Effect of lung-density correction in treatment planning for tangential-fields breast irradiation: a case report

We report on the effect of lung-density correction on dose distribution in a transverse slice containing the isocenter for tangential-fields breast irradiation. In this case study we analyzed the target coverage as well as hot spots for four types of treatment plans: Plan 1 assumes uniform unit density throughout, Plan 2 utilizes all the treatment parameters of Plan 1, but takes into account the lower lung density. Plan 3 is generated by optimizing the dose distribution in the presence of the lower lung density, and Plan 4 is an improvement on Plan 3 by using custom instead of standard wedges. Our analysis shows that consideration of the lower lung density is important for optimal treatment planning for the breast and that specially designed wedges can improve the dose distribution.