title: Tissue heterogeneity effects in treatment plan optimization.
abstract: OBJECTIVE
  There is general agreement that tissue density correction factors improve the accuracy of dose calculations. However, there is disagreement over the proper heterogeneity correction algorithm and a lack of clinical experience in using them. Therefore, there has not been widespread implementation of density correction factors into clinical practice. Furthermore, the introduction of optimized conformal therapy leads to new and radically different treatment techniques outside the clinical experience of the physician. It is essential that the effects of tissue density corrections are understood so that these types of treatments can be safely delivered.
  
  
  METHODS
  In this paper, we investigate the effect of tissue density corrections on optimized conformal type treatment planning in the thorax region. Specifically, we study the effects on treatment plans optimized without type treatment planning in the thorax region. Specifically, we study the effects on treatment plans optimized without tissue density corrections, when those corrections are applied to the resulting dose distributions. These effects are compared for two different conformal techniques.
  
  
  RESULTS
  This study indicates that failure to include tissue density correction factors results in an increased dose of approximately 5-15%. This is consistent with published studies using conventional treatment techniques. Additionally, the high-dose region of the dose distribution expands laterally into the uninvolved lung and other normal structures. The use of dose-volume histograms to compare these distributions demonstrates that treatment plans optimized without tissue density corrections lead to an increased dose to uninvolved normal structures. This increase in dose often violates the constraints used to determine the optimal solution.
  
  
  CONCLUSIONS
  The neglect of tissue density correction factors can result in a 5-15% increase in the delivered dose. In addition, suboptimal dose distributions are produced. To benefit from the advantages of optimized conformal therapy in the thorax, tissue density correction factors should be used.
authors.affiliation: University of Texas Medical Branch, Galveston 77550.
authors.forename: S M
authors.initials: SM
authors.lastname: Morrill
authors.forename: M L
authors.initials: ML
authors.lastname: Langer
authors.forename: R G
authors.initials: RG
authors.lastname: Lane
authors.forename: I I
authors.initials: II
authors.lastname: Rosen
mesh_terms: D002277:Carcinoma / Q000532:radiotherapy; D004938:Esophageal Neoplasms / Q000532:radiotherapy; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy; D011878:Radiotherapy / Q000379:methods*; D011879:Radiotherapy Dosage