Volumetric dose extension for isodose tuning

Purpose: To develop a method that can extend dose from two isodose surfaces (isosurfaces) to the entire patient volume, and to demonstrate its application in radiotherapy plan isodose tuning. Methods: We hypothesized that volumetric dose distribution can be extended from two isosurfaces—the 100% isosurface and a reference isosurface—with the distances to these two surfaces ((Formula presented.) and (Formula presented.)) as extension variables. The extension function is modeled by a three-dimensional lookup table (LUT), where voxel dose values from clinical plans are binned by three indexes: (Formula presented.), (Formula presented.), and (Formula presented.) (reference dose level). The mean and standard deviation of voxel doses in each bin are calculated and stored in LUT. Volumetric dose extension is performed voxel-wisely by indexing the LUT with the (Formula presented.), (Formula presented.), and (Formula presented.) of each query voxel. The mean dose stored in the corresponding bin is filled into the query voxel as extended dose, and the standard deviation be filled voxel-wisely as the uncertainty of extension result. We applied dose extension in isodose tuning, which aims to tune volumetric dose distribution by isosurface dragging. We adopted extended dose as an approximate dose estimation, and combined it with dose correction strategy to achieve accurate dose tuning. Results: We collected 32 post-operative prostate volumetric-modulated arc therapy (VMAT) cases and built the LUT and its associated uncertainties from the doses of 27 cases. The dose extension method was tested on five cases, whose dose distributions were defined as ground truth (GT). We extended the doses from 100% and 50% GT isosurfaces to the entire volume, and evaluated the accuracy of extended doses. The 5 mm/5% gamma passing rate (GPR) of extended doses are 92.0%. The mean error is 4.5%, which is consistent to the uncertainty estimated by LUT. The dose difference in 90.5% of voxels is within two sigma and 97.5% in three sigma. The calculation time is less than 2 seconds. To simulate plan isodose tuning, we optimized a dose with less sparing on rectum (than GT dose) and defined it as a “base dose”—the dose awaiting isosurface dragging. In front-end, the simulated isodose tuning is conducted as such that the base dose was given to plan tuner, and its 50% isosurface would be dragged to the desired position (position of 50% isosurface in GT dose). In back-end, the output of isodose tuning is obtained by (1) extending dose from the desired isosurfaces and viewed the extended dose as an approximate dose, (2) obtaining a correction map from the base dose, and (3) applying the correction map to the extended dose. The accuracy of output—extended dose with correction—was 97.2% in GPR (3 mm/3%) and less than 1% in mean dose difference. The total calculation time is less than 2 seconds, which allows for interactive isodose tuning. Conclusions: We developed a dose extension method that generates volumetric dose distribution from two surfaces. The application of dose extension is in interactive isodose tuning. The distance-based LUT fashion and correction strategy guarantee the computation efficiency and accuracy in isodose tuning.