Target Coverage

The NRG Oncology template for the radiation section of a conventionally fractionated lung trial. Its imaging section allows PET/CT or MRI for structure definition but asks that the final contours be confirmed on the planning CT, follows AAPM TG-132 for deformable registration, and notes that PET can help separate tumor from atelectasis. For plan evaluation it defines the prescription as the dose covering 95% of the PTV, with a protocol-specific D99% requirement, and asks that any dose above 105% of the prescription fall within the PTV rather than in normal tissue outside it.

The template NRG Oncology gives investigators for writing the radiation section of a lung SBRT trial. Its imaging section allows PET/CT or MRI for structure definition, asks that the images be registered accurately to the planning scan (following AAPM TG-132 for deformable registration), notes that PET may be needed to separate tumor from atelectasis or fibrosis, and suggests an extra margin when a fused image is the primary image for the GTV. Its target and planning sections (5.2.4 and 5.2.6–5.2.8) define the plan-quality measures for lung SBRT trials: the prescription as the dose covering 95% of the PTV, a D99% requirement, R100% (prescription isodose volume ÷ PTV), R50% (50% prescription isodose volume ÷ PTV) and D2cm (maximum dose at 2 cm from the PTV in any direction, as a percentage of the prescription), with a table of allowable dose spillage by PTV volume. It describes a 20 mm PTV expansion structure used to control intermediate dose spillage, asks that dose above 105% of prescription be avoided outside the PTV, describes a deliberately heterogeneous dose with the hotspot in the central GTV, defines the maximum dose on a 0.03 cc volume, and ranks planning priorities when target coverage and organ limits conflict.

The NRG Oncology template for the radiation section of a brain radiosurgery trial. Its example text asks for CT slices of 1.25 mm or less, strongly encourages MRI (contrast T1 and a 3D gradient-echo sequence) for target delineation, recommends fusing FDG-PET/CT when available, and asks that the fusion be done by a medical physicist and reviewed by the attending physician. Its plan-evaluation section defines the conformity index (CI, or R100%) as the prescription isodose volume ÷ PTV volume, R50% as the 50% prescription isodose volume ÷ target volume ("R50% defines dose falloff outside the target"), a heterogeneity index D5% ÷ D95%, and coverage as the PTV volume receiving the prescription dose ÷ PTV volume, and notes that criteria such as the CI should account for target size and treatment technology.

ICRU report on prescribing, recording and reporting intensity-modulated photon therapy. DoseLab has not read the report itself (it is sold by the ICRU). Its homogeneity index, (D2% − D98%) / D50%, is checked as quoted in the open-access Yan 2019 paper.

RTOG task-force guidelines for radiosurgery quality assurance, setting out a standard data set and minor and major protocol deviations. The paper itself is paywalled; DoseLab checked its conformity, coverage and homogeneity definitions as quoted in Kataria 2012 and Menon 2018. Citation checked against Crossref.

Retrospective evaluation of SRS/SRT plan-quality metrics for arteriovenous malformations. Its methods section defines each metric: the RTOG conformity index (prescription isodose volume ÷ target volume; ideal 1), RTOG quality of coverage and homogeneity index, and the Paddick conformity index as the product of the under-treatment ratio (share of the target covered) and over-treatment ratio (share of the prescription isodose volume inside the target), noting that ICRU Report 91 recommends the Paddick conformity and gradient indices for reporting stereotactic plans. Full text read in Europe PMC (PMC6299748); citation checked against Crossref.