The goal of radiotherapy is to maximize the dose to the target while minimizing the dose to normal tissue. Treatment plans are optimized for this goal and dose delivery is improved in accuracy and precision. The optimization is based on the delineations of the volumes of interest
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The goal of radiotherapy is to maximize the dose to the target while minimizing the dose to normal tissue. Treatment plans are optimized for this goal and dose delivery is improved in accuracy and precision. The optimization is based on the delineations of the volumes of interest on the medical images of the patient. The problem is that these delineations contain uncertainties and the effect of these uncertainties become more pronounced as the accuracy and precision of dose delivery improves. The delineation uncertainties are caused by various factors such as knowledge and experience of the observers, guidelines, and image quality and modality. The goal of this thesis is to research the effects of delineation uncertainties. Uncertainties are characterized using a rolling ball algorithm (RBA) to modify the delineation. The radius of the ball represents the uncertainty and ranges from -5 mm to 5 mm for the clinical target volume (CTV) and -2 mm to 2 mm for the brain stem. The effect of these uncertainties will be researched for both fixed and re-optimized dose distributions. These are then used as input to create a model that will simulate the dose distributions for different uncertainties using Polynomial Chaos Expansion (PCE). PCE will be used to model dose volume histograms (DVH) of the CTV and the brain stem. The dosimetric effect will be determined by setting confidence intervals in D98% of the CTV and D2% of the brain stem. The widths of the confidence intervals in these two metrics represent the dose uncertainty. This thesis uses three sets of patient data. Each patient had a CTV close to the brain stem. Dose uncertainty in the two metrics was found to increase as the uncertainty of CTV and brain stem delineation increases. For a fixed dose distribution, a delineation uncertainty of 0.75 mm to 1.25 mm in the CTV would lead to a dose uncertainty of 2 Gy in the D98% of the CTV. A delineation uncertainty of 0.25 mm to 0.5 mm in the brain stem would lead to the same dose uncertainty in D2% of the brain stem. For a re-optimized dose distribution, a combined delineation uncertainty of 1.25 mm for two patients and 4.5 mm for one patient would lead to a dose uncertainty of 2 Gy in D98% of the CTV. For the same dose uncertainty in the D2% of the brain stem, there would be a combined delineation uncertainty between 1.0 mm and 4.5 mm. For all three patients, the dose uncertainty in the D2% was more sensitive to delineation uncertainties in the brain stem. The effects of these uncertainties will depend on the nominal situation. For all patients a 2 Gy dose uncertainty corresponds to 2.85% of the prescribed dose to the CTV and 3.33% of the maximum dose constraint of the brain stem. One patient was on the boundary of underdosing the CTV in the nominal situation and a 2 Gy uncertainty would be sufficient to underdose the CTV. The nominal D2% for all three patients was sufficiently low that it is unlikely it would exceed the maximum dose constraint.