Course book Advanced Treatment Planning 2018

Are DVHs (and DVHs derived indicators) the best tool for evaluating treatments?

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Long history and huge literature IGRT and modern high precision techniques can be helpful in making DVH estimation more stable Deformable registration could improve the DVH accuracy during treatment Many biological metrics (considered very useful) are substantially based on (differential) DVH data The DVH is not the appropriate choice for plan evaluation but it is still an appropriate choice

Loss of spatial information (from 3D to 2D) The calculation of DVH strongly depends from delineation accuracy (and OAR choices by the doctors) For some structures (e.g. bladder) different metrics can be used (DSH) because of the lack of importance of irradiation of organ content Interpretation of the plot might be subjective It can’t carry clinical informations about conditions that could affect the outcome

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