A Method for Correcting IMRT Optimizer Heterogeneity Dose Calculations

Radiation therapy treatment planning for volumes close to the patient's surface, in lung tissue and in the head and neck region, can be challenging for the planning system optimizer because of the complexity of the treatment and protected volumes, as well as striking heterogeneity corrections. Because it is often the goal of the planner to produce an isodose plan with uniform dose throughout the planning target volume (PTV), there is a need for improved planning optimization procedures for PTVs located in these anatomical regions. To illustrate such an improved procedure, we present a treatment planning case of a patient with a lung lesion located in the posterior right lung. The intensity-modulated radiation therapy (IMRT) plan generated using standard optimization procedures produced substantial dose nonuniformity across the tumor caused by the effect of lung tissue surrounding the tumor. We demonstrate a novel iterative method of dose correction performed on the initial IMRT plan to produce a more uniform dose distribution within the PTV. This optimization method corrected for the dose missing on the periphery of the PTV and reduced the maximum dose on the PTV to 106% from 120% on the representative IMRT plan.