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Jenny Kouri
DOS 543 Seminar in Med Dos
November 10, 2015
Biologically Based Treatment Planning System (BBTPS)
At the VA Medical Center in Minneapolis, we use Phillips Pinnacle Treatment Planning System
(TPS), which incorporates BBTPS. BBTPS allows the planner to optimize and evaluate with
biologically related models/tools with biological cost functions: min EUD, max EUD, and target
EUD.1 The goal of EUD is to find the uniform dose that gives the same biological effect for a
given non-uniform dose distribution. The dose level of that uniform dose is then the equivalent
uniform dose of the non-uniform distribution.
The concept of EUD is tricky to grasp, which is why it is not used extensively. If the
EUD biological cost functions are used with caution and full understanding, then IMRT can yield
a reduction in overall planning time and optimal treatment plans. Targets, parallel organs, and
serial organs have different EUD adjustable parameters and should be defined prior to
optimization appropriately, which is determined by the value a. This is shown below2:
Effect
Suitable Organs
a<1
Lower doses are given higher
Targets
weights so that cold spots influence
the EUD to a large extent
a=1
Corresponds to the mean dose. Cold Parallel organized tissue
and hot spots are given equal weight such as lung and parotid
a>1
Larger doses are given higher
Serial tissue such as the
weights so that hot spots influence
spinal cord
the EUD to a large extent
For serial structures like the spinal cord, a maximum objective (typically 45 Gy or below)
is vital to satisfy the constraint. Any dose below the maximum will be overlooked by the TPS,
unless there were multiple dose volume objectives. If using the EUD cost function, the TPS will
continue to satisfy the max while trying to push even the lower doses. This is done by creating a
max EUD objective (set a large, positive number for a) and a single EUD objective (set a low
positive number for a). As of about two weeks ago, I started playing around with this cost
function during clinical. I was very excited when I saw this discussion assignment since I have
been trying to figure out how to make the most of the EUDs. I have not mastered serial structures
and EUDs; I need a lot more work

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For parallel structures like the lungs or the parotid glands, a maximum objective is not
needed since the focus is primarily on the mean dose. Historically, the mean dose is the best
measure of for acute and chronic complications for parallel tissues. To satisfy the mean dose, set
a to equal 1 for a max EUD. This creates more ease for the computer during optimization
instead of creating multiple DVH objectives to pre-define a DVH shape. For head and neck
cases, our clinic typically pushes the parotid glands with the EUD cost functions and has been
very successful at carving out the parotids while maintaining coverage for the intimate target
volumes.
Targets are more complicated and typically work better for a single target instead of
multiple PTVs. EUD objectives can be set as a min EUD (large negative a value) and a max
EUD (positive a value) or min EUD (large negative a value) and a max dose objective or
max and min dose objectives with a EUD objective (a=1) for a mean dose. I have only tried
this for a head and neck with 3 PTVs and was not successful, but I am looking forward to
planning with a single PTV and attempting to use the EUD objectives.
Since BBTPS is newer and less common, users must pay attention to the fractionation
scheme of their plan. If it is not of the norm, this being stereotactic or hypofractionation
planning, then EUD objectives will not be applicable since these were modeled after a certain
fractionation scheme. I am very interested to see if different types of BBTPS will develop for
different fractionation models.

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References
1. Allen Li X, Alber M, Deasy J, et al. The use and QA of biologically related models for
treatment planning: short report for the TG-166 of the therapy physics committee of the
AAPM. Med Phys. 2012; 39(3): 1386-1409. http://dx.doi.org/10.1118/1.3685447
2. Hardemark B, Liander A, Rehbinder H, et al. P3IMRT biological optimization and EUD.
Philips Medical Systems. Royal Philips Electronics N.V. 2004:1-3.