DVH Dose Limits

Many of you may have seen the DVH Dose Limit poster published by Mobius 3D
found HERE . This chart stems from many past studies and protocols. The values
found in this chart are frequently used as an initial reference when treatment
planning. The most notable history of dose limiting values includes studies
published by Emami and the QUANTEC studies.
After researching QUANTEC and Emami publications in radiation oncology, post
your answer to the following questions:

How does QUANTEC differ from the Emami data originally published in 1991? What
are some of the limitations of any published data?

DVH Dose Limits

Before 1991, the radiation dose and the size of the treatment fields for radiation therapy
treatment were chosen by the physicians merely based on experience. They understood that these
empirical data were imprecise/ inadequate and did not confirm to the anatomy, physiology and
dosimetry.¹
In 1991, a committee of eight well know clinicians from major institutions in the US was formed
to address this issue and they published Emami’s Paper.¹ They decided that an organ to be
divided into one-third, two-third and whole organ volume. The main goal of this publication was
to address a clinical need based on available information that time and there was still needed
research in this area. Below were limitations of their work:¹
1. It was a literature review up to 1991
2. It predated the 3D-CRT IMRT-IGRT era and DVH
3. It was a tabulation of the estimate for three of the aforementioned arbitrary volumes
4. It was only for external beam with conventional fractionation
5. Only one severe complication was chosen as an endpoint
In 2009, a group or physicians and researchers formed a group called QUANTEC (The
Quantitative Analysis of Normal Tissue Effects in the Clinic).² Their goal was to simplify the
volumetric/ dosimetric information on normal tissue complication and to provide reliable
predictive models between dose-volume parameters and the normal tissue complications. As
with Emami’s Paper, QUANTEC also had its limitations:²
1. The complexity of the subject
2. It lacks the ‘user friendliness” for day-to-day practice

Comparison of Emami vs QUANTEC³

Emami et al QUANTEC
Number of organs 26 16
3D data available Minimal More/ moderate (18 year interval
Format dose/ volume limits Uniform TD 5/5, 50/5 Non-uniform
for ⅓, ⅔, 3/3
Endpoints Specific Specific
Expert opinion Moderate Less

References:
1. Marks LB, Yorke ED, Jackson A, et al. Use of normal tissue complication probability
models in the clinic. Int. J. Radiation Oncology Biol. Phys.2010;76(3):S10-S19
Retrieved from: http://www.sascro.co.za/downloads/Quantec.pdf. Accessed January
28, 2018.
2. Emami B, Lyman J, Brown A. Tolerance of normal tissue to therapeutic radiation.
Retrieved from:
http://cdn.neoscriber.org/cdn/serve/eb/27/eb27adb334594d3093f4ed1b7d088c0a7a39
0f0b/4316-13810-1-PB.pdf. Accessed January 28, 2018
3. Marks LB. Predicting normal tissue injury in the modern era: a review of
QUANTED. Retrieved from: https://www.aapm.org/meetings/amos2/pdf/59-17107-
99588-657.pdf. Accessed January 28, 2018.