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Robustness for Radiation Therapy Treatment Plans

J Buchsbaum1*, A Yock2*, S Flampouri3*, (1) National Cancer Institute/NIH, Bethesda, MD, (2) Vanderbilt University Medical Center, Nashville, TN, (3) University of Florida, Jacksonville, FL


(Monday, 7/30/2018) 8:30 AM - 9:30 AM

Room: Davidson Ballroom A

Even though uncertainties in radiation therapy are now better than ever identified and quantified, the potential severity of their effects on highly conformal dose distributions has lead to increasingly complicated mitigation methods. While simple geometrical target expansions aiming to maintain target coverage in the presence of errors are still in use, complex algorithms accounting for uncertainties during plan optimization are now available. The recent rise of proton radiotherapy, a modality inherently more sensitive to variations than photons, has lead to the development of robust optimization and dose evaluation tools. The novelty of the methods and the tradeoff between robustness and sparing render robustness evaluation essential for plan quality assessment and clinical decision making. Treatment plan robustness, defined as the ability to retain objectives under the influence of uncertainties, varies with treatment site, technique and modality. Currently, plan robustness evaluation is often based on planning treatment volume coverage for conventional treatments and on dose recalculations of various error scenarios for more advanced treatment techniques and modalities. Analysis and presentation of the results of robustness studies is most commonly performed by visualization of DVH bands encompassing individual scenarios but other robustness evaluation metrics have been developed. This course will start with the history and clinician’s perspective on robustness in particle therapy. The technical considerations and limitations of treatment plan robustness will then be discussed. Finally, the current clinical practice and research in proton treatment planning will be presented.

Learning Objectives:
1. Review the uncertainties and mitigation methods per modality
2. Learn about the current robustness evaluation methods and their limitations
3. Identify the needs for robustness evaluation standards to facilitate plan quality evaluations, plan comparisons and correlations with clinical outcomes



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