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The Participant-Reported Implementation Update and Score PRIUS: A Novel Method for Capturing Implementation-Related Data Over Time

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Plan evaluation indices: A journey of evolution.

Ganeshkumar Patel¹, Abhijit Mandal¹, Sunil Choudhary¹

¹Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Reports of Practical Oncology and Radiotherapy : Journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology

|March 27, 2020

Summary

This review analyzes radiotherapy plan evaluation indices like conformity index (CI) and gradient index (GI). While CI definitions evolved, those including organ-at-risk sparing are more reliable; GI is significant, but homogeneity index (HI) is losing credibility.

Keywords:

Complexity metric Conformity index Gradient index Homogeneity index

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Published on: September 11, 2021

Area of Science:

Radiotherapy physics and dosimetry
Medical physics
Radiation oncology

Background:

Modern radiotherapy techniques (VMAT, SRS, SBRT) enable highly conformal plans, improving normal tissue sparing.
These techniques generate multiple plan options with varying dose distributions, necessitating robust evaluation tools.
Dosimetric indices like conformity index (CI), homogeneity index (HI), and gradient index (GI) complement visual isodose verification in plan assessment.

Purpose of the Study:

To conduct a systematic review and analysis of the evolution of dosimetric indices used in radiotherapy plan evaluation.
To examine the historical development and changing definitions of conformity index (CI), homogeneity index (HI), and gradient index (GI).
To assess the reliability and changing roles of these indices in the context of advanced radiotherapy techniques.

Main Methods:

A comprehensive literature search was performed on PubMed and Web of Science for studies published after 1993.
Keywords included "conformity index", "Homogeneity index", "Gradient index", "Stereotactic radiosurgery", "stereotactic Body radiotherapy", "complexity metrics", and "plan evaluation index".
Bibliographies of relevant papers were also reviewed to identify additional studies.

Main Results:

Mathematical definitions of plan evaluation indices have evolved over time.
Conformity index (CI) definitions have varied, with those incorporating organ-at-risk (OAR) sparing demonstrating greater reliability.
Gradient index (GI) has emerged as a significant evaluation tool, while homogeneity index (HI) has diminished in credibility.

Conclusions:

The evolution of dosimetric indices reflects the increasing complexity of radiotherapy planning.
Conformity index (CI) definitions that account for OAR sparing provide more confidence in plan evaluation.
Gradient index (GI) is a valuable addition to plan assessment, and biological indices may play a larger role in future evaluations.