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Are DVHs (and DVHs derived indicators)
the best tool for evaluating treatments?
•
Point:
➢
Long history and
huge literature
➢
IGRT
and modern
high precision
techniques
can be helpful in
making DVH estimation more
stable
➢
Deformable registration
could
improve the DVH accuracy during
treatment
➢
Many
biological metrics
(considered very useful) are
substantially based on (differential)
DVH data
➢
The DVH is not
the
appropriate
choice for plan evaluation but it is
still
an
appropriate choice
•
Counterpoint:
➢
Loss of spatial information
(from
3D to 2D)
➢
The calculation of DVH strongly
depends from
delineation accuracy
(and OAR choices by the doctors)
➢
For some structures (e.g. bladder)
different metrics
can be used
(DSH) because of the lack of
importance of irradiation of organ
content
➢
Interpretation
of the plot might be
subjective
➢
It can’t carry
clinical informations
about conditions that could affect
the outcome