Amanuel Negussie Clinical Practicum I

Planning Assignment (Prostate)

Target organ(s) or tissue being treated: Prostate Prescription: 180cGy per 42 fractions and normalized to the 98% isodose line. Organs at risk (OR) in the treatment area (list organs and desired objectives in the table below): Organ at risk Bladder 6000cGy Rectum Right femoral head 5200cGy 5200cGy Left femoral head Contour all critical structures on the dataset. Expand the prostate structure by 1cm in all directions and call it PTV. Place the isocenter in the center of the PTV. Create a single AP plan using the lowest photon energy in your clinic and 1.5cm margin around the PTV for blocking. From there, apply the following changes (one at a time) to see how the changes affect the plan (copy and paste plans or create separate trials for each change so you can look at all of them): Plan 1: Create a beam directly opposed to the original beam (PA) (assign 50/50 weighting to each beam) a. Where is the region of maximum dose (hot spot)? What is it? The maximum dose is 8706cGy located anteriorly b. What are the doses to the rectum, bladder and femoral heads (evaluate the DVH)? Rectum 3450cGy, bladder 6511cGy, Femoral heads 0cGy Plan 2: Increase the energy of both beams to the highest photon energy available. a. How did the isodose distribution change with the higher energy? There is a better coverage with higher energy. With lower energy, the lateral part of PTV is not well covered b. Did the doses to the rectum and bladder change? Yes. The does to rectum is 4017cGy and 6173cGy to the bladder c. If you change the weighting ratio, how does it affect the dose distribution? Part of the PTV near the low weighted region gets lesser coverage 3232cGy 3342cGy 3547cGy Desired objective(s) 6500cGy Achieved objective(s) 5899cGy

Amanuel Negussie Clinical Practicum I

In other words, the low weighted side gets colder and the high weighted side gets hotter

Plan 3: Add a Rt lateral field. Create a tighter blocked margin posteriorly along the rectum (try using 0.7cm vs. 1.5cm). Now, create an opposed beam, or a Lt. lateral. Assign even weights to all the beams (which should now be 4 beams) a. What is the biggest change you noticed with the isodose lines? There is a better lateral coverage. The isodose lines are more conformed and adequately covers the PTV b. What happened to the rectal, bladder and femoral head doses? Which structure received the biggest dose change? Why? The dose to the femoral heads is higher, but the rectum and bladder dose decreased. The femoral heads received the biggest dose change because of the lateral beams. The AP/PA beam does not pass through the femoral heads. Therefore, no dose was recorded for the femoral heads in the first plan. However, since the beam is laterally distributed with the four fields, they will start receiving some dose. Plan 4: Adjust the weighting of the beams to try and achieve the best possible dose distribution. Which treatment plan covers the target the best? What is the hot spot for that plan? The four field covers the target the best. The hot spot is 7978.5cGy Did you achieve the OR constraints as listed in the table on page 1? List them in the table Yes What did you learn from this planning assignment? Due to the thickness of the pelvic area, a better PTV coverage is achieved with higher energies. What will you do differently next time? I will start paying more attention to the location of the maximum dose and try to push it more towards the PTV.

Amanuel Negussie Clinical Practicum I

Still curious? Try adding 2 more beams, so youll have 6 total beams on the plan (PA, RPO, RAO, AP, LAO, LPO). Assign even weighting to all 6 beams. a. Now what does the isodose distribution look like? Is it more or less conformal than a 4 field plan? Its a lot more conformal than 4 field plan and covers the PTV more adequately b. What are the doses for the critical structures? Bladder 6730, rectum 4180, right femoral head 3490, and left femoral head 3560 c. What are the advantages to using this technique? Disadvantages? Advantage: it allows a better dose coverage to the PTV Disadvantage: higher dose to critical structures