A dose-volume-based tool for evaluating and ranking IMRT treatment plans.

External beam radiotherapy is commonly used for patients with cancer. While tumor shrinkage and palliation are frequently achieved, local control and cure remain elusive for many cancers. With regard to local control, the fundamental problem is that radiotherapy-induced normal tissue injury limits the dose that can be delivered to the tumor. While intensity-modulated radiation therapy (IMRT) allows for the delivery of higher tumor doses and the sparing of proximal critical structures, multiple competing plans can be generated based on dosimetric and/or biological constraints that need to be considered/compared. In this work, an IMRT treatment plan evaluation and ranking tool, based on dosimetric criteria, is presented. The treatment plan with the highest uncomplicated target conformity index (TCI+) is ranked at the top. The TCI+ is a dose-volume-based index that considers both a target conformity index (TCI) and a normal tissue-sparing index (NTSI). TCI+ is designed to assist in the process of judging the merit of a clinical treatment plan. To demonstrate the utility of this tool, several competing lung and prostate IMRT treatment plans are compared. Results show that the plan with the highest TCI+ values accomplished the competing goals of tumor coverage and critical structures sparing best, among rival treatment plans for both treatment sites. The study demonstrates, first, that dose-volume-based indices, which summarize complex dose distributions through a single index, can be used to automatically select the optimal plan among competing plans, and second, that this dose-volume-based index may be appropriate for ranking IMRT dose distributions.