When deciding whether to include an IMN field in a PMRT case, what do you consider a "safe dose" to the heart that you are willing to accept?

I agree with @Dr. First Last about keeping the heart dose as low as possible. Aim for a mean heart dose of ≤ 4 Gy. I prioritize the heart dose constraint, especially in younger women, women with pre-exisiting cardiac conditions and those who have had cardiotoxic chemotherapy. This may sometimes requ...

We routinely treat the IM nodes and chest wall in breath hold for left sided cases. Our average mean heart dose typically ranges from 2.5 to 3.5 Gy, which we feel is acceptable. In general, I follow the ALARA principal with heart dosing and will try to optimize my plan as much as possible, which usu...

We try to make sure no direct photon beam tangent goes through heart by using a partially wide tangent or a combination of photon and electrons. We dont have ABC but that is certainly an option to avoid that.

By doing this our V25 is usually 1 to 2%. The current NRG protocol I think allows upto 5%.

@Dr. First Last, can you please share the references for non-tangential IMRT?