ProKnow DS is an excellent tool to help an organization design standardized treatment plan studies that can be used to measure the quality and quantify the variation of treatment plans across multiple institutions, treatment planners, and delivery modalities. The goal can be to either build a private plan study library (available to your organization only) or create a public plan study (available to the international user base for research and/or in conjunction with scientific meetings) that will be deployed using ProKnow's quality system for treatment planning.
This article will help you get started by describing the basic steps of how to design a plan study using ProKnow DS.
Note Regarding Your ProKnow DS Domain
If you are a ProKnow DS customer, you will already have a secure, private domain.
If you are not yet a ProKnow DS customer but you are building a plan study for a sanctioned workshop, meeting, or study, then you will be provided details about (and access to) a sub-domain dedicated for your specific project.
In order to upload patient data, create and edit patient plan scorecards, etc., you will need to (1) be defined as a user for a ProKnow DS domain and (2) have a base level of permissions necessary to upload DICOM data and create and edit patient scorecards. If you are not yet a user of a domain, or if you find that your permissions are not sufficient, then contact your ProKnow administrator and have him/her configure your user account and set adequate permissions.
Designing a Plan Study
Below are the basic steps to start designing a treatment plan quality study.
Navigate your supported browser to your assigned ProKnow DS domain and log in. See Tutorial: Logging In for the First Time and Beyond for help.
CREATE NEW PATIENT
(Note: If the patient is already created, you can simply select it and proceed with remaining steps.)
Select the Patients module from the main navigation on the left.
From the workspace drop-down list in the upper left, select the applicable workspace where you store (or aim to store) the patient data used for designing plan studies.
Create a new patient dataset with the ID, name, etc. that you desire.
UPLOAD PATIENT IMAGES
If you have not done so already, upload the axial patient images directly to this patient.
Typically, the required image set is comprised of the CT planning images. However, you can also use an axial MR image set, or a combination of registered, multi-modality images (e.g., CT and MR).
Important Anonymization Note
These patient images will ultimately be available via download to those participating in the plan study, so be sure to fully anonymize the DICOM files to remove any sensitive information. Edit, but do not remove, required tags (e.g., patient ID and name). You may clear non-essential tags (i.e., referring physician, institution, etc.).
UPLOAD OR CREATE ANATOMY CONTOURS
If you have already contoured all necessary targets and critical structures using another software system (e.g., your TPS), then you can upload a DICOM RT structure set directly to this patient. If you use this method, be sure to anonymize the RT structure set together with the axial images in order to preserve critical DICOM links.
As an alternative, you can create a new structure set for this patient and use the integrated contouring tools to define all targets and critical structures.
REVIEW AND FINALIZE ANATOMY CONTOURS
Remember that this dataset will be eventually distributed to all plan study participants, so be sure to review all the anatomical structures for accuracy, names, and display colors.
For more information on how to edit labels, colors, and/or contours and how to save the contours as a new version of the structure set, visit the Editing Structures article.
UPLOAD AN EXAMPLE TREATMENT PLAN & DOSE
Before you start drafting a scorecard (i.e., metrics and per-metric objectives), you will want to upload at least one DICOM RT and RT Dose to serve as an example as you build out the scorecard.
After uploading to the test patient, you may need to manually re-associate the RT plan and dose to be under the RT structure set.
Select the plan/dose for the patient. On the Browse tab for the patient, make sure the entire images-structures-plan-dose branch is selected. You can do this by double-clicking the dose entity.
(OPTIONAL) CUSTOMIZE DISPLAY
If desired, normalize the dose display to the desired prescription dose and customize the dose display.
Though it will not affect the plan scorecard or any metrics, you may wish to set the 100% display dose to be the highest prescription dose (Gy). Go to the Dose tab, where you can set the display normalization dose and dose display preferences.
DESIGN THE PLAN SCORECARD (PART 1): METRICS & OBJECTIVES
Start drafting the patient plan scorecard.
Go to the Scorecards tab for the test patient.
Create a new scorecard if none exists. Note: It's helpful to assign a scorecard name that summarizes the prescription and fraction scheme, e.g., "50 Gy in 25 fractions."
Edit the scorecard by defining metrics and creating per-metric objectives. Note: It is advantageous to create multi-level (i.e., not simply pass-fail) objectives, which will make the eventual building of the plan scoring algorithm much easier.
When you have a comprehensive set of metrics and objectives drafted, then take a moment to re-order the metric list to be most intuitive for the eventual user. Re-ordering is possible when in scorecard edit mode. For example, you may wish to have all target coverage metrics first and in priority order, followed by organ-at-risk metrics in order of organ and/or metric priority.
Save your scorecard progress before you either log off each session or exit the patient module.
DESIGN THE PLAN SCORECARD (PART 2): SCORES & WEIGHTS
A ProKnow plan study will feature online plan scoring where absolute performance scores are computed for each metric and summed for an overall score, as originally defined in this publication in Practical Radiation Oncology and as first commercialized in the PlanIQ software.
Therefore, once you have your metrics and objectives defined (as per prior step), your final step will be to assign score functions based on your objectives. The score function encode how -- and how many -- points are awarded based on each plan's performance level for that metric. The composite of all the score functions makes up the plan scoring algorithm. For details on how to build and test your plan scoring algorithm, please contact ProKnow, and you will be sent further instructions. (Note: To expedite response, you may simply request, "Send me further info on how to build my metric score functions.")
(OPTIONAL) TEST OTHER SAMPLE PLANS
If desired, you can upload and associate one or more other RT Plan/RT Dose pairs to the same patient.
If you have permissions to save a scorecard as an organization scorecard template, then save it and then create a new scorecard from that template for the new dose.
If you do not have permission to create an organization scorecard template, you can download any patient scorecard as a file, then create a new scorecard (e.g., for another dose for that patient, or for another patient altogether) by uploading from that saved file.
Publish the Plan Study
Contact ProKnow by emailing firstname.lastname@example.org when you are ready to convert the ProKnow DS scorecard into a PlanIQ plan scoring algorithm to be used by the ProKnow online plan study program.
This is usually accomplished with an interactive web meeting during which objectives are converted to numeric scoring functions and all metrics are prioritized (assigned weights) based on relative importance to plan quality.