When treating chestwall + RNI with VMAT, how much do you crop the PTV into lung as is done with the PTVeval in 3D contouring guides?

Answer from: Radiation Oncologist at Community Practice

We don’t edit PTV for VMAT plans. Chest wall contour (CTV) only includes pec muscles (not intercostal muscles or ribs like RTOG ATLAS) so the amount of PTV (3-5 mm expansion of CTV) overlap with lung is minimal to begin with. We do use a dummy bolus to create skin flash.

Comments

Radiation Oncologist at University of Western Ontario Schulich School of Medicine & Dentistry
What are your thoughts on trials such as RHEAL tha...

Radiation Oncologist at Varian Medical Systems/Allegheny health network
That’s fine for DVH analysis as long as we a...

Radiation Oncologist at Mallory Radiotherapy, PLLC
I can treat with breath hold and VMAT monitoring c...

Radiation Oncologist at University of Texas Health Science Center San Antonio MD Anderson Mays Cancer Center
Do you also remove ribs/IC muscles for T4?

Radiation Oncologist at Varian Medical Systems/Allegheny health network
It’s rare to see true chest wall involvement...

Answer from: Radiation Oncologist at Community Practice

If the patient is breathing, then the chest wall is moving. That motion is a factor in creating any PTV. Patients do not necessarily breathe uniformly every day. They get sick and cough. They have COPD and irregular breathing patterns. Observe the patient as she is not a static planning CT, and she ...

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When treating chestwall + RNI with VMAT, how much do you crop the PTV into lung as is done with the PTVeval in 3D contouring guides?

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