New: ASTRO & VA DVH Recommendations

Every medical physicist and dosimetrist creates or evaluates dozens of patient plans per week for a wide variety of cancer types and fractionation schemes. An important part of this process is determining if a plan meets appropriate dose-volume histogram (DVH) constraints for targets and organs at risk.

It’s often a challenge to find up-to-date, publicly available, and endorsed DVH metrics for different cancer types and dose regimens; they’re often published as disease site-specific recommendations, not as a comprehensive digest of guidelines. As a result, regimens vary from clinic-to-clinic, or even by individuals within a clinic, reducing consistency of care.

Together, the US Department of Veteran Affairs (VA) and the American Society for Radiation Oncology (ASTRO) set out to overcome this challenge and collaborated on a comprehensive set of consensus-derived DVH recommendations for a wide selection of disease sites and fractionation schemes with the goal of creating a thorough database of publicly available and professionally vetted series of metrics.

How the VA and ASTRO developed comprehensive DVH guidelines by consensus

The VA and ASTRO assembled panels of seven radiation oncologists, one therapeutic medical physicist from outside the VA, and one radiation oncologist within the VA. Panels were assigned by disease site, and each evaluated different dose regimens.

The members of the panels worked to build consensus on the best guidelines for DVHs. They evaluated clinical data and multi-site trials whenever possible; when there was limited published guidance, they discussed best practices as a group. Proposed constraints were available for public comment for a three week period, allowing for additional feedback from the radiation oncology community. Final guidelines were drawn based on this feedback.

The guidelines approved for publication passed a >75% agreement or strong agreement threshold from the clinical panel on the plan after all feedback was considered. The ASTRO Board of Directors voted to approve the guidelines in August 2025, and they were subsequently endorsed by the American Association of Physicists in Medicine (AAPM) and the American Association of Medical Dosimetrists (AAMD). The guidelines were published in early 2026.

Importantly, the recommendations are designed to be living guidance. Panels will continue to evaluate and update the tables as new clinical evidence and practice patterns emerge.

Apply new DVH guidelines to your plan evaluation process with ClearCheck

While the recommendations are extremely valuable, translating published constraints into    clinical workflows is time-consuming. Radformation’s Clinical Success Team has made the new DVH guidelines easy to apply with ready-to-use templates for automatic constraint analysis with ClearCheck. ClearCheck automatically evaluates treatment plans against the defined DVH constraints, allowing users to quickly and consistently evaluate plan quality. 

We asked Lauren Brandl, Radformation Clinical Implementation Manager and former UC San Diego dosimetrist, who did much of the work to create the ClearCheck templates, how she thinks these new ASTRO recommendations will help users standardize their care.

What was your first impression of the guidelines in this ASTRO publication?

“I think it’s great to have such specific guidelines for the same body site but with a wide variety of fractionation schemes. For example, there are separate lung guidelines for 3, 4, 5, 8, etc. fraction regimens, and that helps limit any ambiguity or interpolation of what dose guidelines may be appropriate.”

Were there any particular regimens that caught your interest?

“Personally, I was interested in the Rectal: Short-Course Regimen (Table 25, 5 Gy per fraction to 25 Gy). When I was a Dosimetrist in the clinic, these plans could be tough to evaluate and we would discuss supplementing with SBRT constraints, or utilizing EQD2 calculations. I’m happy to see this regimen has its own set of guidelines!”

How have ClearCheck users received these guidelines?

“We received quite a few inquiries about building these constraint templates, so I hope many clinics take advantage of them! We appreciate the work done by ASTRO, the VA, and each disease-site panel to compile this data and make the recommendations simple to implement in the clinic.”

Any final thoughts on the DVH recommendations from ASTRO?

“I think ClearCheck users are going to be really happy with these constraint templates! They will hopefully be a great tool for clinics looking to standardize their dose constraint guidelines, and they’re ready to use with just a few clicks.”

Standardize your plan evaluation in accordance to ASTRO recommendations

ClearCheck allows you to easily load templates for dose plan validation. With these new, extensive guidelines from ASTRO, it’s easier than ever to verify your treatment plans using standardized, clinically-vetted dose constraints.

Check out the new templates here.