This head and neck plan was a little bit of a struggle. The PTV70 D0.

03cc < 7130 cGy seemed nearly impossible to

me since that is just a pixel hot spot of < 101.9%. I attempted to lower the maximum dose as much as possible, but
didn’t want to keep optimizing to try and meet that constraint. To meet the Post Neck constraint, I did a “no entry” on
that structure in the optimizer. This made meeting the Post Neck V35Gy < 10% very easy, avoided shooting beam
through the spinal canal, and it helped meet the Spinal_Cord D0.03cc < 4800 cGy. The Rt_Parotid also had a mean dose
constraint < 2400 cGy. To meet this objective, I ran an upper gEUD in the optimizer of 2200 cGy with a priority of 100. I
also used upper objectives in the optimizer on a zParotid_R_out structure that was cropped 3mm out of the PTVs with
priorities in the 90s and pushed on these upper objectives while keeping the cost under 6%.
 I wasn’t able to meet the Mandible V70Gy < 10%, but I was very close. I used a Mandible_in structure and had
an upper and lower objective. I did this because I wanted the PTV70 to still get coverage but I didn’t want any hot spots
or increased dose to the mandible inside the PTV70. I also wasn’t able to meet the PTV63-PTV70 D20 < 6615 cGy. I tried
pushing on the PTV63_opti upper objective to bring the dose down but it ended up hurting my PTV70 coverage and
when normalizing made the plan hotter. I hope someone has a good trick for this that I can learn from.