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A comparison of volumetric modulated arc radiotherapy techniques to evaluate left

anterior descending artery dose sparing in left non-small cell lung tumor patients
Bryn Dahms, BS; Jessalyn Mitchem, BS, RT(T); Nishele Lenards, PhD, CMD, RT(R)(T),
FAAMD; Ashley Hunzeker, MS, CMD
Medical Dosimetry Program at the University of Wisconsin – La Crosse
I. Abstract
II. Introduction
A. PI: Influence of increased screening and treatment techniques on survival in
patients diagnosed with NSCLC (References: Siegel et al, 1 Ganti et al,2
Howlander et al3)
B. PII: Introduction to volumetric modulated arc therapy
C. PIII: Effects of radiation exposure to the left anterior descending artery
(Reference: Atkins et al,4 Atkins et al,5 McKenzie et al,6 Reshko et al,7 Atkins et
al,8 Yegya-Raman et al9)
D. PIV: Summarize introduction points (References: Howlander et al, 3 Atkins et al7)
1. Problem: The problem is that there is an increased risk for major
adverse cardiac events and coronary heart disease for medial, left-
sided upper lobe lung VMAT patients when the volume of the LAD
receiving 15 Gy exceeds 10%.
2. Purpose: The purpose of this study was to compare dose to the LAD
in VMAT plans optimized with and without an LAD planning organ at
risk volume (PRV) in medial, left-sided, upper lobe non-small cell
lung cancer patients to evaluate dose sparing of the LAD while
maintaining 95% coverage of the PTV with prescribed dose.
3. Hypothesis: Researchers tested the hypothesis that VMAT plans
optimized with an LAD PRV will reduce the LAD V15 Gy dose while
maintaining 95% coverage of the PTV with prescribed dose (H10).
III. Materials and Methods
A. Patient Selection and Setup
1. PI: Patient Population
a. 20 patients
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b. Inclusion criteria: left lung, upper lobe, medially located tumors,

initially treated with VMAT, previously received dose to the
LAD
2. PII: Simulation (4D)
B. Contours
1. PI: Target volumes (GTV, ITV, PTV)
2. PII: OAR (heart and LAD)
C. Treatment Planning
1. PI: Equipment used (Eclipse TPS Version 15 and Varian TrueBeam
Linear Accelerators)
2. PII: Treatment Planning Technical Factors
a. Beam energy
b. Number of arcs
c. Collimator rotation
D. Plan Comparison
1. PI: Evaluation of planning metrics
a. Volume of the LAD receiving greater than or equal 15 Gy
b. Volume of the PTV receiving greater than or equal to 60 Gy
E. Statistical Analysis
1. PI: Shapiro-Wilk test for normality
a. p ≤ 0.05 is significant
b. Data are not normally distributed, we will use a Wilcoxon Signed
Rank test (p ≤ 0.05)
2. Wilcoxon Signed-Rank Test with continuity correction
a. Conducted for both LAD and PTV metrics
b. p ≤ 0.05 is significant
IV. Results
A. PI: PTV Dose
1. Plan normalization consistency between treated and research plans
2. Difference = (Treatment Plan PTV V60 Gy metric) – (Research Plan
PTV V60 Gy metric)
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3. V60 coverage of the PTV

a. Range of V60 Gy PTV coverage in treated plans
b. Range of V60 Gy PTV coverage in research plans
c. Range of observed change in V60 Gy PTV coverage between
treated and research plans
d. Fail to Reject H0: There is insufficient evidence to suggest that
there is a difference in V60 Gy for the PTV between treated and
research plans
i. 𝛼 = 0.05 < 𝑝 = 0.1029
ii. 𝐶𝐼: (−1.245, 0.545)
B. PII: LAD Dose
1. Difference = (Treatment Plan LAD V15 Gy metric) – (Research Plan
LAD V15 Gy metric)
2. V15 coverage of the LAD
a. Range of V15 Gy dose to the LAD in treated plans
b. Range of V15 Gy dose to the LAD in research plans
c. Range of observed change in the LAD V15 Gy metric between
treated and research plans
d. Reject H0: There is statistically significant evidence to suggests
that there is a difference in V15 Gy for the LAD between initial
and research plans
i. 𝛼 = 0.05 > 𝑝 = 0.000143
ii. 𝐶𝐼: (3.541, 11.184)

V. Discussion
VI. Conclusion
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References
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survival, and initial treatment in patients with non–small cell lung cancer in the US.
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