Planning Assignment (Lung)

Target organ(s) or tissue being treated: LUNG

Prescription: 180x34= 6120 cGy
Organs at risk (OR) in the treatment area (list organs and desired objectives
in the table below):
Organ at risk
Spinal Cord

Desired objective(s)
Max dose < 4500 cGy

Achieved objective(s)
4470 cGy

Heart

D33 < 6000 cGy

D67 < 4500 cGy
D100 < 4000 cGy
V20 < 37%
Mean Dose < 2000 cGy
D33 < 6500 cGy
D67 < 5500 cGy
D100 < 4500 cGy

259 cGy
97 cGy
0 cGy
1003 cGy
1444 cGy
259 cGy
97 cGy
0 cGy

Total Lung-CTV
Esophagus

Contour all critical structures on the dataset. Place the isocenter in the
center of the PTV (make sure it isnt in air). Create a single AP field using the
lowest photon energy in your clinic. Create a block on the AP beam with a
1.5 cm margin around the PTV. 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). Refer
to Bentel, pp. 370-376 for references:
Plan 1: Create a beam directly opposed to the original beam (PA) (assign
50/50 weighting to each beam)
a. What does the dose distribution look like?
- For the 6 MV plan, the distribution is not even and the plan is very
hot. It is mostly hot in the tissue before it reaches the lung planning
target volume.
b. Is the PTV covered entirely by the 95% isodose line?
- No
c. Where is the region of maximum dose (hot spot)? What is it?

- The spot is in the anterior tissue surface before the lung begins. It is
7752 cGy, which is 27% hot.
Plan 2: Increase the beam energy for each field to the highest photon
energy available.
a. What happened to the isodose lines when you increased the beam
energy?
- Using 15 MV the plan is much less hot, but the isodose lines are
hugging in more than it does with the lower energy.
b. Where is the region of maximum dose (hot spot)? Is it near the
surface of the patient? Why?
- Yes, it is near the surface because it is close to the point of dmax.
Also, the exit dose from the posterior beam is pushing the hot spot up
a bit closer to the surface.
Plan 3: Adjust the weighting of the beams to try and decrease your hot
spot.
a. What ratio of beam weighting decreases the hot spot the most?
- AP beam= 48%
PA beam= 52%
b. How is the PTV coverage affected when you adjust the beam
weights?
- My PTV coverage remained the same. Any difference was negligible
at 0.06% from the DVH comparison.
Plan 4: Using the highest photon energy available, add in a 3rd beam to the
plan (maybe a lateral or oblique) and assign it a weight of 20%
a. When you add the third beam, try to avoid the cord (if it is being
treated with the other 2 beams). How can you do that?
i. Adjust the gantry angle?
- Yes, I first put the beam at 270 degrees but the cord was
in the field, so I angled the gantry.
ii. Tighter blocked margin along the cord
- I also adjusted a few of the MLCs.
iii. Decrease the jaw along side of the cord

- I also closed the jaw a bit.

b. Alter the weights of the fields and see how the isodose lines
change in response to the weighting.
- Depending on how I adjusted the field weights, my dose or hot
spot areas would shift to different areas.
c. Would wedges help even out the dose distribution? If you think so,
try inserting one for at least one beam and watch how the isodose
lines change.
- Wedges would not help my distribution. However, I inserted a
wedge just to see what would happen. The wedge tilted my isodose
lines and actually created an uneven distribution since I did not
actually need a wedge.

Which treatment plan covers the target the best? What is the hot spot
for that plan?
- The 3-field plan with an added 270 degree lateral beam with no wedges
is the best plan. The hot spot was 6441 cGy.

Did you achieve the OR constraints as listed above? List them in the table
above.
- Yes

What did you gain from this planning assignment?

- I learned how the beam reacts differently while going through air and
tissue and what happens to the distribution as you change energies. I also
saw how the distribution changes by added another field.

What will you do differently next time?

- Next time, instead of added a 270 degree lateral beam, I would try an
oblique angle to see what kind of distribution and plan that would yield.