Remarks on reporting and recording consistent with the ICRU Reference Dose

Background: ICRU 50/62 provides a framework to facilitate the reporting of external beam radiotherapy treatments from different institutions. A predominant role is played by points that represent "the PTV dose". However, for new techniques like Intensity Modulated Radiotherapy (IMRT)- especially step and shoot IMRT - it is difficult to define a point whose dose can be called "characteristic" of the PTV dose distribution. Therefore different volume based methods of reporting of the prescribed dose are in use worldwide. Several of them were compared regarding their usability for IMRT and compatibility with the ICRU Reference Point dose for conformal radiotherapy (CRT) in this study. Methods: The dose distributions of 45 arbitrarily chosen volumes treated by CRT plans and 57 volumes treated by IMRT plans were used for comparison. Some of the IMRT methods distinguish the planning target volume ( PTV) and its central part PTVx ( PTV minus a margin region of x mm). The reporting of dose prescriptions based on mean and median doses together with the dose to 95% of the considered volume (D95) were compared with each other and in respect of a prescription report with the aid of one or several possible ICRU Reference Points. The correlation between all methods was determined using the standard deviation of the ratio of all possible pairs of prescription reports. In addition the effects of boluses and the characteristics of simultaneous integrated boosts ( SIB) were examined. Results: Two types of methods result in a high degree of consistency with the hitherto valid ICRU dose reporting concept: the median dose of the PTV and the mean dose to the central part of the PTV ( PTVx). The latter is similar to the CTV, if no nested PTVs are used and no patient model surfaces are involved. A reporting of dose prescription using the CTV mean dose tends to overestimate the plateau doses of the lower dose plateaus of SIB plans. PTVx provides the possibility to approach biological effects using the standard deviation of the dose within this volume. Conclusion: The authors advocate reporting the PTV median dose or preferably the mean dose of the central dose plateau PTVx as a potential replacement or successor of the ICRU Reference Dose - both usable for CRT and IMRT.