Development of a spatially indexed dose–volume histogram for treatment plan evaluation

Abstract Conventional dose–volume histograms (DVHs) lack spatial information, a critical limitation in evaluating carotid artery sparing in laryngeal volumetric-modulated arc therapy (VMAT). We developed a spatially indexed DVH that integrates the distance between the planning target volume (PTV) and carotid arteries for a more comprehensive plan quality assessment. Three representative cases (distant, intermediate, proximal) were analyzed. For each carotid voxel, dose and minimum Euclidean distance to the PTV were calculated. A color-coded cumulative DVH was generated by mapping the mean dose-specific distance (MDD) to a color gradient (red: proximal, blue: distal). Spatial metrics at 35 Gy were derived: minimum distance (dmin,35Gy), mean dose-specific distance (MD35Gy) and V35Gy,10mm (volume ≥35 Gy within 10 mm of PTV surface). The spatially indexed DVH visually identified spatial risk transitions. In the distant case, V35Gy,10mm was negligible (0.1 cc and N/A). In the intermediate case, despite a low conventional V35Gy (0.9 and 1.8 cc), proximity metrics revealed high-risk areas with a dmin,35Gy of 3.2 mm and V35Gy,10mm of 0.8 and 1.4 cc. The proximal case showed the highest risk, with the DVH shifting to red above 30 Gy; nearly all V35Gy (2.4 and 2.3 cc) was within the 10-mm high-risk zone (V35Gy,10mm: 2.0 and 1.7 cc), with a dmin,35Gy of 2.2 and 1.4 mm. The spatially indexed DVH provides an intuitive method to evaluate the spatial relationship between high-dose regions and the PTV, facilitating better risk stratification and optimization in laryngeal VMAT.