Pract Radiat Oncol. 2023 Oct 30:S1879-8500(23)00290-4. doi: 10.1016/j.prro.2023.09.009. Online ahead of print.
PURPOSE: To evaluate dose volume histogram (DVH) construction differences across eight major commercial treatment planning systems (TPSs) and dose reporting systems (DRSs) for clinically treated plans of various anatomical sites and target sizes.
MATERIALS AND METHODS: Dose files from ten selected clinically treated plans with a hypo-fractionation, stereotactic radiotherapy prescription or sharp dose gradients such as head and neck plans ranging from prescription doses of 18 Gy in 1 fraction to 70 Gy in 35 fractions, each calculated at 0.25 cm and 0.125 cm grid size, were created and anonymized in Eclipse TPS, and exported to seven other major TPS (Pinnacle, RayStation, Elements) and DRS (MIM, Mobius, ProKnow, and Velocity) systems for comparison. Dose-volume constraint points of clinical importance for each plan were collected from each evaluated system (D0.03cc[Gy], volume, and the mean dose were used for structures without specified constraints). Each reported constraint type and structure volume was normalized to the value from Eclipse for a pairwise comparison. A Wilcoxon Rank Sum test was used for statistical significance and a multivariable regression model was evaluated adjusting for plan, grid size, and distance to target center.
RESULTS: For all DVH points relative to Eclipse, all systems reported median values within 1.0% difference of each other, however they were all different from Eclipse. Considering mean values, Pinnacle, RayStation, and Elements averaged at 1.038, 1.046, 1.024 respectively, while MIM, Mobius, ProKnow, and Velocity reported 1.026, 1.050, 1.033 and 1.022 respectively relative to Eclipse. Smaller dose grid size improved agreement between the systems marginally without statistical significance. For structure volumes relative to Eclipse, larger differences are seen across all systems with a range in median values up to 3.0% difference and mean up to 10.1% difference.
CONCLUSION: Large variations were observed between all systems. Eclipse generally reported, at statistically significant levels, lower values than all other evaluated systems. The non-significant change resulting from lowering the dose grid resolution indicates that this resolution may be less important than other aspects of calculating DVH curves, such as the 3D modeling of the structure.