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@ARTICLE{Mescher:128101,
      author       = {H. Mescher$^*$ and S. Ulrich$^*$ and M. Bangert$^*$},
      title        = {{C}overage-based constraints for {IMRT} optimization.},
      journal      = {Physics in medicine and biology},
      volume       = {62},
      number       = {18},
      issn         = {1361-6560},
      address      = {Bristol},
      publisher    = {IOP Publ.},
      reportid     = {DKFZ-2017-04123},
      pages        = {N460 - N473},
      year         = {2017},
      abstract     = {Radiation therapy treatment planning requires an
                      incorporation of uncertainties in order to guarantee an
                      adequate irradiation of the tumor volumes. In current
                      clinical practice, uncertainties are accounted for
                      implicitly with an expansion of the target volume according
                      to generic margin recipes. Alternatively, it is possible to
                      account for uncertainties by explicit minimization of
                      objectives that describe worst-case treatment scenarios, the
                      expectation value of the treatment or the coverage
                      probability of the target volumes during treatment planning.
                      In this note we show that approaches relying on objectives
                      to induce a specific coverage of the clinical target volumes
                      are inevitably sensitive to variation of the relative
                      weighting of the objectives. To address this issue, we
                      introduce coverage-based constraints for intensity-modulated
                      radiation therapy (IMRT) treatment planning. Our
                      implementation follows the concept of coverage-optimized
                      planning that considers explicit error scenarios to
                      calculate and optimize patient-specific probabilities
                      [Formula: see text] of covering a specific target volume
                      fraction [Formula: see text] with a certain dose [Formula:
                      see text]. Using a constraint-based reformulation of
                      coverage-based objectives we eliminate the trade-off between
                      coverage and competing objectives during treatment planning.
                      In-depth convergence tests including 324 treatment plan
                      optimizations demonstrate the reliability of coverage-based
                      constraints for varying levels of probability, dose and
                      volume. General clinical applicability of coverage-based
                      constraints is demonstrated for two cases. A sensitivity
                      analysis regarding penalty variations within this planing
                      study based on IMRT treatment planning using (1)
                      coverage-based constraints, (2) coverage-based objectives,
                      (3) probabilistic optimization, (4) robust optimization and
                      (5) conventional margins illustrates the potential benefit
                      of coverage-based constraints that do not require tedious
                      adjustment of target volume objectives.},
      cin          = {E040},
      ddc          = {570},
      cid          = {I:(DE-He78)E040-20160331},
      pnm          = {315 - Imaging and radiooncology (POF3-315)},
      pid          = {G:(DE-HGF)POF3-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:28741600},
      doi          = {10.1088/1361-6560/aa8132},
      url          = {https://inrepo02.dkfz.de/record/128101},
}