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?

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.

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 ...