Red shell- high risk normal tissue in stereotactic radiosurgery

Due to the ablative nature of high prescription in Stereotactic Radiosurgery or stereotactic body radiation therapy (SRS/SBRT), the normal tissue surrounding the CTV receives the dose higher than tissue's dose constraint. A concept of Red Shell is proposed to define and quantify these tissue damaged in SBRT, using biological equivalent dose (BED) concept. The combination of biological factors and physics factors, including serial and parallel organ, dose gradient, dose distribution and fractionations, are further discussed to interpret the clinical meaning of Red Shell. This concept can also help planner to improve the optimization in planning process.