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3+fd+rectum Planning Assignment

This document outlines the planning and optimization of a 3-field and 4-field radiotherapy plan for a rectal cancer patient. Key steps include contouring the clinical target volume (CTV) and planning target volume (PTV), creating initial beam arrangements, evaluating dose distributions, modifying beam energies and adding wedges to improve conformity. The final optimized 3-field plan uses 23X energy for all beams, with 49% weighting to the posterior beam and 25.5% each to the right and left lateral beams. A 45-degree wedge is used on both laterals. The 4-field plan adds an opposing anterior beam but removes wedges, resulting in more conformal dose around the target volume while potentially increasing dose to

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33 views5 pages

3+fd+rectum Planning Assignment

This document outlines the planning and optimization of a 3-field and 4-field radiotherapy plan for a rectal cancer patient. Key steps include contouring the clinical target volume (CTV) and planning target volume (PTV), creating initial beam arrangements, evaluating dose distributions, modifying beam energies and adding wedges to improve conformity. The final optimized 3-field plan uses 23X energy for all beams, with 49% weighting to the posterior beam and 25.5% each to the right and left lateral beams. A 45-degree wedge is used on both laterals. The 4-field plan adds an opposing anterior beam but removes wedges, resulting in more conformal dose around the target volume while potentially increasing dose to

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api-265264098
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© © All Rights Reserved
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Michelle Rocque

April 2, 2015
Planning Assignment (3 field rectum)
Use a CT dataset of the pelvis. Create a CTV by contouring the rectum (start
at the anus and stop at the turn where it meets the sigmoid colon). Expand
this structure by 1 cm and label it PTV.
Create a PA field with the top border at the bottom of L5 and the bottom
border 2 cm below the PTV. The lateral borders of the PA field should extend
1-2 cm beyond the pelvic inlet to include primary surrounding lymph nodes.
Place the beam isocenter in the center of the PTV and use the lowest beam
energy available (note: calculation point will be at isocenter).
Contour all critical structures (organs at risk) in the treatment area. List all
organs at risk (OR) and desired objectives/dose limitations, in the table
below:
Organ at risk
Bowel Bag (space)

Desired objective(s)
V45<195 cc

Achieved objective(s)
158cc receives 45Gy
which stays within
desired objective

a. Enter the prescription: 45 Gy at 1.8 /fx (95% of the prescribed dose to


cover the PTV). Calculate the single PA beam. Evaluate the isodose
distribution as it relates to CTV and PTV coverage. Also where is/are
the hot spot(s)? Describe the isodose distribution, if a screen shot is
helpful to show this, you may include it.
There is not much exit dose and the posterior entrance dose is very
hot.
b. Change to a higher energy and calculate the beam. How did your
isodose distribution change?
By changing the energy to 23X the entrance dose was lowered and the
isodose lines flattened out. There was exit dose.

c. Insert a left lateral beam with a 1 cm margin around the ant and post
wall of the PTV. Keep the superior and inferior borders of the lateral
field the same as the PA beam. Copy and oppose the left lateral beam
to create a right lateral field. Use the lowest beam energy available for
all 3 fields. Calculate the dose and apply equal weighting to all 3
beams. Describe this dose distribution.
Dose from the posterior field stays deposited with little dose exiting
anteriorly. The lower energy through the laterals keeps too much dose
in lateral tissue (80% isodose). The overall max dose (hot spot) of the
plan is lowered.
d. Change the 2 lateral fields to a higher energy and calculate. How did
this change the dose distribution?
By changing the lateral energy to 23X the dose distribution looked
much better in the periphery lowering lateral tissue dose. The 50, 60
and 70% isodose lines are pulled out to the skin surface not in tissue.
e. Increase the energy of the PA beam and calculate. What change do you
see?
Increasing the PA beam energy from 6X to 23X lowered the hotspot
from 111.1% to 107.9%. The 100% isodose lines shifted anteriorly
covering more of the PTV.
f. Add the lowest angle wedge to the two lateral beams. What direction
did you place the wedge and why? How did it affect your isodose
distribution? (To describe the wedge orientation you may draw a
picture, provide a screen shot, or describe it in relation to the patient.
(e.g., Heel towards anterior of patient, heel towards head of patient..)
This patient is prone. I placed a 10degree dynamic wedge with heel
towards posterior. The hotspot was further reduced to 106.3%. The
dose was attenuated slightly more from posterior to anterior aspect of
the patient.
g. Continue to add thicker wedges on both lateral beams and calculate for
each wedge angle you try (when you replace a wedge on the left ,
replace it with the same wedge angle on the right) . What wedge
angles did you use and how did it affect the isodose distribution? The
higher wedge that was used the better the dose was pushed out of the
periphery of tissue and conformed around the PTV. The integral dose
became lower at the heel and greater at the toe. This could be
greatest seen by the 70% isodose line.
h. Now that you have seen the effect of the different components, begin
to adjust the weighting of the fields. At this point determine which
energy you want to use for each of the fields. If wedges will be used,
determine which wedge angle you like and the final weighting for each

of the 3 fields. Dont forget to evaluate this in every slice throughout


your planning volume. Discuss your plan with your preceptor and
adjust it based on their input. Explain how you arrived at your final
plan. I used 23X for all three fields and weighted them Pa 49% Rt 25.5
and Lt 25.5. I normalized the plan to the 96% isodose and final hotspot
was 105.3%. The wedges I used were dynamic and 45 degree. This
produced a good plan with a small amount of 70% laterally. The
hotspot was posterior in the sacrum. I arrived at this final plan by
following the steps above and changing the parameters, adding and
taking away wedges, changing weighting, and changing energy until
the plan looked appropriate for this patient. I did move the calculation
point because the isocenter was in air.
i. In addition to the answers to each of the questions in this assignment,
turn in a copy of your final plan with the isodose distributions in the
axial, sagittal and coronal views. Include a final DVH.

4 field pelvis
Using the final 3 field rectum plan, copy and oppose the PA field to create an
AP field. Keep the lateral field arrangement. Remove any wedges that may
have been used. Calculate the four fields and weight them equally. How does
this change the isodose distribution? What do you see as possible
advantages or potential disadvantages of adding the fourth field?
The 70% isodose line is conformed around the volume and not in the lateral
portion of the patient. Because this is a rectum patient that we are planning,
a four field configuration would add entrance dose to the bladder and small
bowel. They receive dose from the other plan, but it is exit dose so the
overall integral dose is lower.

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