Skip to main content Accessibility help

Evaluation of various dose homogeneity indices for treatment of patients with cervix cancer using intensity-modulated radiation therapy technique

  • Atia Atiq (a1), Maria Atiq (a1), Khalid Iqbal (a2), Quratul Ain Shamsi (a1) and Saeed Ahmad Buzdar (a1)...



This study is primarily aimed at the analysis of various dose homogeneity indices (HIs) essential for the evaluation of therapeutic plans by employing intensity-modulated radiation therapy (IMRT) on patients with cervix cancer. Also integral dose (ID) to healthy surrounding organs is computed.

Materials and methods

Effectiveness of different HIs (A, B, C, D) was explored for IMRT plans using 15 MV photon beam. In total, 18 patients were selected at random for treatment of cervix cancer, and dose of 5,040 cGy was delivered in 28 equal fractions.


The study was undertaken to compare four HI formulas and coefficient of determination between each set of HI was known by calculating R2 value. Mean±SD of HI A, HI B, HI C and HI D were 1·12±0·02, 0·13±0·04, 0·10±0·02 and 0·99±0·03, respectively. Mean value of ID for rectum is 3·16 and for bladder is 10·3.


Our data suggested that HI calculated using four formulas provided good plan quality. The results advocate that all the studied HIs can be effectively used for assessment of uniformity inside the target volume. However, values of HI C were closest to ideal value as compared with other three formulas; hence, it is considered a better measure to compute homogeneity of dose within target volume. The ID gives satisfactory results for surrounding normal tissues such as rectum and bladder and significant critical tissue sparing was achieved by using IMRT technique.


Corresponding author

Author for correspondence: Atia Atiq, Department of Physics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan. Tel: +92 33363 87927. E-mail:


Hide All

Cite this article: Atiq A, Atiq M, Iqbal K, Shamsi QA, Buzdar SA. (2019) Evaluation of various dose homogeneity indices for treatment of patients with cervix cancer using intensity-modulated radiation therapy technique. Journal of Radiotherapy in Practice18: 32–37. doi: 10.1017/S1460396918000249



Hide All
1. Norihisa, Y, Mizowaki, T, Takayama, K et al. Detailed dosimetric evaluation of intensity-modulated radiation therapy plans created for stage C prostate cancer based on a planning protocol. Int J Clin Oncol 2012; 17 (5): 505511.
2. Yang, R, Xu, S, Jiang, W, Wang, J, Xie, C. Dosimetric comparison of postoperative whole pelvic radiotherapy for endometrial cancer using three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and helical tomotherapy. Acta Oncol 2010; 49 (2): 230236.
3. Sheng, Y. Dose-guided automatic IMRT planning: a feasibility study. Doctoral dissertation, Duke University, 2014.
4. Wydra, D, Emerich, J, Sawicki, S, Ciach, K, Marciniak, A. Major complications following exenteration in cases of pelvic malignancy: a 10-year experience. World J Gastroenterol 2006; 12 (7): 11151119.
5. Feuvret, L, Noël, G, Mazeron, JJ, Bey, P. Conformity index: a review. Int J Radiat Oncol Biol Phys 2006; 64 (2): 333342.
6. Atiq, M, Atiq, A, Iqbal, K, Shamsi, Q, Andleeb, F, Buzdar, SA. Evaluation of dose conformity and coverage of target volume for intensity-modulated radiotherapy of pelvic cancer treatment. Indian J Cancer 2017; 54 (1): 379384.
7. Hawrylewicz, L, Leszczyński, W, Namysł-Kaletka, A, Bronclik, I, Wydmański, J. Protection of organs at risk during neoadjuvant chemoradiotherapy for gastric cancer based on a comparison between conformal and intensity-modulated radiation therapy. Oncol Lett 2016; 12 (1): 692698.
8. Helal, A, Omar, A. Homogeneity index: effective tool for evaluation of 3DCRT. Pan Arab J Oncol 2015; 8 (2): 2024.
9. Lu, JY, Lin, Z, Zheng, J, Lin, PX, Cheung, ML, Huang, BT. Dosimetric evaluation of a simple planning method for improving intensity-modulated radiotherapy for stage III lung cancer. Sci Rep 2016; 6: 23543.
10. Aoyama, H, Westerly, DC, Mackie, TR et al. Integral radiation dose to normal structures with conformal external beam radiation. Int J Radiat Oncol Biol Phys 2006; 64 (3): 962967.
11. Pasciuti, K, Kuthpady, S, Anderson, A, Best, B, Waqar, S, Chowdhury, S. Bladder radiotherapy treatment: a retrospective comparison of 3-dimensional conformal radiotherapy, intensity-modulated radiation therapy, and volumetric-modulated arc therapy plans. Med Dosim 2017; 42 (1): 16.
12. Pathak, P, Vashisht, S. A quantitative analysis of intensity-modulated radiation therapy plans and comparison of homogeneity indices for the treatment of gynecological cancers. J Med Phys 2013; 38 (2): 6773.
13. Naik, A, Gurjar, OP, Bagdare, P et al. Dosimetric comparison between intensity modulated radiotherapy and three dimensional conformal radiotherapy planning in patients with locally advanced cervical carcinoma. Int J Radiat Res 2016; 14 (3): 189196.
14. Shaw, E, Kline, R, Gillin, M et al. Radiation Therapy Oncology Group: radiosurgery quality assurance guidelines. Int J Radiat Oncol Biol Phys 1993; 27 (5): 12311239.
15. Kataria, T, Sharma, K, Subramani, V, Karrthick, KP, Bisht, SS. Homogeneity index: an objective tool for assessment of conformal radiation treatments. J Med Phys 2012; 37 (4): 207213.
16. Yoon, M, Park, SY, Shin, D et al. A new homogeneity index based on statistical analysis of the dose–volume histogram. J Appl Clin Med Phys 2007; 8 (2): 917.
17. Oliver, M, Chen, J, Wong, E, Van Dyk, J, Perera, F. A treatment planning study comparing whole breast radiation therapy against conformal, IMRT and tomotherapy for accelerated partial breast irradiation. Radiother Oncol 2007; 82 (3): 317323.
18. Grégoire, V, Mackie, TR. State of the art on dose prescription, reporting and recording in Intensity-Modulated Radiation Therapy (ICRU report No. 83). Cancer/Radiothérapie 2011; 15 (6): 555559.
19. Magalhães, E. Evaluation of IMRT and VMAT techniques with and without flattening filter using pareto optimal fronts. Doctoral dissertation, Lisbon, 2012.
20. Dybwad, A. Comparison of dose distributions resulting from IMRT and VMAT, and assessment of MLC leaf positioning errors. Master’s thesis, Institutt for fysikk, 2013.
21. Sharyan, HA, Allehyani, SH, Tolba, AR. Dosimetric comparison of 3DCRT versus RapidArc in terms of iso-dose distribution, dose volume histogram (DVH) and dosimetric results for the PTV and critical organs for glioblastoma (GBM). Am J Med Med Sci 2015; 5 (5): 208219.
22. Murthy, K, Shukeili, K, Kumar, S, Davis, C, Chandran, R, Namrata, S. Evaluation of dose coverage to target volume and normal tissue sparing in the adjuvant radiotherapy of gastric cancers: 3D-CRT compared with dynamic IMRT. Biomed Imaging Interv J 2010; 6 (3): e29.
23. Krishna, GS, Srinivas, V, Ayyangar, KM, Reddy, PY. Comparative study of old and new versions of treatment planning system using dose volume histogram indices of clinical plans. J Med Phys 2016; 41 (3): 192197.
24. Yomo, S, Tamura, M, Carron, R, Porcheron, D, Régis, J. A quantitative comparison of radiosurgical treatment parameters in vestibular schwannomas: the Leksell Gamma Knife Perfexion versus Model 4C. Acta Neurochirurgica 2010; 152 (1): 4755.
25. Hermanto, U, Frija, EK, Lii, MJ, Chang, EL, Mahajan, A, Woo, SY. Intensity-modulated radiotherapy (IMRT) and conventional three-dimensional conformal radiotherapy for high-grade gliomas: does IMRT increase the integral dose to normal brain? Int J Radiat Oncol Biol Phys 2007; 67 (4): 11351144.
26. Palm, Å, Johansson, KA. A review of the impact of photon and proton external beam radiotherapy treatment modalities on the dose distribution in field and out-of-field; implications for the long-term morbidity of cancer survivors. Acta Oncol 2007; 46 (4): 462473.
27. International Commission on Radiation Units and Measurements (ICRU). Prescribing, Recording and Reporting Photon Beam Therapy (Supplement to ICRU Report 50). ICRU Report 62. Bethesda, MD: International Commission on Radiation Units and Measurements, 1999.
28. Jhingran, A, Winter, K, Portelance, L et al. A phase II study of intensity modulated radiation therapy to the pelvis for postoperative patients with endometrial carcinoma: radiation therapy oncology group trial 0418. Int J Radiat Oncol Biol Phys 2012; 84 (1): e23e28.
29. Donovan, E, Bleakley, N, Denholm, E et al. Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol 2007; 82 (3): 254264.
30. Michalski, JM, Moughan, J, Purdy, JA et al. Initial results of a phase III randomized study of high-dose 3DCRT/IMRT versus standard dose 3D-CRT/IMRT in patients treated for localized prostate cancer (RTOG 0126). Int J Radiat Oncol Biol Phys 2014; 90 (5): 12631264.
31. Saenz, DL, Paliwal, BR, Bayouth, JE. A dose homogeneity and conformity evaluation between ViewRay and pinnacle-based linear accelerator IMRT treatment plans. J Med Phys 2014; 39 (2): 6470.



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed