title: Application of a novel dose-uncertainty model for dose-uncertainty analysis in prostate intensity-modulated radiotherapy.
abstract: OBJECTIVE
  To analyze dose uncertainty using a previously published dose-uncertainty model, and to assess potential dosimetric risks existing in prostate intensity-modulated radiotherapy (IMRT).
  
  
  METHODS
  The dose-uncertainty model provides a three-dimensional (3D) dose-uncertainty distribution in a given confidence level. For 8 retrospectively selected patients, dose-uncertainty maps were constructed using the dose-uncertainty model at the 95% CL. In addition to uncertainties inherent to the radiation treatment planning system, four scenarios of spatial errors were considered: machine only (S1), S1 + intrafraction, S1 + interfraction, and S1 + both intrafraction and interfraction errors. To evaluate the potential risks of the IMRT plans, three dose-uncertainty-based plan evaluation tools were introduced: confidence-weighted dose-volume histogram, confidence-weighted dose distribution, and dose-uncertainty-volume histogram.
  
  
  RESULTS
  Dose uncertainty caused by interfraction setup error was more significant than that of intrafraction motion error. The maximum dose uncertainty (95% confidence) of the clinical target volume (CTV) was smaller than 5% of the prescribed dose in all but two cases (13.9% and 10.2%). The dose uncertainty for 95% of the CTV volume ranged from 1.3% to 2.9% of the prescribed dose.
  
  
  CONCLUSIONS
  The dose uncertainty in prostate IMRT could be evaluated using the dose-uncertainty model. Prostate IMRT plans satisfying the same plan objectives could generate a significantly different dose uncertainty because a complex interplay of many uncertainty sources. The uncertainty-based plan evaluation contributes to generating reliable and error-resistant treatment plans.
authors.affiliation: University of Florida Proton Therapy Institute, University of Florida, Jacksonville, FL, USA.
authors.forename: Hosang
authors.initials: H
authors.lastname: Jin
authors.forename: Jatinder R
authors.initials: JR
authors.lastname: Palta
authors.forename: You-Hyun
authors.initials: YH
authors.lastname: Kim
authors.forename: Siyong
authors.initials: S
authors.lastname: Kim
mesh_terms: D016001:Confidence Intervals; D006801:Humans; D008297:Male; D015233:Models, Statistical; D009068:Movement; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000295:instrumentation / Q000706:statistics & numerical data*; D012007:Rectum / Q000528:radiation effects; D035501:Uncertainty; D001743:Urinary Bladder / Q000528:radiation effects