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• Cooperation of radiation oncologist, clinical physicist and RTT essential
• Understand why an individual plan is not further improving
• Important to realize that treatment planning reflects anatomical situation at one
moment in time
• Current CTV-ITV-PTV margins take into account anatomical changes of targets but
not OAR
• Adaptive IGRT (e.g. library plans) accounts for these changes in a structured way and
may further help to improve balance between tumor and OAR dose
• Our knowledge on dose constraints and DVH parameters is constantly improving
To consider beyond dose constraints and DVH parameters