Five fraction SBRT limits

Volume Total Dose Max Point Max Dose / Fx

Structure Dose / Fx (Gy) Endpoint Notes Reference
(cc) (Gy) Dose (Gy) (Gy)
Bladder wall 15 18,3 3,7 38 7,6 Cystitis/fistula TG-101
Brachial plexus (ipsilateral) 3 27 5,4 30,5 6,1 Neuropathy TG-101
Brainstem 0,5 23 4,6 31 6,2 Cranial neuropathy TG-101
Bronchus (ipsilateral) 0,5 21 4,2 33 6,6 Stenosis/fistula Avoid circumferential radiation TG-101
Cauda equina 5 30 6,0 32 6,4 Neuritis TG-101
Cochlea 25 5,0 Hearing loss TG-101
Colon 20 25 5,0 38 7,6 Colitis/fistula Avoid circumferential radiation TG-101
Duodenum 5 18 3,6 32 6,4 Ulceration Avoid circumferential radiation TG-101
Duodenum 10 12,5 2,5 32 6,4 TG-101
Esophagus 5 19,5 3,9 35 7,0 Stenosis/fistula Avoid circumferential radiation TG-101
Femoral heads (right and left) 10 30 6,0 Necrosis TG-101
Great vessels 10 47 9,4 53 10,6 Aneurysm TG-101
Heart/pericardium 15 32 6,4 38 7,6 Pericarditis TG-101
Jejunum/ileum 5 19,5 3,9 35 7,0 Enteritis/obstruction Avoid circumferential radiation TG-101
Liver >700 21 4,2 Basic liver function Parallel structure, spare at least this volume* TG-101
Lung (right and left) >1000 13,5 2,7 Pneumonitis Parallel structure, spare at least this volume* TG-101
Lung (right and left) >1500 12,5 2,5 Basic lung function Parallel structure, spare at least this volume* TG-101
Optic Pathway 0,2 23 4,6 25 5,0 Blindness TG-101
Penile bulb 3 30 6,0 50 10,0 Ipotence TG-101
Rectum 20 25 5,0 38 7,6 Proctitis/fistula Avoid circumferential radiation TG-101
Renal corex (right and left) >200 17,5 3,5 Basic renal function Parallel structure, spare at least this volume* TG-101
Renal hilum/vascular trunk 67% 23 4,6 Malignant hypertension TG-101
Rib 1 35 7,0 43 8,6 Pain or fracture TG-101
Sacral plexus 5 30 6,0 32 6,4 Neuropathy TG-101
Skin 10 36,5 7,3 39,5 7,9 Ulceration TG-101
Spinal cord 10% 23 4,6 30 6,0 Myelitis 5-6 mm above and below target Ryu
Spinal cord 0,35 23 4,6 30 6,0 Myelitis TG-101
Spinal cord 1,2 14,5 2,9 30 6,0 Myelitis TG-101
Stomach 10 18 3,6 32 6,4 Ulceration/fistula TG-101
Trachea 4 16,5 3,3 40 8,0 Stenosis/fistula Avoid circumferential radiation TG-101

*For parallel structures, subtract the volume that receives the listed dose from the total size of the organ and verify it is less than the volume listed. For example, a patient's liver is 2000 cc. An integral DVH graph shows 55% receives 21 Gy. This means (100%-55%=)
45% of the liver has been spared from 21 Gy. 45% of this patient's liver is 900 cc, which is more than the listed 700 cc volume, so the plan would meet this liver objective. Note that the DVH point you would use for IMRT optimization in this case would be (2000-
700)/2000 = 65% volume and 21 Gy dose.

Limits in this table are the default DVH objectives in Mobius3D (http://www.mobiusmed.com/)