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Articles 1 - 30 of 34
Full-Text Articles in Radiation Medicine
Ai-Driven Segmentation And Volumetric Response Modeling Of Liver Regions To Radiotherapy, Aashish Chandra Gupta
Ai-Driven Segmentation And Volumetric Response Modeling Of Liver Regions To Radiotherapy, Aashish Chandra Gupta
Dissertations and Theses (Open Access)
In liver-directed radiotherapy (RT), liver regions receiving higher doses typically undergo atrophy while contralateral/adjacent lower-dose regions may exhibit compensatory hypertrophy through regeneration of healthy tissue. Optimizing the RT plan to promote regional hypertrophy while minimizing the risk of developing atrophy has the potential to enhance post-RT liver function and long-term survivorship. However, current clinical practice largely relies on global liver dose-volume metrics during RT-planning, which may obscure favorable dose-response correlation and limit actionable guidance for clinicians. Therefore, we hypothesized that post-RT regional liver response is governed by a combination of region-specific dose-volume and patient clinical features, and that these responses …
Automated Analysis Of Radiation Oncology Incident Reports Using Large Language Models, Nathan A. Dobranski
Automated Analysis Of Radiation Oncology Incident Reports Using Large Language Models, Nathan A. Dobranski
LSU Master's Theses
Patient safety incident reporting in radiation oncology requires expert analysis that is time-intensive and subject to variability. This thesis presents the development and technical validation of a locally deployed large language model (LLM) system for automated incident report analysis across multiple cancer centers. The system was designed for automated summarization and taxonomy assignment of Radiation Oncology Incident Learning System (RO-ILS) reports, operating entirely on local infrastructure to preserve patient privacy. A two-round, multi-rater evaluation methodology was employed, incorporating 600 total expert evaluations from two academic cancer centers. Round 1 established baseline performance using Mistral 7B and Mixtral 8x7B models with …
Mtl_Tx: A Multi-Task Transformer Model For Improved Radiation Time-Series Estimation, Hongfang Zhang, Adam Stavola, Hal Ferguson, Bence Budavari, Hongyi Wu, Chiman Kwan, Jiang Li
Mtl_Tx: A Multi-Task Transformer Model For Improved Radiation Time-Series Estimation, Hongfang Zhang, Adam Stavola, Hal Ferguson, Bence Budavari, Hongyi Wu, Chiman Kwan, Jiang Li
Electrical & Computer Engineering Faculty Publications
Controlling radiation doses at potential radioactive facilities is critical to ensuring the safety of both personnel and the public. At the Thomas Jefferson National Accelerator Facility (JLab), multiple sensors are deployed around the three experimental halls to monitor key parameters, including single-beam current, energy levels, current leakage, and radiation values during accelerator operations. In this study, we developed a Multi-task Transformer model, MTL_TX, to accurately estimate radiation doses at sensor locations based on historical data, with the aim of enhancing safety in accelerator facilities and surrounding public areas. To improve estimation accuracy, we integrated two innovative components into the proposed …
Practical Real-Time Permanent Magnet Energy Spectrometer Using A Diode Array For Therapeutic Electron Beam Tuning And Quality Assurance, Mason W. Heath
Practical Real-Time Permanent Magnet Energy Spectrometer Using A Diode Array For Therapeutic Electron Beam Tuning And Quality Assurance, Mason W. Heath
LSU Doctoral Dissertations
Purpose: Develop a practical, real-time permanent magnet electron energy spectrometer and evaluate it for beam tuning and quality assurance (QA) of therapeutic electron beams.
Methods: Aim 1: A 0.55 T permanent magnet was coupled to Sun Nuclear SRS MapCHECK® PC boards, providing two interlaced diode arrays. Detector response, Rmeas(zdiode) versus diode position zdiode, was extracted from raw diode array readings, correcting for diode sensitivity and other factors. Using Monte Carlo (MC) computed, monoenergetic detector response functions, a curve-fitting algorithm extracted the energy spectrum, from Rmeas(zdiode). The energy spectra for 7-20 …
Optimizing Palliative Spine Radiation: A Dosimetric Comparison Of Hybrid Arc Therapy And Conventional Appa Techniques, Alaina Vaneaton
Optimizing Palliative Spine Radiation: A Dosimetric Comparison Of Hybrid Arc Therapy And Conventional Appa Techniques, Alaina Vaneaton
Masters Projects
This study aimed to evaluate the dosimetric impact of Hybrid Arc Palliative Radiation Therapy (HART) versus conventional anterior-posterior/posterior-anterior (APPA) beam arrangements for thoracic spine metastases. The primary objective was to assess differences in conformity, homogeneity, and organ-at-risk (OAR) sparing between the two techniques. A retrospective plan comparison was conducted using anonymized datasets from twenty patients previously treated with HART. Each case was replanned using a standard APPA technique, normalized to match the target coverage of the original HART plan within 0.1%. All plans were prescribed 20 Gy in 5 fractions. Plan quality was evaluated using conformity index (CI), homogeneity index …
Automated Radiotherapy Treatment Planning For Breast Cancer: A Robust To Ol For Global Deployment, Hana Baroudi
Automated Radiotherapy Treatment Planning For Breast Cancer: A Robust To Ol For Global Deployment, Hana Baroudi
Dissertations and Theses (Open Access)
Breast cancer incidence continues to rise worldwide, particularly in low- and middle-income countries, where limitations in resources already constrain access to timely care. Radiotherapy is a cornerstone of breast cancer management, proven to significantly lower both recurrence and mortality. However, a growing shortage of radiation staff worldwide threatens the prompt delivery of these treatments.This thesis proposes an automated solution to address the limited accessibility of radiotherapy planning in breast cancer management by developing an end-to-end automated treatment planning model and evaluating its performance and limitations across diverse patient populations.
An automated contouring model was trained using data from 104 whole-breast …
Development Of Lineal Energy Spectrum-Based Biological Effects Models For Protons, Joseph M. Decunha, Fada Guan, David Grosshans, Zhongxing Liao, Dragan Mirkovic, Oleg Vassiliev, Radhe Mohan
Development Of Lineal Energy Spectrum-Based Biological Effects Models For Protons, Joseph M. Decunha, Fada Guan, David Grosshans, Zhongxing Liao, Dragan Mirkovic, Oleg Vassiliev, Radhe Mohan
Dissertations and Theses (Open Access)
In this dissertation, methods are developed and described to allow for the rapid calculation of microdosimetric spectra (specifically, lineal energy) for protons. SuperTrack, a GPU-accelerated tool for calculation of microdosimetric spectra was developed and is capable of computing lineal energy spectra up to 5000x faster than using Geant4 directly. Proton lineal energy spectra generated by SuperTrack are indistinguishable from those generated by Geant4. With SuperTrack, large libraries of lineal energy spectra for monoenergetic protons spanning 0-300 MeV have been developed. The proton lineal energy spectra calculated by SuperTrack have been compared to experimental measurements made by a tissue equivalent proportional …
Developing Real-Time, Online Beam Control Of Uhdr Irradiators To Facilitate Flash Translational Investigations, Austin M. Sloop
Developing Real-Time, Online Beam Control Of Uhdr Irradiators To Facilitate Flash Translational Investigations, Austin M. Sloop
Dartmouth College Ph.D Dissertations
The field of radiation oncology seeks novel techniques to increase the therapeutic ratio to treat malignancies while minimizing damage and toxicities in healthy tissues. While it was observed that delivering therapeutic doses at high dose rate could elicit lower biological effects over a half-century ago, the field of ultra-high dose rate (UHDR) radiation therapy (colloquially known as FLASH RT) has seen a resurgence in recent years due to an alignment of accelerator capability, dosimetric advances, and improved biotechnological techniques. This has opened the door to studying potential underlying mechanisms such that we may leverage the effects of FLASH tissue sparing …
Proof-Of-Concept For Converging Beam Small Animal Irradiator, Benjamin Insley
Proof-Of-Concept For Converging Beam Small Animal Irradiator, Benjamin Insley
Dissertations and Theses (Open Access)
The Monte Carlo particle simulator TOPAS, the multiphysics solver COMSOL., and
several analytical radiation transport methods were employed to perform an in-depth proof-ofconcept
for a high dose rate, high precision converging beam small animal irradiation platform.
In the first aim of this work, a novel carbon nanotube-based compact X-ray tube optimized for
high output and high directionality was designed and characterized. In the second aim, an
optimization algorithm was developed to customize a collimator geometry for this unique Xray
source to simultaneously maximize the irradiator’s intensity and precision. Then, a full
converging beam irradiator apparatus was fit with a multitude …
Evaluation Of An End-To-End Radiotherapy Treatment Planning Pipeline For Prostate Cancer, Mohammad Daniel El Basha, Court Laurence, Carlos Eduardo Cardenas, Julianne Pollard-Larkin, Steven Frank, David T. Fuentes, Falk Poenisch, Zhiqian H. Yu
Evaluation Of An End-To-End Radiotherapy Treatment Planning Pipeline For Prostate Cancer, Mohammad Daniel El Basha, Court Laurence, Carlos Eduardo Cardenas, Julianne Pollard-Larkin, Steven Frank, David T. Fuentes, Falk Poenisch, Zhiqian H. Yu
Dissertations and Theses (Open Access)
Radiation treatment planning is a crucial and time-intensive process in radiation therapy. This planning involves carefully designing a treatment regimen tailored to a patient’s specific condition, including the type, location, and size of the tumor with reference to surrounding healthy tissues. For prostate cancer, this tumor may be either local, locally advanced with extracapsular involvement, or extend into the pelvic lymph node chain. Automating essential parts of this process would allow for the rapid development of effective treatment plans and better plan optimization to enhance tumor control for better outcomes.
The first objective of this work, to automate the treatment …
Automated Contouring And Statistical Process Control For Plan Quality In A Breast Clinical Trial, Hana Baroudi, Callistus I Huy Minh Nguyen, Sean Maroongroge, Benjamin D Smith, Joshua S Niedzielski, Simona F Shaitelman, Adam Melancon, Sanjay Shete, Thomas J Whitaker, Melissa P Mitchell, Isidora Yvonne Arzu, Jack Duryea, Soleil Hernandez, Daniel El Basha, Raymond Mumme, Tucker Netherton, Karen Hoffman, Laurence Court
Automated Contouring And Statistical Process Control For Plan Quality In A Breast Clinical Trial, Hana Baroudi, Callistus I Huy Minh Nguyen, Sean Maroongroge, Benjamin D Smith, Joshua S Niedzielski, Simona F Shaitelman, Adam Melancon, Sanjay Shete, Thomas J Whitaker, Melissa P Mitchell, Isidora Yvonne Arzu, Jack Duryea, Soleil Hernandez, Daniel El Basha, Raymond Mumme, Tucker Netherton, Karen Hoffman, Laurence Court
Faculty, Staff and Student Publications
BACKGROUND AND PURPOSE: Automatic review of breast plan quality for clinical trials is time-consuming and has some unique challenges due to the lack of target contours for some planning techniques. We propose using an auto-contouring model and statistical process control to independently assess planning consistency in retrospective data from a breast radiotherapy clinical trial.
MATERIALS AND METHODS: A deep learning auto-contouring model was created and tested quantitatively and qualitatively on 104 post-lumpectomy patients' computed tomography images (nnUNet; train/test: 80/20). The auto-contouring model was then applied to 127 patients enrolled in a clinical trial. Statistical process control was used to assess …
The Safe And Effective Clinical Deployment Of Artificial Intelligence To Ols, Kelly Nealon
The Safe And Effective Clinical Deployment Of Artificial Intelligence To Ols, Kelly Nealon
Dissertations and Theses (Open Access)
18 million new cancer cases are diagnosed each year. Roughly half of these patients will be treated with radiation therapy, a complex technique that requires an interdisciplinary team of clinical staff and expensive equipment to be delivered safely. Cancer centers in Low- and Middle-Income Countries (LMIC) have an especially difficult time meeting the demands of radiation therapy as the complexity of treatment techniques increase, with only 37% of patients in these regions having access to the care they need. Artificial Intelligence (AI) based tools are being developed to simplify the treatment planning and quality assurance processes to increase the number …
Analysis Of Biologically Effective Dose For Retroactive Yttrium-90 Trans-Arterial Radioembolization Treatment Optimization, Mj Lindsey
CMC Senior Theses
Trans-arterial radioembolization (TARE) is a protracted modality of radiation therapy where radionuclides labeled with Yttrium-90 (90Y) are inserted inside a patient's hepatic artery to treat hepatocellular carcinoma (HCC). While TARE has been shown to be a clinically effective and safe treatment, there is little understanding of the radiobiological relationship between absorbed dose and tissue response, and thus there is no dosimetric standard for treatment planning. The Biologically Effective Dose (BED) formalism, derived from the Linear-Quadratic model of radiobiology, is used to weigh the absorbed dose by the time pattern of delivery. BED is a virtual dose that can …
Quantifying The Magnitude Of To Tal Dose Deviation Caused By Various Sources Of Error Among Iroc Phantom Irradiation Results, Sharbacha S. Edward
Quantifying The Magnitude Of To Tal Dose Deviation Caused By Various Sources Of Error Among Iroc Phantom Irradiation Results, Sharbacha S. Edward
Dissertations and Theses (Open Access)
The Imaging and Radiation Oncology Core (IROC) phantoms are used as an end-to-end test of an institution’s radiotherapy processes, and for clinical trial credentialing. Phantoms are treated like patients, and evaluation of the doses received by the thermoluminescent dosimeters (TLDs) inside the phantom, reflects the accuracy with which an institution can image, plan and irradiate a phantom or patient. Recent phantom results show that among the hundreds of various IROC phantoms irradiated annually, 8-17% of institutions fail this test. The purpose of this work was to investigate the various types of errors that may occur during the treatment process and …
Infrastructure Development For Personalized Risk Prediction To Reduce Cardiovascular Disease In Childhood Cancer Survivors, Suman Shrestha
Infrastructure Development For Personalized Risk Prediction To Reduce Cardiovascular Disease In Childhood Cancer Survivors, Suman Shrestha
Dissertations and Theses (Open Access)
Although childhood cancer survivors have lengthy life expectancies, they run the risk of experiencing long-term health issues as a result of their treatment. The most frequent non-cancerous cause of morbidity and mortality for these survivors is cardiac disease. Radiation therapy (RT) has been linked in numerous cohort studies to a higher chance of developing a late cardiac disease in these survivors, and this risk rises with higher mean heart doses and increased RT exposure to larger cardiac volumes. Since, the heart is a heterogeneous organ made up of several distinct substructures, RT dose received by the entire heart does not …
In-Phantom Film Measurements Of Two Treatment Planning Systems For Single-Fraction Spine Sbrt, Michael J. Taylor
In-Phantom Film Measurements Of Two Treatment Planning Systems For Single-Fraction Spine Sbrt, Michael J. Taylor
LSU Master's Theses
Purpose: Treatment planning accuracy for spine stereotactic body radiation therapy (SBRT) varies depending on the dose calculation algorithm utilized in the treatment planning system (TPS). This project compared the end-to-end accuracy between spine SBRT plans calculated in a convolution-superposition based TPS (TPSCS) and Monte Carlo based TPS (TPSMC) with radiochromic film measurements. The hypothesis was that TPSMC would calculate the dose gradient in the critical region between the vertebral body and the spinal cord more accurately than TPSCS.
Methods: Single-fraction spine SBRT treatments following RTOG 0631 and local institutional guidelines were planned in …
Investigating The Uncertainties In Ct Non-Small Cell Lung Cancer Radiomics, Gary Ge
Investigating The Uncertainties In Ct Non-Small Cell Lung Cancer Radiomics, Gary Ge
Theses and Dissertations--Radiation Medicine
Radiomics is a technique that extracts quantitative features, termed radiomic features, from medical images using data-characterization algorithms. These radiomic features can be used to identify tissue characteristics and radiologic phenotyping that are not observable by clinicians in a non-invasive, low-cost manner, potentially generating image biomarkers for clinical decision. To date, there are still many uncertainties involved in radiomics which limit its clinical implementation. Herein, we propose to explore the impact of each component in the radiomics pipeline on predicting clinical outcomes. In Chapter II, we conduct a thorough review of CT lung cancer radiomics studies to examine the typical feature …
Advancement Of A 3d Computational Phantom And Its Age Scaling Methodologies For Retrospective Dose Reconstruction Studies, Aashish Gupta
Advancement Of A 3d Computational Phantom And Its Age Scaling Methodologies For Retrospective Dose Reconstruction Studies, Aashish Gupta
Dissertations and Theses (Open Access)
We have used a 3D age-scalable computational phantom for over two decades for retrospective dose reconstruction studies of childhood cancer survivors (CCS) treated with 2D historic radiotherapy (RT). However, our phantom and its age scaling functions (ASF) must be updated so that it can be used in studies that include survivors treated with contemporary RT. We aimed to implement our phantom and its age scaling functions in DICOM format and determine the feasibility of applying our ASFs to accurately scale the whole-body CT-based anatomies.
In the implementation study, we developed Python scripts that model the phantom and ASFs in a …
Structural Shielding Considerations For Vmat, Ana Lucia Dieguez
Structural Shielding Considerations For Vmat, Ana Lucia Dieguez
LSU Master's Theses
Introduction: As noted in National Council on Radiation Protection and Measurements (NCRP) Report 151, the medical physicist or other qualified expert has the responsibility to keep abreast of any new technology or treatment method that could potentially impact structural shielding design. Volumetric arc therapy (VMAT) became prevalent after the publication of Report 151 and thus was not explicitly addressed in Report 151. If the shielding-related characteristics of VMAT differ enough from the expectations of Report 151, especially in the circumstance of a vault utilized exclusively for VMAT, a shielding design based on Report 151 could potentially be inadequate. The …
Investigate The Delivery Efficiency And Accuracy Of Spot-Scanning Proton Arc (Sparc) In Comparison With Conventional Impt, Automatic Step-And-Shoot Multifield Impt, Lewei Zhao, Gang Liu, Di Yan, Xiaoqiang Li, Xuanfeng Ding
Investigate The Delivery Efficiency And Accuracy Of Spot-Scanning Proton Arc (Sparc) In Comparison With Conventional Impt, Automatic Step-And-Shoot Multifield Impt, Lewei Zhao, Gang Liu, Di Yan, Xiaoqiang Li, Xuanfeng Ding
Conference Presentation Abstracts
No abstract provided.
Changes In Post-Treatment Cardiac Pet Avidity Predict Overall Survival In Lung Cancer Patients Treated With Chemoradiation, T Santangelo, F Forghani, C Rusthoven, R Castillo, E Castillo, B Jones, T Guerrero, Y Vinogradskiy
Changes In Post-Treatment Cardiac Pet Avidity Predict Overall Survival In Lung Cancer Patients Treated With Chemoradiation, T Santangelo, F Forghani, C Rusthoven, R Castillo, E Castillo, B Jones, T Guerrero, Y Vinogradskiy
Conference Presentation Abstracts
No abstract provided.
Toward Online Adaptive Proton Therapy Of Sinonasal Cancer: The Dosimetric Accuracy Of Utilizing Deep-Learning Synthetic Ct From Cbct For Daily Treatment Dose Verification, An Qin, Lewei Zhao, Shupeng Chen, Xiaoqiang Li, Weili Zheng, Di Yan, Rohan Deraniyagala, Xuanfeng Ding
Toward Online Adaptive Proton Therapy Of Sinonasal Cancer: The Dosimetric Accuracy Of Utilizing Deep-Learning Synthetic Ct From Cbct For Daily Treatment Dose Verification, An Qin, Lewei Zhao, Shupeng Chen, Xiaoqiang Li, Weili Zheng, Di Yan, Rohan Deraniyagala, Xuanfeng Ding
Conference Presentation Abstracts
No abstract provided.
Develop A Rotational Robust Optimized Spot-Scanning Proton Arc (Sparc) Algorithm, Shupeng Chang, Gang Liu, Lewei Zhao, Weili Zheng, An Qin, Di Yan, Xiaoqiang Li, Xuanfeng Ding
Develop A Rotational Robust Optimized Spot-Scanning Proton Arc (Sparc) Algorithm, Shupeng Chang, Gang Liu, Lewei Zhao, Weili Zheng, An Qin, Di Yan, Xiaoqiang Li, Xuanfeng Ding
Conference Presentation Abstracts
No abstract provided.
Impact Of Flattening Filter-Free Field On Online Adaptive Radiotherapy Using Virtual Couch Shift (Vcs) Technique, Q Liu, J Liang, D Yan
Impact Of Flattening Filter-Free Field On Online Adaptive Radiotherapy Using Virtual Couch Shift (Vcs) Technique, Q Liu, J Liang, D Yan
Conference Presentation Abstracts
No abstract provided.
A Direct Machine-Specific Parameters Incorporated Spot-Scanning Proton Arc (Sparc) Algorithm, Gang Liu, Lewei Zhao, Di Yan, Xiaoqiang Li, Xuanfeng Ding
A Direct Machine-Specific Parameters Incorporated Spot-Scanning Proton Arc (Sparc) Algorithm, Gang Liu, Lewei Zhao, Di Yan, Xiaoqiang Li, Xuanfeng Ding
Conference Presentation Abstracts
No abstract provided.
The First Modeling Of The Spot-Scanning Proton Arc (Sparc) Delivery Sequence And Investigating Its Efficiency Improvement In The Clinical Proton Treatment Workflow, Gang Liu, Lewei Zhao, Di Yan, Rohan Deraniyagala, Craig Stevens, Xiaoqiang Li, Xuanfeng Ding
The First Modeling Of The Spot-Scanning Proton Arc (Sparc) Delivery Sequence And Investigating Its Efficiency Improvement In The Clinical Proton Treatment Workflow, Gang Liu, Lewei Zhao, Di Yan, Rohan Deraniyagala, Craig Stevens, Xiaoqiang Li, Xuanfeng Ding
Conference Presentation Abstracts
No abstract provided.
Assess The Interplay Effect Based On The Cyclotron Accelerator Proton Therapy System Machine-Specific Delivery Sequence Model, Lewei Zhao, Gang Liu, J Shen, A Lee, Di Yan, Rohan Deraniyagala, Craig Stevens, Weili Zheng, Xiaoqiang Li, S Tang, Xuanfeng Ding
Assess The Interplay Effect Based On The Cyclotron Accelerator Proton Therapy System Machine-Specific Delivery Sequence Model, Lewei Zhao, Gang Liu, J Shen, A Lee, Di Yan, Rohan Deraniyagala, Craig Stevens, Weili Zheng, Xiaoqiang Li, S Tang, Xuanfeng Ding
Conference Presentation Abstracts
No abstract provided.
Nuclear-Targeted Gold Nanoparticles Enhance The Effects Of Radiation Therapy With And Without Liposomal Delivery, Maureen Aliru
Nuclear-Targeted Gold Nanoparticles Enhance The Effects Of Radiation Therapy With And Without Liposomal Delivery, Maureen Aliru
Dissertations and Theses (Open Access)
Less that 10% of pancreatic cancer patients are eligible for curative resection, and clinical trials evaluating chemoradiation in locally advanced patients with unresectable disease have been largely disappointing. New and creative therapeutic approaches are needed to address the unment need for treatment options. The objective of this thesis is to advance radiosensitization of treatment-resistant densely desmoplastic pancreatic cancer using nanoparticles to surmount biological barriers to effective particle distribution for DNA-targeting.
Clinical translation of radiosensitizing nanoparticles has stalled owing to technical challenges. Current strategies to use AuNPs for radiosensitization require large quantities of gold, kilovoltage x-rays, immediate irradiation after intravenous administration, …
Modeling Anatomic Changes For Adaptive Radiotherapy In Locally Advanced Lung Cancer Patient Population, James Alexander Kavanaugh
Modeling Anatomic Changes For Adaptive Radiotherapy In Locally Advanced Lung Cancer Patient Population, James Alexander Kavanaugh
LSU Doctoral Dissertations
Anatomic changes occurring mid-treatment for patients undergoing radiation therapy for locally advanced lung cancer can degrade the quality of the intended treatment plan. These changes include tumor regression, geometric misalignment, and lung density changes (atelectasis and pleural effusion), and are visible on the daily 3D cone beam CT (CBCT). To maintain the intended treatment quality, adaptive radiotherapy (ART) can be employed to modify the treatment plan to account for these anatomic changes. However, the evaluation on when to adapt is currently completed manually by the treating clinicians, resulting in a subjective and inconsistent application. To address these limitations, a series …
Analytical Setup Margin For Spinal Sbrt Based On Measured Errors, Audrey Copeland
Analytical Setup Margin For Spinal Sbrt Based On Measured Errors, Audrey Copeland
LSU Master's Theses
Purpose: No consensus currently exists in the radiotherapy community about the correct margin size to use for spinal SBRT. Margins have been proposed to account for various errors individually, but not with all errors combined to result in a single margin value. The purpose of this work was to determine a setup margin for spinal SBRT based on known and measurable errors during radiotherapy to achieve at least 90% coverage of the clinical target volume (CTV) with the prescription dose for at least 90% of patients and not exceed a 30 Gy point dose or 23 Gy to 10% of …