Adriana Dalea

Planning Assignment (Prostate)

Target organ(s) or tissue being treated: Prostate
Prescription: 7560 cGy. 180 cGy/fraction. 42 fractions.
Organs at risk (OR) in the treatment area (list organs and desired objectives in the table below):
Organ at risk Desired objective(s) Achieved objective(s)
Bladder

Less than 6500 cGy 4533.3 cGy
Small Bowel

Less than 4000 cGy 22.4 cGy
Left femoral head

Less than 5200 cGy 2306.3 cGY
Right femoral head

Less than 5200 cGy 2119.3 cGy
Rectum

Less than 6000 cGy 5486.5 cGy

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)
The energy applied for the beams was 6 MV. Plan was normalized so 95% of the dose to cover
100% of the volume.
a. Where is the region of maximum dose (hot spot)? What is it?
There were two regions with hot spots, they were the anterior and posterior portions of the
external body. The maximum hot spot was 183.1 %.
b. What are the doses to the rectum, bladder and femoral heads (evaluate the DVH)?
Mean doses are: Rectum: 5995.2 cGy; Bladder: 5366.2 cGy; Left femoral head: 271.8 cGy;
Right femoral head: 250.4 cGy. The rectum and the bladder are the most affected
structures, they receive the highest dose. For the rectum, over 60% of the volume receives
100 % of the dose. 50 % of the volume of the bladder receives 100% of the dose.


Plan 2: Increase the energy of both beams to the highest photon energy available.
The beam energy was increased to 18MV.
a. How did the isodose distribution change with the higher energy?
The dose distribution became more uniform, the hot spots areas decreased in size, but they
still remained in the anterior and posterior areas of the body. The hot spot area from the
posterior side increased in comparison with the anterior one. The maximum hot spot was
130.7%.
b. Did the doses to the rectum and bladder change?
The rectum dose increased to 6052.9 cGy, as well as the bladder dose to 5428.3 cGy.
If you change the weighting ratio, how does it affect the dose distribution?
I changed the weight ratio to AP 40%/PA 60% and the doses became 6143.9 cGy for the
rectum, and the bladder dose slightly decreased to 5225.2 cGY.



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?
The isodose lines cover uniformly the target area, the hot spot moved within the PTV
volume. The hot spot is 142.5%.
b. What happened to the rectal, bladder and femoral head doses? Which structure
received the biggest dose change? Why?
Rectum dose increased to: 6339.6 cGy; Bladder: decreased to 4495.4 cGy; Left femoral head
increased to 5210.5 cGy and the right femoral head increased to 5155.4 cGy.
The highest dose change we can observe at the femoral heads. This is because I added the
two right and left lateral beams, and I assigned equal weighting to all four beams.


Plan 4: Adjust the weighting of the beams to try and achieve the best possible dose
distribution.
I adjusted the beams as follows: AP 40.7%, PA 33.5 %, RT LAT 11.8% and LT LAT 14%.
Which treatment plan covers the target the best? What is the hot spot for that plan?
Plan 4 with the weighting of the 4 beams obtained the most conformal dose distribution.
The hot spot was 116.8% and was within the soft tissue on the anterior side of the patient.
This patient was very large, so the scatter dose increased accordingly.
Did you achieve the OR constraints as listed in the table on page 1? List them in the
table
The OR dose constraints were met for plan 4. The values are listed in the table.
What did you learn from this planning assignment?
It was interesting to experiment and work with the beams energies and weighting. I learned
that for a deeper tumor it is more beneficial to increase the beam energy and also, the best
dose distribution and is obtained when we add multiple beams and change the beams
weighting.
What will you do differently next time?
I would probably add more beams and evaluate the dose distribution.
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?
The isodose lines have a more conformal distribution in this plan. There is a 116.2 % hotspot
within the rectum.
b. What are the doses for the critical structures?
Bladder: 4871.8 cGy; Small bowel: 22.2 cGy; Left femoral head: 751.9 cGy; Right femoral
head: 648.3 cGy; Rectum: 5749.6 cGy.
c. What are the advantages to using this technique? Disadvantages?
The advantages for using this technique is the more uniformity of the dose distribution and
the fact that the dose to the femoral necks decreases significantly. As a disadvantage we
can mention that the doses to the rectum and the bladder increase.