CN116209499A - Volume correlation of dose and dose rate information for radiation treatment planning - Google Patents

Abstract

A method for planning a radiation treatment, accessing (802) information comprising a calculated dose and a calculated dose rate for a sub-volume in a treatment target, and also accessing (804) information comprising metric values of the sub-volume as a function of the calculated dose and the calculated dose rate. The graphical user interface includes a rendering based on the calculated dose, the calculated dose rate, and the metric value (806).

Description

Correlation of dose and dose rate information to volumes for radiation treatment planning

Cross References to Related Applications

This application claims priority to U.S. Provisional Application Serial No. 63/043,027, filed June 23, 2020, by Lansonneur et al., entitled "Correlation of Dose and dose rate information to Volume radiation treatment planning," which is incorporated by reference in its Incorporated into this article as a whole.

Background technique

The use of radiation therapy to treat cancer is well known. In general, radiation therapy involves directing beams of high-energy proton, photon, ion, or electron radiation ("therapeutic radiation") into a target or volume within the treatment target (eg, a volume including a tumor or lesion).

Before treating a patient with radiation, a treatment plan specific to that patient is developed. The plan uses simulations and optimizations that can be based on past experience to define aspects of the treatment. Typically, the goal of a treatment plan is to deliver sufficient radiation to unhealthy tissue while minimizing radiation exposure to surrounding healthy tissue.

The aim of the planner is to find the optimal solution with respect to multiple clinical objectives, which is contradictory in the sense that improvements towards one objective may have detrimental effects on the attainment of another. For example, a treatment plan that spares the liver a certain dose of radiation may result in too much radiation to the stomach. These types of tradeoffs lead to an iterative process in which the planner creates different plans to find the one that is best suited to achieve the desired outcome.

Relatively recent radiation biology studies have demonstrated the effectiveness of delivering an entire relatively high therapeutic radiation dose to a target within a single short period of time. This type of treatment is generally referred to herein as FLASH radiation therapy (FLASHRT). Evidence to date suggests that FLASH RT advantageously spares normal healthy tissue from damage when the tissue is exposed to high radiation doses for only a short period of time.

FLASH RT introduces important interdependencies not captured by traditional radiation treatment planning. Current tools such as dose-volume histograms and dose-rate-volume histograms do not capture the interdependence of dose and dose rate. For example, from a clinician's perspective, it is not trivial to develop a dose rate profile for a high-quality plan, since normal tissue may benefit from low dose rates in certain regions if dose is minimized in these regions. Also, for example, irradiating a limited number of spots in the treatment volume can lead to high dose rate delivery, but low dose uniformity at the tumor level, while on the other hand, can be improved by increasing the number of spots at the expense of reduced dose rate. plan quality.

Contents of the invention

In one aspect, the invention provides a computer system as defined in claim 1 . In another aspect, the present invention provides a non-transitory computer-readable storage medium having computer-executable instructions for causing a computer system to perform the method for planning radiation treatment as defined in claim 12 method. In another aspect, the present invention provides a non-transitory computer-readable storage medium having computer-executable instructions for causing a computer system to perform the method for planning radiation treatment as defined in claim 17 method. Optional features are specified in the dependent claims.

Accordingly, some embodiments according to the present invention provide an improved method for generating and evaluating radiation treatment plans for FLASH radiation treatment (FLASH RT) and improving radiation treatment based on these plans.

In some embodiments, a computer-implemented method for planning radiation treatment includes accessing calculations including calculated doses and calculated information on the dose rate, and also accesses information including a measure (eg, number, percentage, or fraction) of the subvolume as a function of the calculated dose and the calculated dose rate. A graphical user interface (GUI) including rendering (eg, a visual display) based on the calculated dose, calculated dose rate, and metric values is then displayed.

In some embodiments, a visualization (e.g., a graphical element) comprising a dose-volume histogram as a first dimension (e.g., an element or aspect of the visualization, or a spatial dimension in a virtual space) of the GUI is drawn, as a second dimension of the GUI Visualization of dose rate-volume histograms in two dimensions, and visualization of metric values in a third dimension as a GUI. For example, rendering may include visualization of calculated dose rates for each subvolume, visualization of calculated doses for each subvolume, and visualization of metrics for each subvolume. In some embodiments, mapping also includes visualization of prescribed dose and prescribed dose rate. In some embodiments, mapping also includes visualization of the normal tissue complication probability for each subvolume. In some embodiments, the mapping also includes visualization of the probability of tumor control for each subvolume. In some embodiments, different property values (eg, color, pattern, gray scale, alphanumeric text, or brightness) are associated with the visualized elements.

Allowing clinicians to better assess the balance between dose rate and dose uniformity, a GUI is displayed that visualizes the calculated dose and calculated dose rate for a subvolume in the treatment target, as well as the calculated dose and A measure of the function that calculates the dose rate. Essentially in a single glance, the clinician can assess the quality of the proposed radiation treatment plan, make changes to the suggested plan, and evaluate the results of the changes.

In radiation therapy techniques, where the intensity of the particle beam is constant or modulated over the delivery field, such as in intensity-modulated radiation therapy (IMRT) and intensity-modulated particle therapy (IMPT), the beam intensity varies with each treatment of the patient. The area (volume within the treatment target) is varied. Depending on the processing mode, the degrees of freedom available for intensity modulation include beam shaping (collimation), beam weighting (spot scanning) and angle of incidence (which may be referred to as beam geometry). These degrees of freedom lead to an almost infinite number of potential treatment plans, so consistently and efficiently generating and evaluating high-quality treatment plans is beyond human capabilities and relies on the use of computer systems, especially when considered in relation to the use of radiation therapy to treat conditions such as cancer. Time constraints associated with disease, and the presence of large numbers of patients undergoing or needing to undergo radiation therapy during any given time period.

Some embodiments according to the invention improve radiation treatment planning and treatment itself by extending FLASH RT to a wider variety of treatment platforms and target sites (eg, tumors). By optimizing the balance between the dose rate delivered to unhealthy tissue (e.g., a tumor) in the volume of the treatment target and the dose rate delivered to surrounding healthy tissue, as compared to conventional techniques for FLASH dose rate, as described herein The treatment plan generated above is optimal for sparing healthy tissue from radiation. When used with the FLASH dose rate, management of patient motion is simplified because the dose is administered over a short period of time (eg, less than a second). Processing planning, while still a complex task, has been improved over conventional processing planning. In addition to these benefits, the GUI helps planners by allowing planners to easily visualize key elements of proposed treatment plans, easily visualize the impact of changes to proposed plans on those elements and compare different plans, and define and establish optimization goals Facilitate treatment plans.

In summary, some embodiments according to the present disclosure relate to generating and implementing a treatment plan that is the most effective (relative to other plans) and has the fewest (or most acceptable) side effects (e.g., outside the treated area lower dose rates). Thus, some embodiments according to the invention improve the field of radiation treatment planning in particular, and the field of radiation therapy in general. Some embodiments according to the invention allow for faster generation of more efficient treatment plans. Furthermore, some embodiments according to the present invention help to improve the functionality of the computer because, for example, by reducing the complexity of generating processing plans, less computing resources are required and consumed, which also means that computer resources are freed up to perform other tasks.

In addition to radiation therapy techniques such as IMRT and IMPT, embodiments according to the present invention may be used in spatially fractionated radiation therapy, including high-dose spatially fractionated grid radiation therapy, mini-beam radiation therapy, and micro-beam radiation therapy.

These and other objects and advantages according to embodiments of the present invention will be appreciated by those skilled in the art after reading the following detailed description illustrated in the various figures.

This overview is provided to introduce some concepts that are further described below in the Detailed Description. This Summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended to be used to limit the scope of the claimed subject matter.

Description of drawings

The accompanying drawings, which are incorporated in and form a part of this specification and in which like numerals describe like elements, illustrate embodiments of the disclosure and, together with the detailed description, serve to explain the principles of the disclosure.

Figure 1 is a block diagram of one example of a computer system upon which embodiments described herein may be implemented.

Figure 2 is a block diagram illustrating one example of an automated radiation therapy treatment planning system in an embodiment according to the invention.

Figure 3 illustrates a knowledge-based planning system in an embodiment according to the invention.

Figure 4 is a block diagram illustrating selected components of a radiation therapy system upon which an embodiment according to the present invention may be implemented.

5A and 5B illustrate examples of dose rate-volume histograms in one embodiment according to the invention.

Figure 5C illustrates sub-volumes within a volume of treatment targets in one embodiment according to the invention.

Figure 5D illustrates an example of an illumination time-volume histogram in one embodiment according to the invention.

6 is a flowchart of one example of computer-implemented operations for radiation treatment planning in an embodiment in accordance with the invention.

Figure 7 illustrates an example of dose rate contours in an embodiment according to the invention.

8, 9, and 10 are flowcharts of one example of computer-implemented operations for planning radiation treatment in an embodiment in accordance with the invention.

Figures 11, 12, 13A, 13B, 14-28, 29A, 29B, 30A, 30B and 31-35 are examples of graphical user interfaces on display devices and are used in accordance with the present invention An embodiment of planning radiation treatment.

Detailed ways

Reference will now be made in detail to various embodiments of the present disclosure, examples of which are illustrated in the accompanying drawings. While described in conjunction with these embodiments, it will be understood that they are not intended to limit the disclosure to these embodiments. On the contrary, the disclosure is intended to cover alternatives, modifications and equivalents, which may be included within the spirit and scope of the disclosure as defined by the appended claims. Furthermore, in the following detailed description of the present disclosure, numerous specific details are set forth in order to provide a thorough understanding of the present disclosure. However, it is understood that the present disclosure may be practiced without these specific details. In other instances, well-known methods, procedures, components, and circuits have not been described in detail so as not to unnecessarily obscure aspects of the present disclosure.

Some portions of the detailed description that follows are presented in terms of procedures, logical blocks, processing, and other symbolic representations of operations on data bits within a computer memory. These descriptions and representations are the means used by those skilled in the data processing arts to most effectively convey the substance of their work to others skilled in the art. In this application, a procedure, logic block, procedure, etc. is considered to be a self-consistent sequence of steps or instructions leading to a desired result. The steps are those employing physical manipulations of physical quantities. Usually, though not necessarily, these quantities take the form of electrical or magnetic signals capable of being stored, transferred, combined, compared, and otherwise manipulated in a computer system. It has proven convenient at times, principally for reasons of common usage, to refer to these signals as transactions, bits, values, elements, symbols, characters, samples, pixels, or the like.

It should be borne in mind, however, that all of these and similar terms are to be associated with the appropriate physical quantities and are merely convenient labels applied to these quantities. Unless otherwise stated, as will be apparent from the following discussion, it should be understood that throughout this disclosure references to terms such as "access", "generate", "represent", "apply", "instruct", "store", "use", Discussion of terms such as "adjust", "include", "compute", "operate", "determine", "visualize", "display", "draw", "relate", "interval", or "round" is Refers to the actions and processes (eg, the flowcharts of FIGS. 6 and 8-10 ) of a computer system or similar electronic computing device or processor (eg, computer system 100 of FIG. 1 ). A computer system or similar electronic computing device manipulates and transforms data represented as physical (electronic) quantities within a computer system memory, registers, or other such information storage, transmission, or display device.

The ensuing discussion includes terms such as "dose", "dose rate", "energy", etc. Unless otherwise stated, a value is associated with each such term. For example, dose has a value and can have different values. For simplicity, the term "dosage" may refer to values such as dosage unless otherwise stated or apparent from the discussion.

Portions of the detailed description below are presented and discussed in terms of methods. Although steps and their ordering describing the operation of these methods are disclosed in the figures herein (eg, FIGS. 6 and 8-10 ), these steps and ordering are merely examples. Embodiments are well suited to performing various other steps or variations of steps recited in the flowcharts of the figures herein, in sequences other than those depicted and described herein.

Embodiments described herein may be discussed in the general context of computer-executable instructions residing on some form of computer-readable storage medium, such as a program module, and executed by one or more computers or other device execution. By way of example, and not limitation, computer readable storage media may comprise non-transitory computer storage media and communication media. Generally, program modules include routines, programs, objects, components, data structures, etc. that perform particular tasks or implement particular abstract data types. The functions of the program modules can be combined or distributed in various embodiments as required.

Computer storage media includes volatile and nonvolatile, removable and non-removable media implemented in any method or technology for storage of information such as computer readable instructions, data structures, program modules or other data. Computer storage media include, but are not limited to, random access memory (RAM), read only memory (ROM), electrically erasable programmable ROM (EEPROM), flash memory or other memory technologies, compact disc ROM (CD-ROM), digital multifunction Disk (DVD) or other optical storage, magnetic disk storage, magnetic tape, magnetic disk storage or other magnetic storage device, or any other medium that can be used to store the desired information and can be accessed to retrieve that information.

Communication media can embody computer-executable instructions, data structures and program modules and includes any information delivery media. By way of example, and not limitation, communication media includes wired media such as a wired network or direct-wired connection, and wireless media such as acoustic, radio frequency (RF), infrared and other wireless media. Combinations of any of the above should also be included within the scope of computer readable media.

Radiation treatment plans using different types of histograms

FIG. 1 shows a block diagram of one example of a computer system 100 upon which embodiments described herein may be implemented. In its most basic configuration, system 100 includes at least one processing unit 102 and memory 104 . This most basic configuration is illustrated by dashed line 106 in FIG. 1 . System 100 may also have additional features and/or functionality. For example, system 100 may also include additional storage (removable and/or non-removable) including, but not limited to, magnetic or optical disks or tape. Such additional storage is illustrated in FIG. 1 by removable storage 108 and non-removable storage 120 . System 100 may also contain communication connection(s) 122 that allow a device to communicate with other devices, eg, in a networked environment using logical connections to one or more remote computers.

System 100 also includes input device(s) 124, such as a keyboard, mouse, pen, voice input device, touch input device, and the like. Also included are output device(s) 126 such as display devices, speakers, printers, and the like. The display device may be, for example, a cathode ray tube display, a light emitting diode display or a liquid crystal display.

In the example of FIG. 1 , memory 104 includes computer readable instructions, data structures, program modules, etc., associated with "optimizer" model 150 . However, the optimizer model 150 may alternatively reside in any one of the computer storage media used by the system 100, or may be distributed on some combination of computer storage media, or may be distributed on some combination of networked computers superior. The functionality of the optimizer model 150 is described below.

Figure 2 is a block diagram illustrating one example of an automated radiation therapy treatment planning system 200 in an embodiment according to the invention. The system 200 includes an input interface 210 that receives patient-specific information (data) 201 , a data processing component 220 that implements the optimizer model 150 , and an output interface 230 . System 200 may be implemented, in whole or in part, on or using computer system 100 (FIG. 1) as a software program, hardware logic, or a combination thereof.

In the example of FIG. 2 , patient-specific information is provided to and processed by optimizer model 150 . In an embodiment, the optimizer model 150 generates predictions, and a treatment plan based on the predictions may then be generated.

FIG. 3 illustrates a knowledge-based planning system 300 in an embodiment according to the invention. In the example of FIG. 3 , system 300 includes knowledge base 302 and process planning toolset 310 . Knowledge base 302 includes patient records 304 (eg, radiation treatment plans), treatment types 306 , and statistical models 308 . Treatment planning toolset 310 in the example of FIG. 3 includes current patient record 312 , treatment type 314 , medical image processing module 316 , optimizer model (module) 150 , dose distribution module 320 , and final radiation treatment plan 322 .

Treatment planning toolset 310 searches knowledge base 302 (via patient record 304 ) for previous patient records that are similar to current patient record 312 . The statistical model 308 can be used to compare the predicted results for the current patient record 312 to statistical patients. Using the current patient record 312 , the selected treatment type 306 , and the selected statistical model 308 , the toolset 310 generates a radiation treatment plan 322 .

More specifically, based on past clinical experience, there may be the type of treatment that is most frequently used when a patient exhibits a particular diagnosis, stage, age, weight, sex, comorbidities, and the like. The first step treatment type can be selected 314 by selecting a treatment type that the planner has used in the past for similar patients. Patient outcomes can be included in the treatment planning process, which can include normal tissue complication probabilities as a function of dose rate and patient-specific treatment type outcomes (e.g., local recurrence failure, and overall survival as a function of dose and/or dose rate ). The medical image processing module 316 provides automatic contouring and automatic segmentation of two-dimensional cross-sectional slices (e.g., from any imaging modality such as, but not limited to, computed tomography (CT), positron emission tomography-CT, magnetic resonance imaging, and ultrasound) , to form a three-dimensional (3D) image using the medical images in the current patient record 312 . The dose and dose rate distribution maps are calculated by the dose and dose rate distribution module 320 , which may utilize the optimizer model 150 .

In an embodiment according to the invention, the optimizer model 150 uses a dose prediction model to provide, for example, a 3D dose distribution, fluence and dose rate, and associated dose-volume histograms (DVH) and dose-volume histograms ( DRVH).

The discussion that follows deals with beams, volumes, doses, dose rates, and other elements or values. The following discussion is in the context of processing modeling elements and calculated values in planning toolset 310 and optimizer model 150 (FIG. 3), unless otherwise noted or explicitly stated in the discussion.

FIG. 4 is a block diagram illustrating selected components of a radiation therapy system 400 upon which embodiments according to the present invention may be implemented. In the example of FIG. 4 , system 400 includes beam system 404 and nozzle 406 .

Beam system 404 generates and delivers beam 401 . Beam 401 may be a beam of protons, electrons, photons, ions, or nuclei (eg, carbon, helium, and lithium). In an embodiment, beam system 404 includes components that direct (eg, bend, steer, or direct) the beam system in a direction toward nozzle 406 and into nozzle 406 , depending on the type of beam. In an embodiment, the radiation therapy system may include one or more multi-leaf collimators (MLCs); each MLC leaf may be moved back and forth independently by the control system 410 to dynamically shape the aperture through which the beam may pass to block the Or parts of the beam that are not blocked, thereby controlling the beam shape and exposure time. The beam system 404 may also include components for regulating (eg, reducing) the energy of the beam entering the nozzle 406 .

The nozzle 406 is used to direct the beam at various locations (volumes in the treatment target) (eg, volumes in the patient) in the treatment chamber supported on a patient support 408 (eg, chair or table). The volume in the treatment target can be an organ, a portion of an organ (eg, a volume or region within an organ), a tumor, diseased tissue, or patient contour. Volumes in the treatment target can include unhealthy tissue (eg, a tumor) and healthy tissue. The volume in the treatment target can be (virtually) divided into voxels. A subvolume may comprise a single voxel or multiple voxels.

Nozzle 406 may be mounted on a gantry or a portion of a gantry that is movable relative to patient support 408, which may also be movable. In an embodiment, beam system 404 is also mounted on or part of a gantry. In another embodiment, the beam system is separate from (but in communication with) the gantry.

The control system 410 of Figure 4 receives and implements a prescribed radiation treatment plan. In an embodiment, the control system 410 includes a computer system having a processor, memory, input devices (eg, a keyboard), and possibly a display in a known manner. Control system 410 may receive data regarding the operation of system 400 . Control system 410 may control parameters of beam system 404, nozzle 406, and patient support 408, including parameters such as beam energy, intensity, direction, size, and/or shape, based on the data it receives and in accordance with a prescribed radiation treatment plan. parameter.

As mentioned above, the jet 401 entering the nozzle 406 has a certain energy. Accordingly, in an embodiment in accordance with the present disclosure, nozzle 406 includes one or more components that affect (eg, reduce, modulate) the energy of the beam. The term "beam energy modifier" is used herein as a general term for one or more components that affect the energy of a beam in order to control the extent of the beam depending on the type of beam (e.g., the amount of beam penetration into a target). extent), control the dose delivered by the beam and/or control the depth-dose curve of the beam. For example, for a proton or ion beam having a Bragg peak, the beam energy modifier can control the position of the Bragg peak in the volume of the treatment target. In various embodiments, the beam energy modifier 407 includes a range modulator, a range shifter, or both a range modulator and a range shifter.

In radiation therapy techniques in which the intensity of the particle beam is constant or modulated across the delivery field, such as Intensity Modulated Radiation Therapy (IMRT) and Intensity Modulated Particle Therapy (IMPT), the beam intensity is constant or modulated at each treatment region in the patient (the volume in the treatment target) is variable. Depending on the processing mode, the degrees of freedom available for intensity modulation include beam shaping (collimation), beam weighting (spot scanning) and angle of incidence (which may be referred to as beam geometry). These degrees of freedom lead to an almost infinite number of potential treatment plans, and thus the consistent and efficient generation and evaluation of high-quality treatment plans is beyond human capabilities and relies on the use of computer systems, especially when considered in relation to the use of radiation therapy to treat diseases such as cancer time constraints associated with the disease, and the large number of patients undergoing or needing to undergo radiation therapy during any given time period.

The beam 401 may have virtually any regular or irregular cross-sectional (eg, eye view of the beam) shape. For example, the shape of beam 401 may be defined using an MLC that occludes a portion or portions of the beam. Different beams can have different shapes.

In an embodiment, the beam 401 comprises a certain number of beam segments or sub-beams (may also be referred to as spots). Beam 401 is assigned a maximum energy (eg, 80 MeV), and the energy level of each beam segment is defined as a percentage or fraction of the maximum energy. Essentially, each beam segment is weighted according to its energy level; some beam segments are weighted to have a higher energy level than others. By weighting the energy of each beam segment, in effect, the intensity of each beam segment is also weighted. A defined energy level or intensity can be achieved for each beam segment using the beam energy conditioner 407 .

Each beam segment can deliver a relatively high dose rate (relatively high dose over a relatively short period of time). For example, each beam segment may deliver at least 40 Grays (Gy) in less than a second, and may deliver as much as 120 Gy per second or more.

In operation, in an embodiment, beam segments are delivered sequentially. For example, a first beam segment is delivered to the volume in the treatment target (on), and then off, then a second beam segment is on, then off, and so on. Each beam segment may only be turned on for a fraction of a second (eg, on the order of milliseconds).

A single beam can be used and applied from different directions and in the same plane or in different planes. Alternatively, multiple beams may be used in the same plane or in different planes. The direction and/or number of beams may be varied over multiple sessions (ie, split in time) such that a uniform dose is delivered over the volume of the treatment target. The number of beams delivered at any one time depends on the number of gantry or nozzles in the radiation treatment system (eg, radiation treatment system 400 of FIG. 4 ) and the treatment plan.

In an embodiment according to the invention, a DRVH (which is distinct from a DVH) is generated for the volume in the treatment target. A DRVH can be generated based on a proposed radiation treatment plan. The DRVH can be stored in computer system memory and used to generate the final radiation treatment plan to be used to treat the patient. Values of parameters affecting dose rate may be adjusted until the DRVH meets or relates to goals for patient therapy.

Figure 5A illustrates an example of a DRVH 500 in an embodiment according to the present invention. DRVH plots the cumulative dose rate-volume in the treatment target frequency distribution, which summarizes the simulated dose rate distribution within the treatment target volume of interest resulting from the proposed radiation treatment plan. The simulated dose rate distribution may be determined using the optimizer model 150 of FIG. 1 . DRVH indicates the dose rate and the percentage of the volume of the treated target that receives that dose rate. For example, as shown in Figure 5A, 100% of the volume in the treatment target receives a dose rate of X or greater (at least X), 50% of the volume in the treatment target receives a dose rate of Y or greater (at least Y), etc. . DRVH 500 may be displayed as a graphical user interface (GUI) or a portion thereof (see discussion below).

For example, a volume in a treatment target may include different organs, or it may include healthy tissue and unhealthy tissue (eg, a tumor). Accordingly, referring to FIGS. 5B and 5C , the DRVH 510 includes a plurality of curves 512 and 514 respectively showing the curves for a first sub-volume 522 of the volume 504 in the treatment target (e.g., for an organ, or for healthy tissue). A simulated dose rate distribution and a simulated dose rate distribution for a second subvolume 524 (eg, for a second organ, or for unhealthy tissue). More than two simulated dose rate distributions can be included in the DRVH. DRVH 510 may be displayed as or as part of a GUI.

In an embodiment according to the invention, an illumination time-volume histogram (which is different from, but can be used with, DVH and/or DRVH) is generated for the volume in the treatment target. The exposure time-volume histogram may be stored in computer system memory and used in conjunction with or instead of the DVH and/or DRVH to generate a radiation treatment plan.

Figure 5D illustrates an example of an illumination time-volume histogram 550 in one embodiment in accordance with the present invention. The exposure time-volume histogram plots the cumulative exposure time-volume in the treatment target frequency distribution, which summarizes the simulated exposure time distribution within the volume of the treatment target that would result from the proposed radiation treatment plan. The simulated irradiation time distribution can be determined using the optimizer model 150 of FIG. 1 . The irradiation time-volume histogram indicates the irradiation times (time lengths) and the percentage of the volume irradiated for those time lengths. DRVH 550 may be displayed as or as part of a GUI.

6 is a flowchart 600 of one example of computer-implemented operations for radiation treatment planning including generating a DVH, DRVH or exposure time-volume histogram in some embodiments according to the invention. Flowchart 600 may be implemented as computer-executable instructions (eg, optimizer model 150 of FIG. 1 ) residing on some form of computer-readable storage medium (eg, in memory of computer system 100 of FIG. 1 ). .

In block 602 of FIG. 6 , a suggested radiation treatment plan is defined (eg, using the optimizer model 150 of FIGS. 1 and 2 ), stored in, and accessed from computer system memory. The recommended radiation treatment plan includes values for parameters that may affect dose and dose rate, as well as other parameters. Parameters that can affect dose and dose rate include, but are not limited to, the number of shots to treat the volume in the target, the duration of each shot (irradiation time), and the dose deposited in each shot. The parameters may also include the direction of the beams to be directed into the volume of the treatment target, and the beam energy of each beam. Parameters may also include the period of time during which the irradiation is applied (e.g., multiple irradiations are applied over a period of time such as one hour, where each irradiation in the period is separated from the next by another period of time) and each The time interval between exposure sessions (for example, each hour-long session is separated by a day from the next). If the volume in the treatment target is divided into subvolumes or voxels, the parameter values may be based on each subvolume or voxel (eg, a value per subvolume or voxel).

Appropriate dose threshold curve(s) (eg, normal tissue retained dose versus dose rate or exposure time) can be utilized in optimization model 150 (FIG. 3) to formulate dose limits for radiation treatment plans. For example, beam direction (gantry angle) and beam segment weighting can be determined using an appropriate (eg tissue-dependent) dose threshold curve. That is, parameters affecting dose can be adjusted during radiation treatment planning such that constraints in the dose threshold curve are met. Dose threshold curves can be tissue dependent. For example, the dose threshold curve for the lungs may be different than the dose threshold curve for the brain.

Dose constraints may include, but are not limited to: a maximum limit on irradiation time for each subvolume (voxel) in the target (e.g., treatment time less than x1 seconds for each voxel of target tissue); voxel) of irradiation time (e.g., treatment time is less than x2 seconds for each voxel of normal tissue; x1 and x2 can be the same or different); minimum dose rate for each subvolume (voxel) in the target constraints (e.g., dose rate greater than y1 Gy/sec for each voxel of target tissue); and/or minimum constraints on dose rate for each subvolume (voxel) outside the target (e.g., for each voxel of normal tissue prime, the dose rate is greater than y2 Gy/sec; y1 and y2 can be the same or different). Typically, the limits are aimed at minimizing the amount of time normal tissue is irradiated.

In block 604, in one embodiment, a DVH and a DRVH are generated based on parameter values in the proposed radiation treatment plan. Dose and dose rate can be determined for each subvolume or voxel. The dose rate is the sum of the doses deposited in each irradiation divided by the sum of the irradiation durations. Dose rates can be determined and recorded using fine-grained temporal indices (e.g., time increments on the order of milliseconds); that is, for example, the dose per subvolume or voxel can be measured in time increments per beam and per section on the order of milliseconds. amount to record. Dose and dose rate are cumulative. For example, depending on the beam direction and energy, some parts of the volume in the target (eg, subvolumes or voxels) may be treated with higher cumulative doses and dose rates than others. Dose and dose rate per subvolume or voxel can be calculated to include ray tracing (and Monte Carlo simulations), where each beam particle is tracked to determine the primary scattering, secondary scattering, etc. Acquire true voxel-based or subvolume-based dose rates during each shot.

In one embodiment, an illumination time-volume histogram is generated. Irradiation time-volume histograms can be generated in essentially the same manner as just described for generating DRVHs.

In block 606, the DVH, DRVH, and/or exposure time-volume histogram may be evaluated by determining whether the proposed radiation treatment plan satisfies the goals (eg, clinical goals) specified for the treatment of the patient. Clinical goals or goals can be expressed in terms of a set of quality metrics (such as goal homogeneity, vital organ preservation, etc.) with corresponding target values. Another way of evaluating histograms is a knowledge-based approach that incorporates and reflects current best practice gleaned from multiple previous similar treatments of other patients. Yet another way to assist the planner is to use a multi-criteria optimization (MCO) method for process planning. Pareto surface navigation is an MCO technique that facilitates the exploration of trade-offs between clinical objectives. For a given set of clinical objectives, a treatment plan is considered Pareto optimal if it satisfies those objectives and if no metric can be improved without worsening at least one other metric.

As noted above, for FLASH RT, dose rates of at least 40 Gy in less than 1 second, and as much as 120 Gy per second or more, can be used. Therefore, another way to assess DVH and DRVH is to define dose thresholds and dose rate thresholds based on the FLASH RT dose rate, and also specify thresholds for dose and dose rate in treatment targets. DVH and DRVH can be assessed by determining whether a measure of the volume in the treatment target (eg, fraction, number, or percentage of subvolumes or voxels) satisfies dose and dose rate thresholds. For example, a dose rate volume histogram may be considered satisfactory if 60% of the volume in the treatment target (in particular, the fraction of the volume in the treatment target comprising unhealthy tissue) receives a dose rate of at least 50 Gy per second.

In block 608 of FIG. 6 , some or all of the parameter values of the proposed radiation treatment plan may be iteratively adjusted to generate different DVH, DRVH and/or exposure time-volume histograms to determine the resulting histogram A final set of parameter values (or multiple histograms) that results in a prescribed (final) radiation treatment plan that best meets the goals of patient treatment (clinical goals) or meets the aforementioned thresholds.

In block 610, the final set of parameter values is then included in a prescribed radiation treatment plan for treating the patient.

In general, radiation treatment plans are optimized based on dose, dose rate, and/or exposure time in accordance with embodiments of the present invention. This is not to say that treatment plan optimization is based solely on dose, dose rate and/or exposure time.

Correlation of dose, dose rate and volume for treatment plans

8, 9, and 10 are flowcharts 800, 900, and 1000 (800-1000) of examples of computer-implemented methods for planning radiation treatment in embodiments according to the invention. Flowcharts 800-1000 may be implemented as computer-executable instructions (eg, optimizer model 150 of FIG. 1 ) residing on some form of computer-readable storage medium (eg, in memory of computer system 100 of FIG. ). In these embodiments, a GUI is generated and displayed as a result of the disclosed methods. For example, the GUI visualizes the calculated dose (eg, total calculated dose) and calculated dose rate of a subvolume in the target in a single rendering, and the metric of the subvolume as a function of the calculated dose and calculated dose rate. Examples of GUIs according to the present invention are provided in Figures 11, 12, 13A, 13B and 14-28, 29A, 29B, 30A, 30B and 31-35.

In block 802 of FIG. 8 , the calculated dose (e.g., the total calculated dose) for a subvolume (e.g., any number of voxels of any three-dimensional shape making up the volume of the subvolume) in the treatment target is accessed from computer system memory. and calculated dose rate information, and information including a measure (eg, number, percentage, or fraction) of the subvolume as a function of the calculated dose and the calculated dose rate.

In block 804, information including a measure (number, percentage, or fraction) of the subvolume as a function of calculated dose (eg, total calculated dose) and calculated dose rate is also accessed from computer system memory.

In block 806, a GUI including a rendering (eg, a visual display) based on the calculated dose, calculated dose rate, and metric values is displayed on the computer system's display device 126 (FIG. 1).

In block 808 of FIG. 8, different property values (eg, color, pattern, grayscale, alphanumeric text, or brightness) are associated with elements of the visualization in the GUI.

Referring now to FIG. 9, in block 902, a radiation treatment plan is accessed from computer system memory. The radiation treatment plan includes, for example, the number of beams to be directed into and into the volume in the treatment target, the direction of the beams, and the range of dose rates for each beam.

In block 904, the dose per subvolume (eg, the total dose) is calculated using the number and direction of the beams and the range of dose rates.

In block 906, the dose rate for each subvolume is calculated using the number and direction of the beams and the range of dose rates.

In block 908, for different levels or ranges (e.g., intervals) of dose (e.g., total dose) and different levels or ranges (e.g., intervals) of dose rate, a determination is made to receive at least a corresponding dose level (e.g., total dose). dose) and at least a measure (eg, number, fraction, or percentage) of the subvolume corresponding to the dose rate level.

In block 910, a GUI including a rendering (eg, a visual display) based on the calculated dose, calculated dose rate, and metric values is displayed on the display device 126 (FIG. 1).

Referring now to FIG. 10, in block 1002, a DVH for a volume in a treatment target is generated.

In block 1004, a volumetric DRVH is generated.

In block 1006, a GUI including the combined rendering of the DVH and DRVH is displayed on the computer system's display device 126 (FIG. 1). The combined plot visualizes the measure of the volume computed to receive a given dose as a function of dose rate, and also visualizes the measure of the volume computed to receive a given dose rate as a function of dose.

In an embodiment, the rendering in the GUI generated and displayed as described above includes the visualization of the DVH (e.g., the graphic element ), visualization of DRVH as the second dimension of the GUI, and visualization of metric values as the third dimension of the GUI. For example, rendering may include visualization of calculated dose rates for each subvolume, visualization of calculated doses for each subvolume (eg, calculated total dose), and visualization of metrics for each subvolume. In an embodiment, the mapping also includes visualization of the prescribed dose and prescribed dose rate. In an embodiment, the mapping also includes visualization of the normal tissue complication probability (NTCP) for each subvolume. In an embodiment, the mapping also includes visualization of the probability of tumor control (TCP) for each subvolume.

Although the operations in FIG. 6 and FIGS. 8-10 are presented in series and in a particular order, the invention is not limited thereto. These operations may be performed in a different order and/or in parallel, and operations may also be performed in an iterative fashion. As mentioned above, due to the different parameters that need to be considered, the ranges of values of these parameters, the interrelationships of these parameters, the need for efficient treatment plans with minimal risk to the patient, and the need for rapid generation of high quality treatment plans , it is important to use an optimizer model 150 that executes consistently on the computer system 100 (FIG. 1) for radiation treatment planning as disclosed herein.

11, 12, 13A, 13B, and 14-28, 29A, 29B, 30A, 30B, and 31-35 illustrate radiation treatments that may be used to display and plan radiation in accordance with an embodiment of the invention. An example of a GUI with associated information. The GUI may be generated using the methods described above, and using computer-executable instructions (e.g., the optimizer model 150 of FIG. ) and can be displayed on the output device 126 of the computer system.

Embodiments in accordance with the invention are not limited to the GUIs illustrated in FIGS. 11, 12, 13A, 13B and 14-28, 29A, 29B, 30A, 30B and 31-35. In general, the GUI in embodiments according to the invention allows the interdependence between dose, dose rate, dose per volume and dose rate, and measures of volume as a function of dose and as a function of dose rate to be easily visualized. Visualization for radiation treatment planning. In the discussion below, doses, dose rates, etc. are calculated values.

Furthermore, the disclosed GUIs may include information other than that included in the examples. For example, the GUI can also be used to present information such as the direction of the beams to be directed into each sub-volume and the beam energy of each beam.

In an embodiment, drop-down menus or other types of GUI elements (not shown) may be used to select and establish GUI settings (e.g., properties, thresholds, etc.) and (multiple) of information to be displayed at any one time. )type.

Furthermore, a GUI does not have to be a static display. For example, the information presented in the GUI can be programmed to change over time or in response to user input to illustrate cumulative dose or dose rate versus time. Also, for example, the GUI can be programmed to sequentially present different cross-sectional slices of the volume in the treatment target to provide a depth dimension to the two-dimensional representation, or to manipulate (e.g., rotate) the virtual three-dimensional representation so that it can be viewed from different perspectives .

In the example of FIG. 11 , GUI 1100 includes a two-dimensional plot of dose rate versus dose. Dose and dose rate per subvolume (eg, voxel) are plotted in two dimensions. The distribution (metric) of the subvolumes is projected onto the dose axis to generate the DVH, and also onto the dose rate axis to generate the DRVH.

In the example of FIG. 12, GUI 1200 includes two-dimensional plots of dose rate versus dose for normal tissue and for tumor. Dose and dose rate per subvolume (eg, voxel) are visualized (plotted) in two dimensions. Tissue-specific filters are defined in the graph for normal tissue and tumor-specific filters are defined in the graph for tumor tissue. Different filters can be defined to account for different tissue responses to dose and dose rate. Voxels can be color coded to indicate relative values of NTCP and TCP. In the example of FIG. 12, a color key is included in GUI 1200 and is associated with each graph as shown. The color of the voxel in the graph can be compared to the key to indicate the relative value of NTCP or TCP.

In the example of FIGS. 13A and 13B , GUI 1300 includes visualization of dose and dose rate. GUI 1300 includes the rendering of a plane at the isocenter of the volume of the treatment target. The total area of the plane is divided into different smaller regions, where the size of each smaller region is indicative of (eg, proportional to) the volume of the target receiving a certain dose level (FIG. 13A) or dose rate (FIG. 13B). Smaller areas can be color coded to indicate dose levels. In the example of FIGS. 13A and 13B , color keys are included in GUI 1300 to associate colors in the plot with different dose levels and different dose rate levels, respectively. The color of each smaller area can be compared to the color in the key to determine the dose/dose rate level for each smaller area.

In the example of FIG. 14 , GUI 1400 includes plots of dose along one axis and a measure (percentage) of the volume receiving a given dose along the corresponding axis, and dose rate along the other axis and receiving a given dose along the corresponding axis. Plotting of dose rate as a percentage of volume. GUI 1400 is useful for visualizing and identifying qualitative trends. In this figure, each "X" represents a voxel with dose and dose rate. Each "X" has some transparency so that the density of the points in the graph can be visualized.

In the example of FIG. 15, GUI 1500 includes a two-dimensional plot of dose rate levels (ranges or intervals) on one axis and dose levels (ranges or intervals) on the other axis. A measure (percentage) of volume received for a given combination of dose and dose rate is projected into the plot. In the example of FIG. 15, about 9% of the volume receives a dose of at least about 17.5 Gy at a dose rate of about 250 Gy per second. The projection of the volume can be color coded to indicate a measure of the volume receiving a given dose and dose rate. In the example of FIG. 15 , color keys are included in GUI 1500 to associate colors in the drawing with different measures of volume. The color or colors of the projection of the volume can be compared to the colors in the key to determine the dose/dose rate level for each smaller area.

GUI 1500 allows easy visualization and identification of overall quantitative properties. For example, intra-field dose rate gradients and field edges with peaks of 18 Gy and 260 Gy per second, respectively, are easily visualized as shown by the circled areas in Figures 16, 17, and 18.

In the example of FIG. 19, GUI 1900 includes a two-dimensional plot of dose rate levels (ranges or intervals) on one axis and dose levels (ranges or intervals) on the other axis. In this example, for each point in the plot, a measure (eg, a percentage) of the volume at or above the dose level and dose rate is represented as a color. In the example of FIG. 19 , color keys are included in GUI 1900 to associate colors in the drawing with different measures of volume. Also, in this example, the horizontal slice (indicated by the dashed line in Figure 19) represents the DVH of the volumetric region above a given dose rate.

In the example of FIG. 20, GUI 2000 includes a two-dimensional plot of dose rate levels (ranges or intervals) on one axis and dose levels (ranges or intervals) on the other axis. In this example, each line in the plot represents a measure (eg, a percentage) of volume at or above a given dose level and dose rate. In the example of FIG. 20, each line is a different color, and a color key is included in GUI 2000 to associate the color of the line being drawn with a different measure of volume. For example, in the example of FIG. 21, approximately 60% of the volume receives at least 17.5 Gy at a dose rate of at least 250 Gy per second.

In the example of FIG. 22, GUI 2000 also includes an area 2010 representing the prescribed dose and dose rate. In this example, the prescription is at least 150 Gy per second to 90% of the volume receiving more than 10 Gy. In this example, the prescription is satisfied because the area 2010 is enclosed by a line corresponding to 90% of the volume.

In the example of FIG. 23 , for a given dose rate (e.g., at least 40 Gy per second), GUI 2300 includes a two-dimensional plot of dose rate levels (ranges or intervals) on one axis and received dose rates on the other axis. A measure (fraction) of volume for a given dose. In this example, each line in the plot represents a different subvolume (eg, planning target volume (PTV), right lung, and spinal cord). In the example of FIG. 23, each line is a different color, and a color key is included in GUI 2300 to associate the color of the line being drawn with the associated subvolume. In this example, 80% of the PTVs received doses above 60Gy and a dose rate of 40Gy per second.

In the example of FIG. 24, GUI 2400 includes a two-dimensional plot of dose rate levels (range or interval) on one axis and a measure (percentage) of the volume receiving a given dose on the other axis. GUI 2400 represents a graph of the DVH for regions at or above a certain dose rate. In this example, each line in the plot represents a different dose rate. In the example of FIG. 24, each line is a different color, and a color key is included in the GUI 2400 to associate the color of the line being drawn with a different dose rate.

In the example of FIG. 25 , for a given dose rate (e.g., 150 Gy per second), GUI 2500 includes a two-dimensional plot of dose rate levels (range or bin) on one axis and received given dose rates on the other axis. A measure (percentage) of the volume of a given dose. GUI 2500 represents a visualization (graph) of the DVH for regions at or above a given dose rate. In the example of FIG. 25, GUI 2500 also includes an area 2502 representing the prescribed dose and dose rate. In this example, the prescription is at least 150 Gy per second to 90% of the volume receiving more than 10 Gy.

In the example of FIG. 26 , GUI 2600 includes the plotting of a scatter plot of dose rate levels (ranges or intervals) on one axis and dose levels (ranges or intervals) on the other axis, showing different subvolumes (e.g. , spinal cord, right lung and PTV) dose and dose rate distribution. In this example, each subvolume is represented as a different color, and a color key is included in the GUI 2600 to associate the colors in the drawing with the different subvolumes.

In the examples of FIGS. 27 and 28 , GUIs 2700 and 2800 include rendering of volumes (eg, CT images). In these examples, contour lines of different colors are used to delineate portions of the volume (eg, voxels) that have doses and dose rates above a certain threshold, below a certain threshold, or within a certain range. Color keys are included in GUIs 2700 and 2800 to associate colors in the plot with dose levels, for example. In the example of FIG. 27 , the dose distribution is shown in the depicted rectangular area only for subvolumes (voxels) with dose rates between 40 Gy and 120 Gy per second. In the example of FIG. 28 , the depicted rectangular area contains voxels with a dose above 10 Gy and a dose rate above 10 Gy per second.

In the example of FIG. 29A , GUI 2900 includes a plot of cumulative dose versus time. GUI 2900 is useful for determining the time interval (dt) required to deliver a given dose level (eg, 90%).

Figure 29B illustrates an example of a GUI 2910 where more than one dose rate is specified per voxel. When a specific dose or dose rate range is specified, the corresponding dose is displayed. In the example of Figure 29B, the lower line in the graph (which can be displayed using a first color) represents dose rate as a function of time, and the upper line in the graph (which can be displayed in a second, different color) represents dose rate as a function of time. cumulative dose. The slope of the upper line is the dose rate as a function of time. For the illustrated voxels, GUI 2910 provides visualization of dose, average dose rate, and dose to be delivered for a dose rate or range of dose rates. In this example, GUI 2910 shows a dose of 60Gy, an average dose rate of approximately 40Gy per second, and a dose of approximately 40Gy delivered at a dose rate in the range of 150Gy to 200Gy per second.

In the example of FIG. 30A , GUI 3000 includes the rendering of an overlay of isodose contour lines on the dose rate distribution in a volume (eg, a CT image). In the example of Figure 30A, different colors are used to indicate different dose levels and different dose rates. Color keys are included in GUI 3000 to associate colors in the plot with dose levels and dose rates. The plots can be manipulated using the keys by using the pointers shown in the figure to select different dose levels and different dose rates to be plotted in the GUI 3000 . For example, one color could be used to represent doses in the 5-11 Gy range, and different shades of that color could be used to represent different dose rate ranges corresponding to that dose range (e.g., 151-201 Gy, 201-252 Gy, and 252-303Gy). The user can interactively change the position of the pointer on either or both of the vertical and horizontal axes. By changing the positions of these pointers, the corresponding ranges of doses and dose rates associated with a particular color or shade are also changed, and the isodose contour lines in GUI 3000 will be changed accordingly.

Figure 30B illustrates an example of a GUI 3010 in which doses corresponding to a particular dose rate range are drawn on top of a CT image (eg, the CT image also shown in Figure 30A). In this example, dose rate range limits are applied individually for each voxel and the corresponding fraction of the dose is visualized. Alternatively, a dose rate distribution limited by the accumulated dose in each voxel can be visualized; for example, the GUI can display the dose rate in each voxel at which X percent of the dose has been accumulated at each voxel dosage. The user can select the dose percentage used to select the displayed dose rate for each voxel. Similar to above, the user can also interactively select and adjust the position of the pointer to associate colors with dose ranges. In this example, the user can also adjust the position of the pointer to select a dose rate range. Only the doses that will be delivered at the selected dose rate are drawn in the GUI 3010. The example of Figure 30B shows isodose contours for doses to be delivered at a dose rate range of 201-252 Gy per second.

In the example of FIG. 31 , for a given volume or subvolume (e.g., structure "S1"), GUI 3100 includes dose rate levels (ranges or intervals) on one axis of the graph and dose rate levels (ranges or intervals) on the other axis of the graph. A two-dimensional plot of the measure (percentage) of the volume on which a given dose is received. The lines in the graph delineate the different areas of the visualization. These lines delimit regions representing different DVHs corresponding to different dose rates. In this example, each region is represented by a different coloring level, and a key is included in GUI 3100 to associate the coloring level in the visualization with dose level and dose rate. Also, in this example, different pointers are included in the drawing to indicate different purposes (eg, prescribed dose and dose rate).

In the example of FIG. 32 , GUI 3200 includes rendering of the area where the beams overlap in three dimensions. The number of times a voxel is traversed by the beam is color-coded. GUI 3200 includes x and y coordinates in the plane of the volume shown in the visualization, and also includes a z coordinate indicating the depth of the plane in the volume. Specific targets in the volume are outlined in the example of FIG. 32 . In this example, five beams are shown, and a key is included in GUI 3200 to associate the color of a voxel with the number of beams reaching that voxel.

In the example of FIG. 33 , GUI 3300 includes a plot of the cumulative dose delivered above a certain dose rate threshold (eg, above 40 Gy per second). In the example of Figure 33, different colors are used to indicate different cumulative doses. A color key is included in the GUI 3300 to associate colors in the plot with dose levels and dose rates. Specific targets in the volume are outlined in the example of FIG. 33 .

In the example of FIG. 34 , GUI 3400 includes a plot of the cumulative dose delivered below a certain dose rate threshold (eg, below 40 Gy per second). In the example of Figure 34, different colors are used to indicate different cumulative doses. Color keys are included in the GUI 3400 to associate colors in the plot with dose levels and dose rates. Specific targets in the volume are outlined in the example of FIG. 34 .

In the example of FIG. 35 , GUI 3500 includes a plot of the DVH for doses delivered above a certain dose rate threshold (eg, above 40 Gy per second). In this example, the dashed line represents total DVH, and the solid line represents DVH above a certain dose rate threshold (eg, above 40 Gy per second). The difference between each pair of solid and dashed lines indicates the portion of the organ at risk volume that was not delivered at a sufficiently high dose rate. In the example of Figure 35, different colors are used to indicate different organs or structures. Color keys are included in GUI 3500 to associate colors in the drawing with different organs or structures.

In summary, some embodiments according to the invention improve radiation treatment planning and treatment itself by extending FLASH RT to a wider variety of treatment platforms and target sites. Compared to conventional techniques, even for non-FLASH dose rates, by design reducing (if not minimizing) the magnitude (and in some cases integration) of the dose to normal tissue (off-target), as described herein The resulting treatment plan is optimal for sparing normal tissue from radiation. When used with the FLASH dose rate, management of patient motion is simplified because the dose is administered over a short period of time (eg, less than a second). Process planning, while still a complex task of finding a balance between competing and relevant parameters, is simplified relative to conventional planning. The techniques described herein can be used in stereotactic radiation surgery and stereotactic body radiation therapy with single or multiple metastases.

In addition to these benefits, the GUI also readily visualizes the impact of changes to the proposed treatment plan on those elements by allowing the planner to easily visualize key elements of the proposed treatment plan (e.g., dose rate per subvolume), and Easily visualize comparisons between different plans to facilitate treatment planning.

In addition to radiation treatment techniques where the intensity of the particle beam is constant or modulated over the delivery field (such as IMRT and IMPT), embodiments according to the invention may be used for space-fractionated radiation treatment, including high-dose space-fractionated grid radiation treatment, mini-beam radiation therapy and micro-beam radiation treatment.

Although the subject matter has been described in language specific to structural features and/or methodological acts, it is to be understood that the subject matter defined in the appended claims is not necessarily limited to the specific features or acts described above. Rather, the specific features and acts described above are disclosed as example forms of implementing the claims.

Claims (20)

1. A computer system comprising: processor; a display device coupled to the processor; and a memory coupled to the processor and comprising instructions that, when executed, cause the processor to perform a method for planning radiation treatment, the method comprising: accessing information including calculated doses and calculated dose rates for treating a plurality of subvolumes in a volume in a target; accessing information comprising measures of said plurality of subvolumes as a function of said calculated dose and said calculated dose rate; and A graphical user interface (GUI) including a plot based on the calculated dose, the calculated dose rate, and the metric value is displayed on the display device. 2. The computer system of claim 1, wherein said rendering comprises visualization of a dose-volume histogram as a first dimension of said GUI, a visualization of a dose-volume histogram as a second dimension of said GUI. Visualization, and visualization of the metric as a third dimension of the GUI. 3. The computer system of claim 1 or 2, wherein the rendering comprises a visualization of the calculated dose for each subvolume of the plurality of subvolumes. 4. The computer system of claim 1 , 2 or 3, wherein the rendering comprises a visualization of a calculated dose rate for each subvolume of the plurality of subvolumes. 5. The computer system of claim 1 , 2, 3 or 4, wherein the rendering includes a visualization of the metric value for each subvolume of the plurality of subvolumes. 6. The computer system of any one of claims 1 to 5, wherein the mapping further comprises visualization of prescribed dose and prescribed dose rate. 7. The computer system of any one of claims 1 to 6, wherein the GUI further comprises a visualization of a normal tissue complication probability for each subvolume of the plurality of subvolumes. 8. The computer system of any one of claims 1 to 7, wherein the GUI further comprises a visualization of a probability of tumor control for each subvolume of the plurality of subvolumes. 9. The computer system according to any one of claims 1 to 8, wherein the method further comprises: associating attribute values to said rendered elements corresponding to said calculated dose, said calculated dose rate, and said metric value; and The element is displayed according to the attribute value. 10. The computer system of claim 9, wherein the attribute value is a value of an attribute selected from the group consisting of: color, pattern, gray scale, alphanumeric text, and brightness. 11. The computer system according to any one of claims 1 to 10, wherein said mapping further comprises isodose contours and isodose rate contours. 12. A non-transitory computer readable storage medium having computer executable instructions for causing a computer system to perform a method for planning radiation treatment, the method comprising: accessing a radiation treatment plan including the number of beams to be directed into and into a volume in a treatment target, the direction of the beams, and a range of dose rates for each of the beams , wherein the volume includes a plurality of subvolumes; calculating a dose for each subvolume of the plurality of subvolumes using the number and direction of the beams and the dose rate range; calculating a dose rate for each subvolume of the plurality of subvolumes using the number and direction of the beams and the dose rate range; For a different dose level and a different dose rate level, determining a measure of the subvolume calculated to receive at least the corresponding dose level and at least the corresponding dose rate level; and A graphical user interface (GUI) including a result of the determination is displayed on a display device of the computer system. 13. The non-transitory computer readable storage medium of claim 12, wherein the GUI includes a visualization of a dose-volume histogram as a first dimension of the GUI, a dose volume histogram as a second dimension of the GUI. Visualization of the rate-volume histogram, and visualization of the metric as a third dimension of the GUI. 14. The non-transitory computer readable storage medium of claim 12 or 13, wherein the rendering includes one or more visualizations selected from the group consisting of: each subvolume of the plurality of subvolumes A visualization of the calculated dose for the volume, a calculated dose rate for each of the plurality of subvolumes, and a visualization of the metric value for each of the plurality of subvolumes. 15. The non-transitory computer readable storage medium of any one of claims 12 to 14, wherein the rendering further comprises one or more visualizations selected from the group consisting of: prescription dose and A visualization of a prescribed dose rate, a visualization of a probability of normal tissue complications for each of the plurality of subvolumes, and a visualization of a probability of tumor control for each of the plurality of subvolumes. 16. The non-transitory computer readable storage medium of any one of claims 12 to 15, wherein the method further comprises: associating attribute values to said rendered elements corresponding to said calculated dose, said calculated dose rate, and said metric value; and The element is displayed according to the attribute value. 17. A non-transitory computer readable storage medium having computer executable instructions for causing a computer system to perform a method for planning radiation treatment, the method comprising: generating a dose-volume histogram (DVH) for a volume in a treatment target, wherein the DVH is indicative of a measure of the volume receiving a dose; generating a dose rate-volume histogram (DRVH) for the volume, wherein the DRVH indicates a measure of the volume receiving dose rate; and A graphical user interface (GUI) is displayed on a display device of the computer system, the graphical user interface comprising a combined rendering of the DVH and the DRVH, wherein the combined rendering will be calculated as the A measure of volume is visualized as a function of dose rate, and a measure of said volume calculated to receive a given dose rate is also visualized as a function of dose. 18. The non-transitory computer readable storage medium of claim 17, wherein the GUI includes a visualization of the DVH as a first dimension of the GUI, the DRVH as a second dimension of the GUI , and the visualization of the metric as the third dimension of the GUI. 19. The non-transitory computer readable storage medium of claim 17 or 18, wherein the rendering includes one or more visualizations selected from the group consisting of: each subvolume of the plurality of subvolumes A visualization of the calculated dose for the volume, a calculated dose rate for each of the plurality of subvolumes, and a visualization of the metric value for each of the plurality of subvolumes. 20. The non-transitory computer readable storage medium of claim 17, 18 or 19, wherein the rendering further comprises one or more visualizations selected from the group consisting of: prescription dose and prescription dose A visualization of a rate, a visualization of a normal tissue complication probability for each of the plurality of subvolumes, and a visualization of a tumor control probability for each of the plurality of subvolumes.

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