An updated approach for deriving PTV margins using image guidance and deformable dose accumulation

Amy Frederick, Sarah Quirk, Petra Grendarova, Lukas Van Dyke, Tyler Meyer, Sarah Weppler, Michael Roumeliotis

Research output: Contribution to journalArticlepeer-review

Abstract

Objective. To demonstrate an updated approach for deriving planning target volume (PTV) margins for a patient population treated with volumetric image-guided radiotherapy. Approach. The approach uses a semi-automated workflow within commercial radiotherapy applications that combines dose accumulation with the bidirectional local distance (BLD) metric. The patient cohort is divided into derivation and validation datasets. For each patient in the derivation dataset, a treatment plan is generated with a 0 mm PTV margin (the idealized treatment scenario without the influence of the standard margin). Deformable image registration enabled dose accumulation of these zero-margin plans. PTV margins are derived by using the BLD to calculate the geometric extent of underdosed regions of the clinical target volume (CTV). The PTV margin is validated by ensuring the specified CTV coverage criterion is met when the margin is applied to the validation dataset. Main results. The methodology was applied to two cohorts: 40 oropharyngeal cancer patients and 50 early-stage breast cancer patients. Ten patients from each cohort were used for validation. PTV margins derived for the oropharyngeal and early-stage breast cancer patient cohorts were 3 and 5 mm, respectively, and ensure that 95% of the prescription dose is delivered to 98% of the CTV for 90% of patients. Dose accumulation showed that the CTV coverage criterion was achieved for at least 90% of patients when the margins were applied. Significance. This methodology can be used to derive appropriate PTV margins for realistic treatment scenarios and any disease site, which will improve our understanding of patient outcomes.

Original languageEnglish (US)
Article number075004
JournalPhysics in medicine and biology
Volume67
Issue number7
DOIs
StatePublished - Apr 7 2022
Externally publishedYes

Keywords

  • IGRT
  • PTV margins
  • deformable image registration
  • dose accumulation
  • head and neck cancer
  • image-guided radiotherapy
  • partial breast irradiation

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging

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