IMRT 19 Fields

This SIB Esophagus plan was generated using the Ethos Treatment Management system with the intent of daily online adaptive treatments. Planning directives were used to guide the intelligent optimization engine (IOE) to balance target coverage and OAR sparing in accordance with RTOG 1010 criteria. 
Clinical goals for the PTV and heart were ranked with most importance to reduce hotspots and to improve the dose gradient between the regions of overlap. Highest importance was also used to reduce the mean dose to the Heart and the V20 of the lung. The remaining clinical goals of reducing low dose to the lungs, kidneys, and liver were prioritized from highest to lowest respectively. A RapidPlan model was also implemented to reduce the low dose to OARs and to help evaluate the clinical goal values by comparing them to the DVH prediction bands.
A plan from Eclipse was imported to utilize a unique 19 field beam geometry. Starting from the PA field, each beam angle is spaced every 19 degrees so that no one beam directly opposes each other. The collimator is equally rotated every 9.5 degrees to allow for a unique path of MLC travel for each field. This geometry helps further open the solution space for the IOE to find the most optimal plan.

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