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We report on a retrospective dosimetric study, comparing 3D conformal radiotherapy ( 3DCRT ) and hybrid intensity modulated radiotherapy ( hIMRT ). We evaluated plans based on their planning target volume coverage, dose homogeneity, dose to organs at risk ( OAR s) and exposure of normal tissue to radiation. The Homogeneity Index ( HI ) was used to assess the dose homogeneity in the target region, and we describe a new index, the normal tissue index ( NTI ), to assess the dose in the normal tissue inside the tangent treatment portal.    Methods  Plans were generated for 25 early‐stage breast cancer patients, using a  hIMRT  technique. These were compared with the 3 DCRT  plans of the treatment previously received by the patients. Plan quality was evaluated using the  HI ,  NTI  and dose to  OAR s.    Results  The  hIMRT  technique was significantly more homogenous than the 3 DCRT  technique, while maintaining target coverage. The  hIMRT  technique was also superior at minimising the amount of tissue receiving  D  105%  and above ( P  < 0.0001). The ipsilateral lung and contralateral breast maximum were significantly lower in the  hIMRT  plans ( P  < 0.05 and  P  < 0.005), but the 3 DCRT  technique achieved a lower mean heart dose in left‐sided breast cancer patients ( P  < 0.05).    Conclusion  Hybrid intensity modulated radiotherapy plans achieved improved dose homogeneity compared to the 3 DCRT  plans and superior outcome with regard to dose to normal tissues. We propose that the addition of both  HI  and  NTI  in evaluating the quality of intensity modulated radiotherapy ( IMRT ) breast plans provides clinically relevant comparators which more accurately reflect the new paradigm of treatment goals and outcomes in the era of breast  IMRT .

journal of medical radiation sciences

Intensity modulated radiotherapy and 3D conformal radiotherapy for whole breast irradiation: a comparative dosimetric study and introduction of a novel qualitative index for plan evaluation, the normal tissue index