Surface dose display

Surface dose display is a means of comparing different treatment plans to evaluate which one is
optimal for patient treatment. It is a 3-dimensional (3D) display. The color on the surface of a
given 3D structure signifies the dose level. The color of each point gives the dose range and the
intensity is controlled by the distance of the given point from the viewer. This is depth cueing. A
number of structures can be displayed simultaneously. The real-time motion of the dose
distribution patterns overlaid on the anatomy can greatly assist in the understanding of displays
of 3D data. The concepts of images of regret can be extended to surfaces of regret as well in
which the color on the surface indicates the degree of deviation from the desired dose.1 The
dosimetrists at my clinic rarely use this feature. They used it in the past with an earlier version
of Pinnacle, but it often crashed the system. Thus, they got in the habit of not using it. However,
it can be useful as a visual representation of dose coverage of the PTV, as well as, dose to critical
structures. The images below demonstrate surface dose display for an esophagus patient. For
this case the goal was to deliver 95% of the prescription dose to 100% of the PTV. The coverage
of the PTV is demonstrated in figures 1-6. The surface dose display allows the user to change
the setting for both the contoured structure, as well as, for the isodose curve. Figures 1, 3, and 5
display the anterior, lateral, and superior views respectively of both the tumor and the isodose
line as surface. This fills in the contour. In contrast, figures 2, 4, and 6 display the anterior,
lateral, and superior views respectively of the tumor in the surface setting and the dose in the
transparent setting. It may be favorable to use the transparent setting to allow the visualization
of different contours that overlay one another simultaneously. Figures 7-9 represent the dose to
the heart, spinal cord, and PTV in the anterior, lateral, and superior views. Figures 10-12
demonstrate the dose to the total lungs minus the PTV. It should be noted although the figures
below only represent the anterior, lateral, and superior views, the surface dose display allows the
user to manipulate the structures to be viewed in any axis. Furthermore, the application also
allows multiple dose levels to be displayed at the same time. Often the more structures and
doses added to the display the more challenging it is to analyze all the dose distributions to
certain regions of interest. (Joseph Lynch, CMD, oral communication, March 25, 2016).

Figure 1. Anterior View

Turquoise: PTV
Lavender: 95%
PTV: Min PTV dose greater than or equal to 95% prescription dose

Figure 2. Anterior View

Turquoise: PTV
Lavender: 95%
PTV: Min PTV dose greater than or equal to 95% prescription dose

Figure 3. Lateral View

Turquoise: PTV
Lavender : 95%
PTV: Min PTV dose greater than or equal to 95% prescription dose

Figure 4. Lateral View

Turquoise: PTV
Lavender : 95%
PTV: Min PTV dose greater than or equal to 95% prescription dose

Figure 5. Superior View

Turquoise: PTV
Lavender : 95%
PTV: Min PTV dose greater than or equal to 95% prescription dose

Figure 6. Superior View

Turquoise: PTV
Lavender : 95%
PTV: Min PTV dose greater than or equal to 95% prescription dose

Figure 7. Anterior View

Turquoise: PTV
Red: Heart
Blue: Spinal Cord
Yellow: 4500 cGy
Heart: 66% of the heart can receive max of 4500 cGy
Spinal Cord: Max dose to 0.03 cc 4500

Figure 8. Lateral View

Turquoise: PTV
Red: Heart
Blue: Spinal Cord
Yellow: 4500 cGy
Heart: 66% of the heart can receive max of 4500 cGy
Spinal Cord: Max dose to 0.03 cc 4500

Figure 9. Superior View

Turquoise: PTV
Red: Heart
Blue: Spinal Cord
Yellow: 4500 cGy
Heart: 66% of the heart can receive max of 4500 cGy
Spinal Cord: Max dose to 0.03 cc 4500

Figure 10. Anterior View
Turquoise: PTV
Yellow/Green: Total Lungs - PTV
Pink: 2000 cGy
Total Lungs - PTV: : 37% of the total lungs - PTV can receive max of 2000 cGy


Figure 11. Lateral View
Turquoise: PTV
Yellow/Green: Total Lungs - PTV
Pink: 2000 cGy
Total Lungs - PTV: : 37% of the total lungs - PTV can receive max of 2000 cGy

Figure 12. Superior View
Turquoise: PTV
Yellow/Green: Total Lungs - PTV
Pink: 2000 cGy
Total Lungs - PTV: 37% of the total lungs - PTV can receive max of 2000 cGy

1. Kahn F, Gerbi B. Treatment Planning in Radiation Oncology. 3rd ed. Philadelphia, PA:
Lippincott, Williams & Wilkins; 2012.