Comments on ‘Reconsidering the definition of a dose–volume histogram’—dose–mass histogram (DMH) versus dose–volume histogram (DVH) for predicting radiation-induced pneumonitis

Abstract

In a recently published paper (Nioutsikou et al 2005 Phys. Med. Biol. 50 L17) the authors showed that the use of the dose-mass histogram (DMH) concept is a more accurate descriptor of the dose delivered to lung than the traditionally used dose-volume histogram (DVH) concept. Furthermore, they state that if a functional imaging modality could also be registered to the anatomical imaging modality providing a functional weighting across the organ (functional mass) then the more general and realistic concept of the dose-functioning mass histogram (D[F]MH) could be an even more appropriate descriptor. The comments of the present letter to the editor are in line with the basic arguments of that work since their general conclusions appear to be supported by the comparison of the DMH and DVH concepts using radiobiological measures. In this study, it is examined whether the dose-mass histogram (DMH) concept deviated significantly from the widely used dose-volume histogram (DVH) concept regarding the expected lung complications and if there are clinical indications supporting these results. The problem was investigated theoretically by applying two hypothetical dose distributions (Gaussian and semi-Gaussian shaped) on two lungs of uniform and varying densities. The influence of the deviation between DVHs and DMHs on the treatment outcome was estimated by using the relative seriality and LKB models using the Gagliardi et al (2000 Int. J. Radiat. Oncol. Biol. Phys. 46 373) and Seppenwoolde et al (2003 Int. J. Radiat. Oncol. Biol. Phys. 55 724) parameter sets for radiation pneumonitis, respectively. Furthermore, the biological equivalent of their difference was estimated by the biologically effective uniform dose (D) and equivalent uniform dose (EUD) concepts, respectively. It is shown that the relation between the DVHs and DMHs varies depending on the underlying cell density distribution and the applied dose distribution. However, the range of their deviation in terms of the expected clinical outcome was proven to be very large. Concluding, the effectiveness of the dose distribution delivered to the patients seems to be more closely related to the radiation effects when using the DMH concept.

Quantitative Assessment of Irradiated Lung Volume and Lung Mass in Breast Cancer Patients Treated with Tangential Fields in Combination with Deep Inspiration Breath Hold (DIBH)

“…To quantify organ dose, Mavroidis et al [21] proved the DMH concept to be superior to the calculation of DVHs. Our commercial treatment-planning system does not provide calculation of a DMH, but solely region-dependent density values with consecutive calculation of mass.…”

A graphic user interface toolkit for specification, report and comparison of dose–response relations and treatment plans using the biologically effective uniform dose

“…The GUI of BEUDcal provides a friendly interface to implement the BEUD calculation by simply inputting the differential DVHs of the different tissues exported from TPS. The BEUD evaluation has been successfully applied to compare the differences between planned and delivered IMRT dose distributions [23]. Moreover, previous studies have utilized BEUD on plan comparisons between helical tomotherapy and MLC-based IMRT for brain, cranio-spinal, head-and-neck, lung and prostate tumors [24, 25].…”

Dose-mass inverse optimization for minimally moving thoracic lesions

“…(Nioutsikou et al , 2005; Butler et al , 2004) To date, mass information has been utilized only in evaluation of treatment plans and radiobiological modeling for NSCLC. (Butler et al , 2004; Forster et al , 2001; Mavroidis et al , 2006; Nioutsikou et al , 2005; Tucker et al , 2006; Wei et al , 2005) Dose-mass histograms (DMHs) were introduced for evaluation and review of thoracic treatment plans. (Butler et al , 2004; Forster et al , 2001) Shortly after, the analytic rationale (not complete in our opinion) for their application was outlined.…”

“…(Butler et al , 2004; Forster et al , 2001) Shortly after, the analytic rationale (not complete in our opinion) for their application was outlined. (Mavroidis et al , 2006; Nioutsikou et al , 2005) More recently a conceptual study, shedding more light on the mathematical formalism of dose-mass inverse optimization, was published. (Mihaylov and Moros, 2014)…”