Tools for the analysis of dose optimization: I. Effect-volume histogram

With the advent of dose optimization algorithms, predominantly for intensity-modulated radiotherapy (IMRT), computer software has progressed beyond the point of being merely a tool at the hands of an expert and has become an active, independent mediator of the dosimetric conflicts between treatment goals and risks. To understand and control the internal decision finding as well as to provide means to influence it, a tool for the analysis of the dose distribution is presented which reveals the decision-making process performed by the algorithm. The internal trade-offs between partial volumes receiving high or low doses are driven by functions which attribute a weight to each volume element. The statistics of the distribution of these weights is cast into an effect-volume histogram (EVH) in analogy to dose-volume histograms. The analysis of the EVH reveals which traits of the optimum dose distribution result from the defined objectives, and which are a random consequence of under- or misspecification of treatment goals. The EVH can further assist in the process of finding suitable objectives and balancing conflicting objectives. If biologically inspired objectives are used, the EVH shows the distribution of local dose effect relative to the prescribed level. (author)