title: A novel method for the evaluation of uncertainty in dose-volume histogram computation.
abstract: OBJECTIVE
  Dose-volume histograms (DVHs) are a useful tool in state-of-the-art radiotherapy treatment planning, and it is essential to recognize their limitations. Even after a specific dose-calculation model is optimized, dose distributions computed by using treatment-planning systems are affected by several sources of uncertainty, such as algorithm limitations, measurement uncertainty in the data used to model the beam, and residual differences between measured and computed dose. This report presents a novel method to take them into account.
  
  
  METHODS
  To take into account the effect of associated uncertainties, a probabilistic approach using a new kind of histogram, a dose-expected volume histogram, is introduced. The expected value of the volume in the region of interest receiving an absorbed dose equal to or greater than a certain value is found by using the probability distribution of the dose at each point. A rectangular probability distribution is assumed for this point dose, and a formulation that accounts for uncertainties associated with point dose is presented for practical computations.
  
  
  RESULTS
  This method is applied to a set of DVHs for different regions of interest, including 6 brain patients, 8 lung patients, 8 pelvis patients, and 6 prostate patients planned for intensity-modulated radiation therapy.
  
  
  CONCLUSIONS
  Results show a greater effect on planning target volume coverage than in organs at risk. In cases of steep DVH gradients, such as planning target volumes, this new method shows the largest differences with the corresponding DVH; thus, the effect of the uncertainty is larger.
authors.affiliation: NW Medical Physics, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom. francisco.cutanda@hotmail.com
authors.forename: Francisco Cutanda
authors.initials: FC
authors.lastname: Henríquez
authors.forename: Silvia Vargas
authors.initials: SV
authors.lastname: Castrillón
mesh_terms: D000465:Algorithms; D001932:Brain Neoplasms / Q000532:radiotherapy; D006801:Humans; D008168:Lung; D008175:Lung Neoplasms / Q000532:radiotherapy; D008297:Male; D009369:Neoplasms / Q000532:radiotherapy*; D010386:Pelvic Neoplasms / Q000532:radiotherapy; D011467:Prostate; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated; D012007:Rectum; D013116:Spinal Cord; D035501:Uncertainty; D001743:Urinary Bladder