A dose-volume histogram based decision-support system for dosimetric comparison of radiotherapy treatment plans.
A dose-volume histogram based decision-support system for dosimetric comparison of radiotherapy treatment plans.
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DOI：
10.1186/s13014-015-0569-3
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发表时间：
2015-12-29
期刊：
影响因子：
--
通讯作者：
Núñez L
中科院分区：
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作者：
Alfonso JC;Herrero MA;Núñez L
任何放射治疗方案的选择通常是在对不同光束配置获得的几个初步等剂量分布进行评估后做出的。尽管规划技术取得了相当大的进步，但这种最后决定仍然是一项具有挑战性的任务，它将大大受益于有效和可靠的评估工具。对于所考虑的任何剂量计计划，治疗计划系统提供的剂量-体积直方图数据用于估计计划目标覆盖范围以及保留危险器官和剩余健康组织。然后将这些部分指标组合成剂量分布指数（DDI），为每个相互竞争的放疗计划提供统一的、易于阅读的评分。为了评估所提出的评分系统的性能，对50例脑癌患者的DDI数据进行了回顾性评估。根据肿瘤部位和恶性程度将患者分为三组。对于每个患者，设计三个暂定方案并在计划期间记录，最终选择其中一个进行治疗。因此，我们能够比较DDI得分较高的计划和实际交付的计划。当计划目标覆盖和保留危险器官被认为同样重要时，具有最高DDI评分的暂定计划显示与所考虑的50例患者中的32例实际交付的计划一致。在剩下的18例中，有15例（分别为3例）的DDI值最高的计划仍然与实际选择的计划一致，前提是保留风险器官的优先级高于目标覆盖（分别为低优先级）。DDI为初步放疗计划的剂量学比较提供了一种直接和非主观的工具。特别是，DDI很容易量化具有相似外观的剂量-体积直方图的竞争方案之间的差异，并且可以很容易地对任何肿瘤类型和定位实施，而不考虑所考虑的计划系统和照射技术。此外，DDI允许估计为保护处于危险中的器官或更好地覆盖目标而分配的不同优先事项对剂量学的影响。
The choice of any radiotherapy treatment plan is usually made after the evaluation of a few preliminary isodose distributions obtained from different beam configurations. Despite considerable advances in planning techniques, such final decision remains a challenging task that would greatly benefit from efficient and reliable assessment tools. For any dosimetric plan considered, data on dose-volume histograms supplied by treatment planning systems are used to provide estimates on planning target coverage as well as on sparing of organs at risk and the remaining healthy tissue. These partial metrics are then combined into a dose distribution index (DDI), which provides a unified, easy-to-read score for each competing radiotherapy plan. To assess the performance of the proposed scoring system, DDI figures for fifty brain cancer patients were retrospectively evaluated. Patients were divided in three groups depending on tumor location and malignancy. For each patient, three tentative plans were designed and recorded during planning, one of which was eventually selected for treatment. We thus were able to compare the plans with better DDI scores and those actually delivered. When planning target coverage and organs at risk sparing are considered as equally important, the tentative plan with the highest DDI score is shown to coincide with that actually delivered in 32 of the 50 patients considered. In 15 (respectively 3) of the remaining 18 cases, the plan with highest DDI value still coincides with that actually selected, provided that organs at risk sparing is given higher priority (respectively, lower priority) than target coverage. DDI provides a straightforward and non-subjective tool for dosimetric comparison of tentative radiotherapy plans. In particular, DDI readily quantifies differences among competing plans with similar-looking dose-volume histograms and can be easily implemented for any tumor type and localization, irrespective of the planning system and irradiation technique considered. Moreover, DDI permits to estimate the dosimetry impact of different priorities being assigned to sparing of organs at risk or to better target coverage.