title: "SABER": A new software tool for radiotherapy treatment plan evaluation.
abstract: OBJECTIVE
  Both spatial and biological information are necessary in order to perform true optimization of a treatment plan and for predicting clinical outcome. The goal of this work is to develop an enhanced treatment plan evaluation tool which incorporates biological parameters and retains spatial dose information.
  
  
  METHODS
  A software system is developed which provides biological plan evaluation with a novel combination of features. It incorporates hyper-radiosensitivity using the induced-repair model and applies the new concept of dose convolution filter (DCF) to simulate dose wash-out effects due to cell migration, bystander effect, and/or tissue motion during treatment. Further, the concept of spatial DVH (sDVH) is introduced to evaluate and potentially optimize the spatial dose distribution in the target volume. Finally, generalized equivalent uniform dose is derived from both the physical dose distribution (gEUD) and the distribution of equivalent dose in 2 Gy fractions (gEUD2) and the software provides three separate models for calculation of tumor control probability (TCP), normal tissue complication probability (NTCP), and probability of uncomplicated tumor control (P+). TCP, NTCP, and P+ are provided as a function of prescribed dose and multivariable TCP, NTCP, and P+ plots are provided to illustrate the dependence on individual parameters used to calculate these quantities. Ten plans from two clinical treatment sites are selected to test the three calculation models provided by this software.
  
  
  RESULTS
  By retaining both spatial and biological information about the dose distribution, the software is able to distinguish features of radiotherapy treatment plans not discernible using commercial systems. Plans that have similar DVHs may have different spatial and biological characteristics and the application of novel tools such as sDVH and DCF within the software may substantially change the apparent plan quality or predicted plan metrics such as TCP and NTCP. For the cases examined, both the calculation method and the application of DCF can change the ranking order of competing plans. The voxel-by-voxel TCP model makes it feasible to incorporate spatial variations of clonogen densities (n), radiosensitivities (SF2), and fractionation sensitivities (alpha/beta) as those data become available.
  
  
  CONCLUSIONS
  The new software incorporates both spatial and biological information into the treatment planning process. The application of multiple methods for the incorporation of biological and spatial information has demonstrated that the order of application of biological models can change the order of plan ranking. Thus, the results of plan evaluation and optimization are dependent not only on the models used but also on the order in which they are applied. This software can help the planner choose more biologically optimal treatment plans and potentially predict treatment outcome more accurately.
authors.affiliation: Department of Radiation Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhao
authors.forename: Michael C
authors.initials: MC
authors.lastname: Joiner
authors.forename: Colin G
authors.initials: CG
authors.lastname: Orton
authors.forename: Jay
authors.initials: J
authors.lastname: Burmeister
mesh_terms: D000465:Algorithms; D004307:Dose-Response Relationship, Radiation; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016730:Program Development; D011381:Programming Languages; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D018787:Radiation Oncology / Q000379:methods*; D011874:Radiometry / Q000379:methods; D011880:Radiotherapy Planning, Computer-Assisted / Q000295:instrumentation* / Q000379:methods*; D012984:Software; D016896:Treatment Outcome; D014584:User-Computer Interface