Dose Volume Constraints for Organs at Risk

Dose Volume Constraints for OARs
Conventional fractionation

Spinal Cord – 40 Gy (max)

Brainstem – 54 Gy (max)

Optic nerves – 54 Gy (max)

Parotid Glands – 35 Gy (max)
25 Gy (<50%)

Brain – 50 Gy (minimize volume above 30 Gy as much as possible)

Mandible – 70 Gy (max)

Cochlea/Middle Ear – 30 Gy (max)

Oral Cavity – 30 Gy (mean)

Brachial Plexus – 60 Gy (max)

Posterior Neck Avoidance – 45 Gy (mean)

Lens – 5 Gy (max)

Eyes – 45 Gy (max)

Optic Chiasm – 54 Gy (max)

Optice Nerves – 54 Gy (max)

Lung – 20 Gy (<35%)

Heart – 40 Gy (max)

Esophogus – 60 Gy (<50%)

Kidney – 20 Gy (max)
< 50% of combined both kidneys
< 75% of one side of kidney if another kidney is not functional

Liver – 30 Gy (<40%)

Femoral heads – 45 Gy (max)

Small Bowel – 48 Gy (max)

Rectum –
40 Gy (<60%)
45 Gy (<50%)
60 Gy (<40%)
70 Gy (<20%)
75.6 Gy (<15%)
78 Gy (<5%)

Bladder – 70 Gy (<20%)

Femoral Heads – 45 Gy (<50%)

Pituitary gland – 36 Gy (max, adults), 18 Gy (max, children), very safe


Dose Volume Constraints for OARs
SRS, single fraction
Brainstem – 12 Gy (max)
Optic nerves – 12 Gy (max)
Optic Chiasm – 12 Gy (max)
Optice Nerves – 12 Gy (max)
Retina – 12 Gy (max)
Normal Brain – 20 Gy (max)
Lens – 2 Gy (max)
Skin – 5 Gy (max)


Dose Volume Constraints for OARs
SBRT, 3-5 fractions

Spinal Cord – 18 Gy (max), 10 Gy (<10%) single fraction
3 Gy per fraction always safe, only draw cord within 4 mm of PTV

Lung – 20 Gy (<15% of total lung capacity) total

Heart – 6-8 Gy (max) per fraction

Esophogus – 6 Gy (max), 4 Gy (<75%) per fraction

Stomach – 8 Gy (max) per fraction

Small bowel – 4 Gy (max) per fraction

Kidney – 1 functioning kidney: 2 Gy (max), 1 Gy (<75%) per fraction
2 kidneys: 3 Gy (max) per fraction to one, test to make sure both work

Liver – 15 Gy (<700 cc) total

Bronchii and trachea – 8 Gy (max) per fraction

Skin – 4 Gy (max) per fraction