Karen Krueger

Parotid Lab
August 5, 2015
Plan 1 Wedged Pair- The patient was supine, with a large mask (that covered the patients
shoulders), on head rest A. A knee sponge was placed under the knees and the patients arms
were by her side.

GTV = 100% > 6000cGy

100%= 6021cGy

Met

PTV > 95% 6000cGy

95% = 6000cGy

Met

Max= 2811cGy
V48= 0

Met

Max= 3190cGy
V50= 0

Met

Mean= 219.3cGy

Met

Max= 6692cGy
V70= 0
V60= 0

Met

Spinal Cord
Max < 4500cGy
V48<0.03cc
Spinal Cord +5mm
< 5000cGy
V50 <0.01cc
Contralateral Parotid
Mean < 2000cGy
Mandible
Max < 7500cGy
V70 <1%
V60<15%
Larynx
Max < 6600cGy
Mean 4400cGy
V50 <27%
Oral Cavity
Max < 6000cGy
Mean <3000cGy
Brainstem
Max < 5400cGy
Mean <3600cGy
V52 <0.03cc
Lens
0% = 300cGy

Max

Met
Max= 235.7cGy
Mean= 185.7
V50= 0
Max= 3837.1cGy
Mean= 2417.5cGy

Met

Max= 2851.47cGy
Mean= 1852.5cGy
V52= 0

Met

R Lens= 183.2cGy
L Lens= 173.7cGy

Met

Cochlea mean< 4500cGy

Mean=3667.2cGy

Met

Plan 1 Wedged Pair

1) a) When the chin is extended, the eyes and mandible are moved further away from the treatment
field. The dose to the eyes and mandible can be reduced by extending the chin. b) All constraints
were met.
When I began planning the wedged pair, I placed the isocenter in the center of the PTV. I
fit the multi-leaf collimator (MLC) with a 1.0cm margin around the PTV. I then created a plan
with two wedged fields with a 90 hinge angle. I used a 45 wedge. I tried to choose gantry
angles that would keep the dose away from the spine when wedged. I then normalized the plan
for 100% to cover 95% of the PTV. The coverage looked great, but the plan was really hot. I
decreased the normalization and I lost coverage. I tried adjusting my gantry angles and changed
my hinge angle to 110. I tried every wedge available. When I normalized the plan to the PTV it
was too hot. I then moved my isocenter to the medial edge of the PTV and normalized to the
isocenter. The plan was cooler, but I was lacking coverage superficially. I changed my gantry
angles many times. As I brought the angles closer together, my superficial coverage improved. I
ended up with the gantry angles of 240 and 330. I still couldnt get coverage of the PTV. I
spoke with a classmate about my problem and he asked if I had cropped my PTV from the body.
I had but only by 0. My PTV was going all the way to the body surface. He explained that I
should crop it 3mm from the body surface, so I did. My coverage was instantly better. However,
I was still lacking superficial coverage. I therefore added a 0.5cm bolus to the field. I adjusted
the weighting of the fields. I then changed the wedge to a 60 wedge. After adjusting the
weighting, I finally had a plan that met the organs at risk (OR) dose constraints.
One thing that I learned from this plan is that it may not be best to normalize to a volume
when planning. Sometimes this makes your plan too hot. It is sometimes necessary/helpful to
past point or move the isocenter medially to improve coverage. After moving the isocenter

medial, you can then normalize to the isocenter, normalize to a reference point, or normalize to
an isodose level. I normalized to the isodose level of 88.9 for optimum coverage. I also learned
that a wedged pair allows coverage of the deep aspect of the tumor volume, but you have to work
to get the superficial coverage. I also learned that moving the gantry angles closer together
improves the superficial coverage. I am now aware that the PTV should be cropped inside the
body for treatment planning.

Figure 1. Isodose distribution of the wedged pair including the maximum dose location.
Planning target volume (PTV) shown in red.

Figure 2. Isodose distribution of the wedged pair. Gross tumor volume (GTV) shown in
orange, PTV shown in red.

Figure 3. Dose volume histogram (DVH) for the wedged pair.

Figure 4. DVH for wedged pair.

Plan 1 Wedged Pair

Figure 5. Plan for wedged pair.

Figure 6. Abutting photon field for lymph nodes. GTV shown in orange. PTV shown in
red.

Figure 7. Isodose coverage of nodes including the maximum dose location.

Figure 8. Plan sum isodose distribution.

Figure 9. Plan sum maximum dose location.

Figure 10. Plan sum DVH.