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@ARTICLE{Niebuhr:168316,
      author       = {N. I. Niebuhr$^*$ and M. Splinter$^*$ and T. Bostel$^*$ and
                      J. Seco$^*$ and C. M. Hentschke and R. O. Floca$^*$ and J.
                      Hörner-Rieber$^*$ and M. Alber and P. Huber$^*$ and N. H.
                      Nicolay$^*$ and A. Pfaffenberger$^*$},
      title        = {{B}iologically consistent dose accumulation using daily
                      patient imaging.},
      journal      = {Radiation oncology},
      volume       = {16},
      number       = {1},
      issn         = {1748-717X},
      address      = {London},
      publisher    = {BioMed Central},
      reportid     = {DKFZ-2021-00826},
      pages        = {65},
      year         = {2021},
      note         = {#EA:E040#LA:E040#},
      abstract     = {This work addresses a basic inconsistency in the way dose
                      is accumulated in radiotherapy when predicting the
                      biological effect based on the linear quadratic model (LQM).
                      To overcome this inconsistency, we introduce and evaluate
                      the concept of the total biological dose, bEQDd.Daily
                      computed tomography imaging of nine patients treated for
                      prostate carcinoma with intensity-modulated radiotherapy was
                      used to compute the delivered deformed dose on the basis of
                      deformable image registration (DIR). We compared
                      conventional dose accumulation (DA) with the newly
                      introduced bEQDd, a new method of accumulating biological
                      dose that considers each fraction dose and tissue
                      radiobiology. We investigated the impact of the applied
                      fractionation scheme (conventional/hypofractionated),
                      uncertainties induced by the DIR and by the assigned
                      α/β-value.bEQDd was systematically higher than the
                      conventionally accumulated dose with difference hot spots of
                      3.3-4.9 Gy detected in six out of nine patients in regions
                      of high dose gradient in the bladder and rectum. For
                      hypofractionation, differences are up to 8.4 Gy. The
                      difference amplitude was found to be in a similar range to
                      worst-case uncertainties induced by DIR and was higher than
                      that induced by α/β.Using bEQDd for dose accumulation
                      overcomes a potential systematic inaccuracy in biological
                      effect prediction based on accumulated dose. Highest impact
                      is found for serial-type late responding organs at risk in
                      dose gradient regions and for hypofractionation. Although
                      hot spot differences are in the order of several Gray, in
                      dose-volume parameters there is little difference compared
                      with using conventional or biological DA. However, when
                      local dose information is used, e.g. dose surface maps,
                      difference hot spots can potentially change outcomes of
                      dose-response modelling and adaptive treatment strategies.},
      keywords     = {Delivered dose (Other) / Dose accumulation (Other) / Image
                      guidance (Other) / Linear quadratic model (Other) / Normal
                      tissue response (Other) / Radiobiology (Other)},
      cin          = {E040 / E050 / E041 / E230 / E055},
      ddc          = {610},
      cid          = {I:(DE-He78)E040-20160331 / I:(DE-He78)E050-20160331 /
                      I:(DE-He78)E041-20160331 / I:(DE-He78)E230-20160331 /
                      I:(DE-He78)E055-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:33823885},
      doi          = {10.1186/s13014-021-01789-3},
      url          = {https://inrepo02.dkfz.de/record/168316},
}