Plan space: representation of treatment plans in multidimensional space.
OBJECTIVE
Treatment planning balances the need to provide adequate radiation coverage of the target with the need to reduce against the risk of overdosing normal tissues. An acceptable plan fulfills minimum dose-volume criteria for irradiation of tumor and normal tissues. However, multiple plans can satisfy these minimum criteria, and some plans provide for better protection of normal tissue than others. Here, we present a method to help the planner compare plans and decide whether a particular plan is the "best" plan on the basis of a set of certain dose-volume conditions.


METHODS
Treatment plans are represented as points in multidimensional space. One dimension is assigned to the target and one to normal tissues of each anatomic structure under consideration. Minimum target dose is used as the target axis coordinate and the percentage volume of each normal structure receiving more than a specified dose as each normal-tissue coordinate. Images of plan space are developed for model phantom anatomy as well as for two clinical cases in the thorax and abdomen.


RESULTS
When a sufficient number of plans have been plotted, a feasibility boundary becomes evident. This hypersurface in plan space represents the limit of the given treatment technique. By using a plan on this boundary, the benefits of a given treatment modality are maximized, providing assurance that the selected plan is the "best" plan. The beam angles and relative weights of a plan can be changed to alter its position in plan space, allowing improvements in an existing plan. Frequently, plans with normal-tissue dose distributions superior to the minimum acceptable criteria can be selected. The benefits of using plan-space images have been demonstrated at sites in the thorax and abdomen.


CONCLUSIONS
Instead of defining dose-volume criteria at the outset, it is possible to select the best achievable plans by first evaluating the space of possible plans for a particular patient's unique anatomy and then choosing the plan with the optimum dose-volume characteristics. No attempt is made to arrive at a single plan score so that explicit judgments about the relative worth of individual structures are avoided. Visualization of plan-space images allows physicians to make choices based on their assessment of the relative significance of irradiation of each normal structure.
Gopal
Ramesh
R
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Starkschall
George
G
D006801:Humans; D007680:Kidney Neoplasms / Q000532:radiotherapy; D008175:Lung Neoplasms / Q000532:radiotherapy; D009369:Neoplasms / Q000532:radiotherapy*; D019047:Phantoms, Imaging; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D012984:Software