IMRT Planning

[deleted4401]

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On my physics rotation and been thinking ...

Do most centers have in-house IMRT planning? I.e. do you give your dosimetrist/physicist a prescription/constraints and they hammer out a plan for you? And if that's the case, what time frame is a plan ready: if you give prostate contours/script to planning at 10am Monday, what time is beam on? Tuesday afternoon? Wednesday? Thursday?

Or, do most centers have a consultant/planning service that you electronically transmit images and a prescription to that do the planning and than transmit the fluence maps/MLCs back to your physics department. How long does a typical prostate plan take to be ready?

Is there a certain number of cases that you would need (i.e. IMRT plans per linac) to make it cost-effective to have an in-house physicist vs. sending the plans out?

If you have experience with both, any idea of costs/benefits of in-house vs. outside planning? Any idea of how much a typical plan costs if you send it out?

Thanks
S

 

[qwert]

As we are told, UPMC is pretty unique for an academic center in contracting the plans out. May have something to do with reimbursement part of the deal.

We do all IMRT in-house. There is at least 2 physicists on site at all times, and all dosimetrists are trained in IMRT. It usually takes a week b/n sim and beam-on. In urgent cases, we can do it in 48 hours.

On my physics rotation and been thinking ...

Do most centers have in-house IMRT planning? I.e. do you give your dosimetrist/physicist a prescription/constraints and they hammer out a plan for you? And if that's the case, what time frame is a plan ready: if you give prostate contours/script to planning at 10am Monday, what time is beam on? Tuesday afternoon? Wednesday? Thursday?

Or, do most centers have a consultant/planning service that you electronically transmit images and a prescription to that do the planning and than transmit the fluence maps/MLCs back to your physics department. How long does a typical prostate plan take to be ready?

Is there a certain number of cases that you would need (i.e. IMRT plans per linac) to make it cost-effective to have an in-house physicist vs. sending the plans out?

If you have experience with both, any idea of costs/benefits of in-house vs. outside planning? Any idea of how much a typical plan costs if you send it out?

Thanks
S

 

[Gfunk6]

We do all of our IMRT planning in house. We have a dosimetrist who specializes in IMRT planning for H&N, one for GU/GYN, one for GI, and one who does most everything. We also have several physicists dedicated to IMRT research/oversight.

Planners generally ask for a minimum of 48 hours from approved volumes to plan. However, we frequently push this envelope to 24 hours or less.

Before you told me Simul, I had no idea that academic centers contracted their plans out. As you say there must be a significant cost-benefit.

 

[deleted4401]

I actually don't know a whole lot yet about the economics of it, but I'm trying to learn. Our center (and all 25 satellites) "contracts out". I say that in quotes because the entity that does our IMRT planning is a physics company that happens to be a for-profit UPMC venture. I don't know how exactly how these partnerships work. This company also does work for other centers that don't have in-house IMRT planning, but those clinics have nothing to do with UPMC.

Anyone else with any knowledge?

S

 

[IndyXRT]

We do all of our IMRT planning on site. It is done almost exclusively by dosimetrists (although sometimes staff or residents will work on optimizing a tough plan, since it's easier when you can play with the constraints in real time). We usually allow one week between simulation and start time, but can accomplish it in 48-72 hours if need be. The hold up is often the QA, though, not the planning.

 

[xraydude]

I'd say most people do in house - we have 6 physicists and 8 dosi, and plans can be ready as fast as needed. Depends on urgency on the case, and the complexity - ie are you talking head and neck or prostate. Prostates take no time to plan, are pretty standard, and take minimal review. Head and neck can be multiple iterations till I like the plan.

I think the places using an outside service are those that are less experienced with IMRT - the goal of D3 is to provide services until the center can do it on their own.

Financially, it makes no sense to send the work out, unless you don't know how to do it. You need your dosi and physics anyway for 2D, 3D, machine calibration etc, so it's not like they are already there.

 

[qwert]

What do you guys do if you don't like the plan?

I actually don't know a whole lot yet about the economics of it, but I'm trying to learn. Our center (and all 25 satellites) "contracts out". I say that in quotes because the entity that does our IMRT planning is a physics company that happens to be a for-profit UPMC venture. I don't know how exactly how these partnerships work. This company also does work for other centers that don't have in-house IMRT planning, but those clinics have nothing to do with UPMC.

Anyone else with any knowledge?

S

 

[deleted4401]

We are allowed to send it back.
You have to put in constraints and they aim to meet them.
As far as I know, they do good work, but I haven't worked anywhere else.

S