Scenario-based radiation therapy margins for patient setup, organ motion, and particle range uncertainty

This work extends and validates the scenario-based generalization of margins presented in Fredriksson and Bokrantz (2016 Phys. Med. Biol . 61 2067–82). Scenario-based margins are, in their original form, a method for robust planning under setup uncertainty where the sum of a plan evaluation criterion over a set of scenarios is optimized. The voxelwise penalties in the summands are weighted by a distribution of coefficients defined such that the method is mathematically equivalent to the use of conventional geometric margins if the scenario doses are calculated using the static dose cloud approximation. The purpose of this work is to extend scenario-based margins to general types of geometric uncertainty and to validate their use on clinical cases. Specifically, we outline how to incorporate density heterogeneity in the calculation of coefficients and demonstrate the extended method’s ability to safeguard against setup errors, organ motion, and range shifts (and comb...

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