiency and reduce planner workload while maintaining or improving plan quality. This study demonstrates the impact of TPAS on SABR planning efficiency and quality across two distinct disease sites.
Methods
Fourteen liver SABR and twenty spine SABR cases were replanned using TPAS. Estimated manual planning times were compared with actual TPAS planning times, including preparation, optimization, and dose calculation. Plan quality was independently reviewed by Radiation Oncologists (ROs) in blinded comparisons, focusing on organ-at-risk sparing, PTV coverage, and overall preference.
Results
In all 34 cases, TPAS plans were unanimously preferred by reviewing ROs over manual plans, confirming that efficiency gains did not compromise quality. TPAS improved average PTV coverage (V100%) from 84.7 ± 15.0% to 90.9 ± 7.2% for spine plans and from 81.98 ± 16.29% to 90.1 ± 9.2% for liver SABR, with all individual TPAS plans showing increased coverage. TPAS reduced estimated planning times from ~3 hours to ~40 minutes for liver SABR, and from on average 8 to 14 hours to ~1 hour for spine SABR. Manual times were based on typical clinical experience.
Conclusion
TPAS substantially reduces SABR planning time while generating clinically superior treatment plans. This efficiency gain can reduce dosimetry workload, shorten patient wait times, and support broader clinical adoption of automated planning. These results demonstrate that TPAS has been successfully integrated into routine SABR workflows, contributing to improved resource utilization and enhanced patient care.