 I'm Nicola Lambre from Humanitas Research Hospital. I'm going to present you our paper published on the Journal of Applied Clinical Medical Physics, titled Evaluation of Plant Complexity and Dosimetric Plant Quality of Total Marrow and Lymphoid Irradiation using Volumetric Modulated Arc Therapy. Total Marrow and Lymphoid Irradiation, TMLI, is a radiotherapy technique used for patients who underwent hematopoietic cell transplantation in acute leukemia. TMLI allows to irradiate hematopoietic tissue in a more targeted form compared to standard TBI, because it allows to spare also the organs at risk. At our institute since 2010, we are treating TMLI patients by means of volumetric modulated arc therapy, VIMAT, and this study is part of the AUTOMI project, whose aim is to automate the TMLI workflow and also provide guidance to centers which are going to introduce this technique in their clinic. In this study, we investigated the impact of the planner experience and the treatment planning system algorithm version on the TMLI plan optimization and plant quality using 82 retrospective TMLI plans delivered at our institute. For these plans, we evaluated the complexity matrix and those statistics, in particular the D2% to the PTV and the MINDOS to the organs at risk. The results were stratified based on the optimization algorithm used in the clinic. In this slide you can see the scatter plots of the three complexity metrics that we evaluated for each plan plotted against the plan date and the colors represent the three phases which underwet into the clinic. We found a significant decrease in plan complexity when moving from PRO3 to the PO algorithm and also moderate correlations with time were found for all three indices within the PRO3 phase, indicating a reduction in plan complexity which could be due to the planner's experience only. In this table, I reported the those statistics for the PTV and the organs at risk with values shown as percentage of the dose prescription. We found a significant difference between the PRO3 and PO phases only for the MINDOS to the right kidney. Whereas between the PO and RP plus PO phases, we found that the D2% to the PTV increased while the MINDOS to the brain right kidney and bowel significantly decreased. To investigate for potential correlations between the complexity matrix and the patient specific quality assurance results, we performed on 11 representative plans, i.e. 110 fields, patient specific QA at 3% 2 mm with 97% tolerance and we found an average gamma passing rate of 98 plus minus 2% with 80% of the beam passing the tests. For more, we found that the gamma passing rate was strongly or moderately correlated to the analyzed complexity matrix. In conclusion, TMLI plans are among the most complex plans in our clinic. The plan complexity depends on the planner's experience and the optimization algorithm. We have found a significant reduction in the plan complexity over the years while keeping a similar or even improved osometric plan quality. Furthermore, the plan complexity could provide a measure to decide whether a new TMLI plan should undergo a procurement QA. You can find more information about this paper on the journal website or you can contact me to this email. Thank you for your attention.