title: Retrospective reconstructions of active bone marrow dose-volume histograms.
abstract: OBJECTIVE
  To present a method for calculating dose-volume histograms (DVH's) to the active bone marrow (ABM) of patients who had undergone radiation therapy (RT) and subsequently developed leukemia.
  
  
  METHODS
  The study focuses on 15 patients treated between 1961 and 1996. Whole-body RT planning computed tomographic (CT) data were not available. We therefore generated representative whole-body CTs similar to patient anatomy. In addition, we developed a method enabling us to obtain information on the density distribution of ABM all over the skeleton. Dose could then be calculated in a series of points distributed all over the skeleton in such a way that their local density reflected age-specific data for ABM distribution. Dose to particular regions and dose-volume histograms of the entire ABM were estimated for all patients.
  
  
  RESULTS
  Depending on patient age, the total number of dose calculation points generated ranged from 1,190,970 to 4,108,524. The average dose to ABM ranged from 0.3 to 16.4 Gy. Dose-volume histograms analysis showed that the median doses (D50%) ranged from 0.06 to 12.8 Gy. We also evaluated the inhomogeneity of individual patient ABM dose distribution according to clinical situation. It was evident that the coefficient of variation of the dose for the whole ABM ranged from 1.0 to 5.7, which means that the standard deviation could be more than 5 times higher than the mean.
  
  
  CONCLUSIONS
  For patients with available long-term follow-up data, our method provides reconstruction of dose-volume data comparable to detailed dose calculations, which have become standard in modern CT-based 3-dimensional RT planning. Our strategy of using dose-volume histograms offers new perspectives to retrospective epidemiological studies.
authors.affiliation: Radiation Epidemiology Group, Center for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Médicale, UMR 1018, Villejuif, France; Institut Gustave Roussy, Villejuif, France; University Paris-Sud XI, Villejuif, France.
authors.forename: Cristina
authors.initials: C
authors.lastname: Veres
authors.affiliation: Radiation Epidemiology Group, Center for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Médicale, UMR 1018, Villejuif, France; Institut Gustave Roussy, Villejuif, France; University Paris-Sud XI, Villejuif, France.
authors.forename: Rodrigue S
authors.initials: RS
authors.lastname: Allodji
authors.affiliation: Radiation Epidemiology Group, Center for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Médicale, UMR 1018, Villejuif, France; Institut Gustave Roussy, Villejuif, France; University Paris-Sud XI, Villejuif, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Llanas
authors.affiliation: Radiation Epidemiology Group, Center for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Médicale, UMR 1018, Villejuif, France; Institut Gustave Roussy, Villejuif, France; University Paris-Sud XI, Villejuif, France.
authors.forename: Jérémi
authors.initials: J
authors.lastname: Vu Bezin
authors.affiliation: Institut Gustave Roussy, Villejuif, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Chavaudra
authors.affiliation: Institut Gustave Roussy, Villejuif, France.
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Mège
authors.affiliation: Institut Gustave Roussy, Villejuif, France.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Lefkopoulos
authors.affiliation: Institut National de la Santé et de la Recherche Médicale UMR 759, Orsay, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Quiniou
authors.affiliation: Institut Gustave Roussy, Villejuif, France; Institut National de la Santé et de la Recherche Médicale, UMR 1030, Villejuif, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Deutsh
authors.affiliation: Radiation Epidemiology Group, Center for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Médicale, UMR 1018, Villejuif, France; Institut Gustave Roussy, Villejuif, France; University Paris-Sud XI, Villejuif, France.
authors.forename: Florent
authors.initials: F
authors.lastname: de Vathaire
authors.affiliation: Radiation Epidemiology Group, Center for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Médicale, UMR 1018, Villejuif, France; Institut Gustave Roussy, Villejuif, France; University Paris-Sud XI, Villejuif, France. Electronic address: ibrahim.diallo@gustaveroussy.fr.
authors.forename: Ibrahima
authors.initials: I
authors.lastname: Diallo
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001853:Bone Marrow / Q000033:anatomy & histology* / Q000528:radiation effects*; D001842:Bone and Bones / Q000033:anatomy & histology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007953:Leukemia, Radiation-Induced; D008297:Male; D016555:Matched-Pair Analysis; D008488:Medical Illustration; D008875:Middle Aged; D009369:Neoplasms / Q000532:radiotherapy; D011829:Radiation Dosage; D012189:Retrospective Studies; D013997:Time Factors