IMRT SX1

Name (ID): W_BRST_005, W_BRST_005 (W_BRST_005)
Plan or PlanSum ID: 10F_SX1

For this challenging anatomy chestwall case, ten (10) fields were selected such that the beam edges defined the shape of the chest wall with most beams concentrated at the medial and lateral sides of the patient.  As is usual with these multifield IMRT chestwall/breast cases, the challenges were as follows:

Achieving the heart mean dose constraint
Dose to the contralateral breast
Target dose heterogeneity

Meeting the ipsilateral lung dose constraints was more straightforward because the Halcyon machine uses a flattening filter free beam that inherently produces less out-of-field dose than a “flattened” beam.  In addition, the two-stage stacked and staggered MLC reduces interleaf leakage.  Finally, as a consequence of the very challenging anatomy, it was difficult to meet the constraints for max allowed dose and the plan was more heterogeneous than is normally desired.  However, all protocol constraints were still met with only minor deviations sited.

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