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Worst-Case Robustness Evaluation Methods for IMPT: A Critical Comparison.

Chunbo Liu1,2, Chris J Beltran2, Jiajian Shen3

  • 1Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

International Journal of Particle Therapy
|August 20, 2025
PubMed
Summary
This summary is machine-generated.

Evaluating intensity-modulated proton therapy (IMPT) robustness is crucial for safe dose delivery. This study compared methods, recommending a combined approach using DVH bands and voxel-wise worst-case analysis for effective clinical IMPT plan evaluation.

Keywords:
Intensity-modulated proton therapyRobustness evaluationWorst-case approach

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Radiotherapy Planning

Background:

  • Robustness evaluation is essential for ensuring accurate dose delivery in intensity-modulated proton therapy (IMPT) clinical practice.
  • Despite its importance, a consensus on the optimal method for IMPT plan robustness evaluation is lacking.
  • This study investigates various methods within the worst-case approach to inform clinical decision-making.

Purpose of the Study:

  • To compare the effectiveness of different robustness evaluation methods for intensity-modulated proton therapy (IMPT) plans.
  • To provide insights into selecting a practical and clinically applicable IMPT plan evaluation strategy.
  • To identify correlations and capabilities of various robustness assessment techniques.

Main Methods:

  • Evaluated five robustness assessment methods on 20 clinical IMPT plans (10 prostate, 10 head and neck).
  • Methods included: error-bar dose distribution (ebDD), root-mean-square error dose (RMSED) distribution, voxel-wise worst-case, physical scenario worst-case, and dose-volume histogram (DVH) band.
  • Analyzed correlations between methods and assessed their quantitative/qualitative abilities to detect dose errors.

Main Results:

  • Strong correlations observed between ebDD and RMSED, and between voxel-wise worst-case and physical scenario worst-case.
  • DVH band offers a clear overview of dose variations against criteria but lacks spatial localization.
  • Voxel-wise worst-case excels at pinpointing specific areas of concern within the dose distribution.
  • Physical scenario worst-case identifies problem areas but can be cumbersome for multiple regions/metrics.

Conclusions:

  • Different robustness evaluation methods provide distinct, valuable information for IMPT plan assessment.
  • A combined strategy is proposed: utilize DVH bands from physical uncertainty scenarios for criterion checking.
  • Employ voxel-wise worst-case analysis to spatially localize risks when DVH bands indicate potential issues.