SU-F-J-68: Deformable Dose Accumulation for Voxel-Based Dose Tracking of PTV Cold Spots for Adaptive Radiotherapy of the Head and Neck




To utilize deformable dose accumulation (DDA) to determine how cold spots within the PTV change over the course of fractionated head and neck (H&N) radiotherapy.


Voxel-based dose was tracked using a DDA platform. The DDA process consisted of B-spline-based deformable image registration (DIR) and dose accumulation between planning CT's and daily cone-beam CT's for 10 H&N cancer patients. Cold spots within the PTV (regions receiving less than the prescription, 70 Gy) were contoured on the cumulative dose distribution. These cold spots were mapped to each fraction, starting from the first fraction to determine how they changed. Spatial correlation between cold spot regions over each fraction, relative to the last fraction, was computed using the Jaccard index Jk (Mk,N), where N is the cold spot within the PTV at the end of the treatment, and Mk the same region for fraction k.


Figure 1 shows good spatial correlation between cold spots, and highlights expansion of the cold spot region over the course of treatment, as a result of setup uncertainties, and anatomical changes. Figure 2 shows a plot of Jk versus fraction number k averaged over 10 patients. This confirms the good spatial correlation between cold spots over the course of treatment. On average, Jk reaches ∼90% at fraction 22, suggesting that possible intervention (e.g. reoptimization) may mitigate the cold spot region. The cold spot, D99, averaged over 10 patients corresponded to a dose of ∼65 Gy, relative to the prescription dose of 70 Gy.


DDA-based tracking provides spatial dose information, which can be used to monitor dose in different regions of the treatment plan, thereby enabling appropriate mid-treatment interventions.

This work is supported in part by Varian Medical Systems, Palo Alto, CA.