title: A new tool for dose conformity evaluation of radiosurgery treatment plans.
abstract: OBJECTIVE
  A novel method for dose conformity evaluation of treatment plans produced by the stereotactic radiosurgery treatment planning system is postulated.
  
  
  METHODS
  By consolidating the information contained in the integral dose-volume histogram and the treatment volume ratio, a plot of treatment volume ratio versus percentage dose may be considered as a useful tool for plan evaluation. To validate the suggested argument, two simple experiments simulating the conformal and nonconformal cases were conducted on the geometric phantom that is commercially available from Radionics. An actual patient treatment plan is also included to explore the effectiveness of the proposed parameters. It is an attempt to establish the baseline of a conformal plan.
  
  
  RESULTS
  A plot showed the ability to give the user an idea whether the size of the collimator was adequate to cover the delineated lesion when the user-defined criteria had been in place. Two parameters, namely take-off dose (TOD) and take-off volume (TOV) were defined. The former was defined as the maximum dose level found on the surface of the target volume. The TOD is also the maximum possible dose to be received by the adjacent normal tissue. The latter was defined as the percentage of the target volume that received the TOD. Another parameter, irradiated percentage volume (IPV), was defined here as the percentage of the target volume receiving at least the prescribed dose. When the prescribed dose is also the TOD, the IPV becomes the TOV. They were proved to be effective in evaluating the dose conformity. Another term known as equivalent fall-off distance (EFOD) was defined as the equivalent radial distance calculated between two isodose lines. In fact, the dose fall-off rate can also act as a measuring index for plan comparison, because a fast dose fall-off rate is often a requirement for radiosurgery in order to minimize the risk of radiation damage to the surrounding structures. The two phantom studies showed consistent results with the theoretical predictions. The ability of the plot was further explored in the patient treatment plan studies. It was demonstrated that the plot had a remarkable ability to check whether the hot spot is in the vicinity of the lesion. A baseline of a conformal plan was also established; for example, a plan is said to be conformal if its IPV has attained a value of not less than 95% and its associated TVR is not greater than 2.
  
  
  CONCLUSIONS
  The proposed method has demonstrated the effectiveness in dose conformity evaluation. It supplements the integral dose-volume histogram to provide a complete information of a treatment plan in terms of dose uniformity and conformity.
authors.affiliation: Department of Clinical Oncology, University of Hong Kong, Queen Mary Hospital, China. leunght@ha.org.hk
authors.forename: L H
authors.initials: LH
authors.lastname: Leung
authors.forename: D T
authors.initials: DT
authors.lastname: Chua
authors.forename: P M
authors.initials: PM
authors.lastname: Wu
mesh_terms: D005069:Evaluation Studies as Topic; D019047:Phantoms, Imaging; D055585:Physical Phenomena; D010825:Physics; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods*