Probeam

This 3 field plan scored 146.29 out 150 in the 2021 AAMD-Plan Study: Thorax / Lung (rank of 16 out of 229 submissions).

The plan includes three fields with each beam directed at a certain section of the bulky planning volume (Beam 1 is aimed at the R SCLAV PTV | Beam 2 is aimed at the Mediastinal PTV |  Beam 3 is aimed at the primary tumor volume).  All beams were positioned manually taking into account the shortest path length, the most homogeneous path through healthy tissue, and avoiding distal fall-off overlap. Plan quality and score would likely have been further improved with more fields. 

Dose-specific optimization OARs (original anatomical OAR with a margin were carved out of the PTV) were used to decrease the maximum dose to the ipsilateral brachial plexus, the esophagus and the pericardium.  To further reduce the dose to these overlapping OARs, in the final stages of planning a high priority was put on the maximum dose metric of these dose specific structures.  These individual dose specific structures included the brachial plexus, the esophagus and the pericardium, each with the overlapped 62Gy dose cloud. A ring was also used during optimization to help achieve the conformation number.

_{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.
Leading plans by expert planner. Your results may vary.}