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IMRT1

Rx: 63Gy/35fx

2012 AAMD / ROR Plan Challenge

2:27 IMRT treatment field delivery time

Beams
DVH
Metrics

Name (ID): Z002443-LUNG, AAPM (AAPM Z002443-LUNG)
Plan or PlanSum ID: IMRT8F_IDb

Structure ID Structure Code Patient Structure DVH Objective Evaluator Variation Priority Met Achieved
PTV63   PTV63 V63.0Gy[%] >=95 90   Goal 95.10 %
PTV63   PTV63 V59.85Gy[%] >=99 97   Goal 99.76 %
PTV63   PTV63 D0.03cc[Gy] <=67 72.3   Goal 66.978 Gy
GTV63   GTV63 V63.0Gy[%] >=99 97   Goal 99.77 %
SPINAL_CORD   SPINAL_CORD D0.03cc[Gy] <45     Goal 35.608 Gy
TOTAL LUNG - GTV   TOTAL LUNG - GTV V20.0Gy[%] <=24 35   Variation 25.25 %
TOTAL LUNG - GTV   TOTAL LUNG - GTV Mean[Gy] <=16 21   Goal 15.872 Gy
TOTAL LUNG - GTV   TOTAL LUNG - GTV V10.0Gy[%] <=40 55   Goal 36.16 %
HEART   HEART V50.0Gy[%] <=2 8   Goal 1.78 %
ESOPHAGUS   ESOPHAGUS Mean[Gy] <=15 30   Variation 20.568 Gy
PERIPHERAL RING   PERIPHERAL RING V53.55Gy[cc] <=0 30   Variation 7.81 cc
LEFT_LUNG   LEFT_LUNG V10.0Gy[%] <=30 40   Goal 18.21 %
Technical Plan Creation Comments

This eight (8) field IMRT plan utilized manually selected gantry positions to follow the shape of the target in the transverse view and unique collimator rotations per field selected in the beams eye view.  There were few real challenges in this case, the metrics with opportunity for significant improvement were the mean dose to the esophagus and improved target homogeneity.  Even accounting for those metrics, retrospectivly, this IMRT plan scored higher than every case submitted to the lung plan study that year.  This high score is probably attributable to the two-stage stacked and staggered MLC design with reduced interleaf leakage compared to previous designs and also attributable to Eclipse improvements since the study was held (namely: intermediate dose calculation). 

A ten field plan was also created which was able to score an additional one (1) point higher, but since this eight (8) field plan already scores higher than all the plans in the completion it was selected due to its slight advantage in treatment field delivery time vs the ten (10) field plan. 

Physician Comments

All 3 advanced lung cancer plans are very similar. The prescribed dose of 63 Gy is on the lower side but within guidelines. The target and OAR goals are all achieved similarly. Given the size and complex shape of the treated area, the lung sparing achieved is pretty impressive. These are clinically acceptable plans.

Comparative Plan Quality
Links

Review 3rd party software generated full treatment plan report

PDF

                              

Download full DICOM CT, struct, plan and dose file         

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Any reference to a "plan study" are simply what the organizers call each case and may not be a "study" in the FDA sense as they may not have been published in a peer reviewed journal.
Varian does not provide medical advice and these are illustrative examples only.
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