Data-Driven Approach to Generating Achievable Dose–Volume Histogram Objectives in Intensity-Modulated Radiotherapy Planning

Wu, Binbin; Ricchetti, Francesco; Sanguineti, Giuseppe; Kazhdan, Michael; Simari, Patricio; Jacques, Robert; Taylor, Russell; McNutt, Todd

doi:10.1016/j.ijrobp.2010.05.026

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Volume 79, Issue 4 , Pages 1241-1247, 15 March 2011

Data-Driven Approach to Generating Achievable Dose–Volume Histogram Objectives in Intensity-Modulated Radiotherapy Planning

Presented orally at the 51st Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Chicago, IL, November, 2009.

Binbin Wu, Ph.D.
- Department of Radiation Oncology and Molecular Radiation Science, Johns Hopkins University, Baltimore, MD
Francesco Ricchetti, M.D.
- Department of Radiation Oncology and Molecular Radiation Science, Johns Hopkins University, Baltimore, MD
Giuseppe Sanguineti, M.D.
- Department of Radiation Oncology and Molecular Radiation Science, Johns Hopkins University, Baltimore, MD
Michael Kazhdan, Ph.D.
- Department of Computer Science, Johns Hopkins University, Baltimore, MD
Patricio Simari, Ph.D.
- Department of Computer Science, Johns Hopkins University, Baltimore, MD
Robert Jacques, B.S.
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD
Russell Taylor, Ph.D.
- Department of Computer Science, Johns Hopkins University, Baltimore, MD
Todd McNutt, Ph.D.
- Department of Radiation Oncology and Molecular Radiation Science, Johns Hopkins University, Baltimore, MD
- Reprint requests to: Todd McNutt, Ph.D., Department of Radiation Oncology and Molecular Radiation Science, Johns Hopkins University, 401 N. Broadway, Suite 1440, Baltimore, MD 21231-2410. Tel: (410) 614-4594; Fax: (410) 502-1419

Received 24 February 2010; received in revised form 14 May 2010; accepted 14 May 2010. published online 27 August 2010.

Purpose

To propose a method of intensity-modulated radiotherapy (IMRT) planning that generates achievable dose–volume histogram (DVH) objectives using a database containing geometric and dosimetric information of previous patients.

Methods and Materials

The overlap volume histogram (OVH) is used to compare the spatial relationships between the organs at risk and targets of a new patient with those of previous patients in a database. From the OVH analysis, the DVH objectives of the new patient were generated from the database and used as the initial planning goals. In a retrospective OVH-assisted planning demonstration, 15 patients were randomly selected from a database containing clinical plans (CPs) of 91 previous head-and-neck patients treated by a three-level IMRT-simultaneous integrated boost technique. OVH-assisted plans (OPs) were planned in a leave-one-out manner by a planner who had no knowledge of CPs. Thus, DVH objectives of an OP were generated from a subdatabase containing the information of the other 90 patients. Those DVH objectives were then used as the initial planning goals in IMRT optimization. Planning efficiency was evaluated by the number of clicks of the “Start Optimization” button in the course of planning. Although the Pinnacle³ treatment planning system allows planners to interactively adjust the DVH parameters during optimization, planners in our institution have never used this function in planning.

Results

The average clicks required for completing the CP and OP was 27.6 and 1.9, respectively (p <.00001); three OPs were finished within a single click. Ten more patient's cord + 4 mm reached the sparing goal D_0.1cc <44 Gy (p <.0001), where D_0.1cc represents the dose corresponding to 0.1 cc. For planning target volume uniformity, conformity, and other organ at risk sparing, the OPs were at least comparable with the CPs. Additionally, the averages of D_0.1cc to the cord + 4 mm decreased by 6.9 Gy (p <.0001); averages of D_0.1cc to the brainstem decreased by 7.7 Gy (p <.005). The averages of V(30 Gy) to the contralateral parotid decreased by 8.7% (p <.0001), where V(30 Gy) represents the percentage volume corresponding to 30 Gy.