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Defining robustness protocols: a method to include and evaluate robustness in clinical plans.

McGowan, SE; Albertini, F; Thomas, SJ; Lomax, AJ; (2015) Defining robustness protocols: a method to include and evaluate robustness in clinical plans. Physics in Medicine & Biology , 60 (7) pp. 2671-2684. 10.1088/0031-9155/60/7/2671. Green open access

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Abstract

We aim to define a site-specific robustness protocol to be used during the clinical plan evaluation process. Plan robustness of 16 skull base IMPT plans to systematic range and random set-up errors have been retrospectively and systematically analysed. This was determined by calculating the error-bar dose distribution (ebDD) for all the plans and by defining some metrics used to define protocols aiding the plan assessment. Additionally, an example of how to clinically use the defined robustness database is given whereby a plan with sub-optimal brainstem robustness was identified. The advantage of using different beam arrangements to improve the plan robustness was analysed. Using the ebDD it was found range errors had a smaller effect on dose distribution than the corresponding set-up error in a single fraction, and that organs at risk were most robust to the range errors, whereas the target was more robust to set-up errors. A database was created to aid planners in terms of plan robustness aims in these volumes. This resulted in the definition of site-specific robustness protocols. The use of robustness constraints allowed for the identification of a specific patient that may have benefited from a treatment of greater individuality. A new beam arrangement showed to be preferential when balancing conformality and robustness for this case. The ebDD and error-bar volume histogram proved effective in analysing plan robustness. The process of retrospective analysis could be used to establish site-specific robustness planning protocols in proton therapy. These protocols allow the planner to determine plans that, although delivering a dosimetrically adequate dose distribution, have resulted in sub-optimal robustness to these uncertainties. For these cases the use of different beam start conditions may improve the plan robustness to set-up and range uncertainties.

Type: Article
Title: Defining robustness protocols: a method to include and evaluate robustness in clinical plans.
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1088/0031-9155/60/7/2671
Publisher version: http://dx.doi.org/ 10.1088/0031-9155/60/7/2671
Language: English
Additional information: Copyright © 2015 Institute of Physics and Engineering in Medicine Content from this work may be used under the terms of the Creative Commons Attribution 3.0 licence. Any further distribution of this work must maintain attribution to the author(s) and the title of the work, journal citation and DOI.
Keywords: Algorithms, Databases as Topic, Humans, Proton Therapy, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted, Radiotherapy, Intensity-Modulated
UCL classification: UCL
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science
URI: https://discovery.ucl.ac.uk/id/eprint/1547719
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