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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