Thus, BED values are calculated by clicking on the button “”BED and Fractionaction Calculation”". Figure 4 Example of IsoBED CP-868596 concentration calculation for the case of prostate and lymph nodes treatment. Then the SIB schedule is calculated by selecting the control

box “”IsoBED Calculation”". The results of such evaluations are visualized in the “”IsoBED DOSES”" area. The dose limits are visualized in the “”OAR CONSTRAINTS”" area. DVH import Import procedures consist of copying DVH files, exported from TPS, in a folder with the patient’s name contained in a directory where an IsoBED.exe file is installed. DVH files are different depending on the TPS source. IsoBED can import DHV data files from Eclipse, Pinnacle and Brainscan. Dose distribution and radiobiological analysis Figures 5, 6 and 7 show different screens generated by the software through which different types of evaluations for prostate-pelvis, head & neck and lung cases can be performed. On the right side of the screen there is a window where the

patient of interest can be selected, while in the lower part of the screen the fraction number, dose per fraction and the district of interest can be set. Thus, the total dose can be calculated and all the imported DVHs are visualized. Figure 5 DVHs imported from TPSs for Sequential and SIB Technique in a) prostate, b) Head & Neck and c) Lung cases. Numered circles represents the OAR costraints. Figure 6 NTD 2 -VH for Sequential

and SIB Technique in a) prostate, b) Head & Neck and c) Lung cases. Numered circles represents the OAR costraints. Figure 7 Protein Tyrosine Kinase inhibitor Radiobiological curves (TCP, NTCP and P + ) for Sequential and SIB Technique in a) prostate, b) Head & Neck and c) Lung cases. Figures 5a, 5b and 5c show the DVHs imported from TPSs calculated with different modalities (SIB and sequential). The user can choose which volume of interest to view by selecting them from a list visualized at the lower-left corner of the screen. Furthermore, in the same area, the total volume or one between, the minimum, maximum, average, median and modal dose percentage for each plan and each structure shown in the Cobimetinib order histogram is displayed. In order to perform radiobiological calculations the (α/β)values can be set for each structure by choosing a dropdown menu in which the list of parameters incorporated in a dedicated database appears. These values are derived from literature data and from experience at our Institute [9–20]. The “”NTD2″” button transforms every DVH into the NTD2VH (Figures 6a, 6b and 6c). Finally, the TCP, NTCP and P+ curves against the dose prescribed to the reference target can be calculated with the “”TCP-NTCP”" button and their values are shown in the lower area of the screen (Figures 7a, 7b and 7c). Software Validation All the outcomes from IsoBED software were compared with an automatic excel spreadsheet specially designed for this purpose.