Chair Heterogeneity Index: Describing the dose heterogeneity inside the tumor volume where there is a boost volume

In this report, Chair Heterogeneity Index (CHI) was introduced to assess the dose heterogeneity inside the target with a boost volume. CHI was defined by dividing (V(Rx) − V(Dl)) by (V(Dm) − V(Dh)): V(Rx), V(Dl), V(Dm) and V(Dh) were four points selected from the target cumulative dose volume histogram curve. The effectiveness of CHI was validated by assessing the treatment plans for nasopharyngeal cancer (NPC, 12 cases), breast cancer after breast-conserving-surgery (BC, 10 cases), and stereotactic radiosurgery after whole brain irradiation (SRS, 9 cases). Our results indicate that both CHI and HI of the target can distinguish Volumetric Modulated Arc Therapy (VMAT) from Intensity Modulated Radiation Therapy (IMRT, p < 0.05) while the mean differences in CHI (NPC 1.16, BC 1.19 and SRS 3.3) were larger than those in HI (NPC 0.03, BC 0.02 and SRS 0.02). In addition, CHI of the combination volume (the target minus the boost) were statistically higher in VMAT than IMRT in all three kinds of cancer. In conclusion, CHI was effective in assessing the dose heterogeneity inside a target containing a boost volume.