Parotid Planning Assignment

Aaron Wright
Clinical Practicum II
6/9/15
Clinical Lab Assignment: Parotid Treatment Technique Comparison
PLAN #1
For plan 1 an ipsilateral wedged pair was assigned for the first technique comparison.
The patients chin was in the extended position this allowed me to have a wedged pair in oblique
angles. The chin in the extended position moves the oral cavity and mandible up to help sparing.
The chin up also helps the region of abutting fields at the match-line by moving the mandible up
and out of the supraclavicular field. I accomplished coverage of the PTV by 95%, for this plan
the PTV required a reduction of 0.6 mm from the skin surface for accurate representation of
isodose curves using the XiO TPS.

Figure 1 The blue colorwash represents the gorss tumor volume in skin (GTVIS). The cayenne
or turquois colorwash represents the planned tumor volume in skin (PTVIS). The mandible is
contoured in light orange and the left parotid is represented by the light red colorwash. The
Sumner
spinal cord
hasRadiation
been contoured in green wire. Other contours of critical structures not shown in
the
Aug 07 2015 15:03:32

Planner
image
are ID:
thefrank
right inner
ear.
Teletherapy Sources
Version XiO - Release 4.60.00

Doc: 01020150807.144552.021
Patient
ID: M283958
The beam
angles, energies and wedges are shown here on the plan data:
Name: BROWN,LARRY R
Studyset ID: CTTP(image)
Description: CT GUIDED RAD THER FIE
Rescaled CTs: no Air: -790 Water: 1
Plan ID: 3A
Plan description: AARON WEDGE PAIR
Treatment Date: May 29 2015
Beam weighting mode: Absolute dose/MU
Beam Number
Beam Number
Beam Number
31
32
33
__________________
__________________ __________________
Description
Machine ID
Collimator
Setup/Dist (cm)
SSD/Wt fan SSD (cm)
Field Size at Isocenter
Field Size (cm)
Field Size (cm)
Coll. Eq. Square (cm)
Blk. Eq. Square (cm)
Gantry/Coll angle (deg)
Couch (deg)
Isocenter/Beam entry
X, Y, Z(cm)
Tx aids:
Wedge ID/Orient
WF/norm
Variable Wedge Angle(deg)
Port
Port/MLC normalization
Calc algorithm
Weight (cGy)/No. fractions
X, Y, Z (cm)
Defined at
Depth; skin (cm)
Effective; skin (cm)
TAR/TPR/PDD
At depth
At effective
PSCF(0)/PSCF(ec)
Dose Output
SCD/SWD (cm)
Ref. Depth or Dmax(cm)
Tray Factor(composite)
Min or MU(open/wdg)
Integer MU(open/wdg)
RAO
6Xa
Asym
SAD/100.0
94.5/93.1
RPO
6Xa
Asym
SAD/100.0
92.4/91.8
APSC
6Xa
Asym
SAD/100.0
93.4/97.1
LW/RW 0.0/10.1
UL/LL 8.9/0.7
9.84
7.18
315/90
0
Iso
-0.07/-18.75/1.55
LW/RW 0.0/10.2
UL/LL 0.4/7.6
8.97
6.38
225/90
0
Iso
-0.07/-18.75/1.55
LW/RW 12.6/0.0
UL/LL 8.0/-1.5
8.58
7.54
0/90
0
Iso
-0.07/-18.75/1.55
EDW/Toe-Out
0.853/wedged
45
MLC
blocked
Fastsuperpos
2988.0/30
-3.50/-13.50/0.95
Arb.point
4.9
5.3
TPRxPSCF/PSCF(0)(blk
1.726
1.698
0.700/0.999
0.797(cGy/MU)
100.0/98.0
10.0
1.000
118.21 (MU)
118
EDW/Toe-In
0.904/wedged
45
MLC
blocked
Fastsuperpos
2988.0/30
-3.50/-13.50/0.95
Arb.point
5.4
5.4
1.677
1.694
0.700/0.991
0.785(cGy/MU)
100.0/97.2
10.0
1.000
110.79 (MU)
111
---/-----/----MLC
blocked
Fastsuperpos
5040.0/28
-4.24/-25.00/1.17
Arb.point
3.3
3.4
1.825
1.822
0.700/0.988
0.779(cGy/MU)
100.0/100.4
10.0
1.000
180.39 (MU)
180
The hot spot was 10% hot on the plan with adequate coverage of 95% to the PTVIS. The
right inner ear did not pass the constraints guidelines at 51.47 Gy.
Critical structures were managed with adequate sparing except for the inner ear as the two
oblique fields are in this area to treat the parotid tumor volume.
A listing of critical structures and prescription recommendations are found in the table
below.
SUMNER
Radiation Oncology
HIGHPOINT HEALTH SYSTEMS

Patient: Wedge Pair
Student: Aaron Wright
Date: 8/7/2015
Rt Parotid
Structures
SPINAL CORD
Brain Stem
Mandible
RTOG 1016 Limits
Actual
Met
MAX 50 Gy
29.45 Gy
Yes
0.03 cc PRV CANNOT EXCEED 50 Gy

52 Gy Max Dose
0.0 vol
26.78 Gy
0.0 vol
Yes
Yes
Yes
Max 70 Gy
Max 66.18 Gy
Yes
Oral Cavity
Mean Dose 30-35Gy
21.13 Gy
Yes
Larynx
Mean dose < 20 Gy
2.25 Gy
Yes
< 50 Gy
Max 51.47 Gy
No
Mean Dose Contralateral <22 Gy

50% either Parotid < 30 Gy
LT 6.7 Gy
LT 0.0 %
Yes
Yes
Inner Ears
Parotid
Physician
RT
Date
PLAN #2
For plan 2 the same patient data set was used for an accurate comparison all isocenters
were the same and all fields abutted the supraclavicular field going to a total of 50.4 Gy. For the
second plan the required fields were a photon field paired with an ipsilateral electron field. The
plans hot spot was increased in comparison to the wedged pair fields. A 16 MeV field was
paired with a 6 MV field to the ipsilateral right parotid. Both fields abutted the supraclavicular
field for lower nodes.
The critical structure contours are exactly the same in the display the isodose lines are
represented by the same colors as well.
The photon beam was set to 270 degrees, as well as the corresponding electron field. The
plan data shown below entails the beam energies and specifics for each beam.
Sumner Radiation
Aug 07 2015 15:00:23
Planner ID: frank
Teletherapy Sources
Patient ID: M283958

Name: BROWN,LARRY R
Plan ID: 3B
Plan description: AARON P+E
Beam Number
33
__________________
Description
Machine ID
Collimator
Setup/Dist (cm)
SSD/Wt fan SSD (cm)
Cone ID
Field Size (cm)
Field Size (cm)
Couch (deg)
X, Y, Z(cm)
Tx aids:
Port
Calc algorithm
X, Y, Z (cm)
Defined at
Depth; skin (cm)
TAR/TPR/PDD
At depth
At effective
PSCF(0)/PSCF(ec)
Dose Output
SCD/SWD (cm)
SSD(output) (cm)
Min or MU(open/wdg)

Doc: 01020150807.144409.021
Beam Number
34
__________________
Beam Number
35
__________________
APSC
6Xa
Asym
SAD/100.0
93.4/97.1
RT LAT SALIVARY GLAN RT LAT e

6Xa
16e
Asym
Sym
SAD/100.0
SSD/110.0
94.0/92.5
110.0/110.0
--LW/RW 12.6/0.0
UL/LL 8.0/-1.5
8.58
7.54
0/90
0
Iso
-0.07/-18.75/1.55
--LW/RW 4.9/4.6
UL/LL 11.0/0.0
10.20
7.92
270/0
0
Iso
-0.07/-18.75/1.55
15x15
Width 15.0
Length 15.0
----270/0
0
Entry
-7.71/-14.25/0.83
MLC
blocked
Fastsuperpos
5040.0/28
-4.24/-25.00/1.17
Arb.point
3.3
3.4
1.825
1.822
0.700/0.988
0.779(cGy/MU)
100.0/100.4
--10.0
1.000
180.39 (MU)
180
MLC
blocked
Fastsuperpos
2150.5/30
-3.50/-13.50/0.95
Arb.point
4.1
4.3
1.772
1.762
0.700/1.002
0.801(cGy/MU)
100.0/96.6
--10.0
1.000
67.76 (MU)
68
Aperture
blocked
Pencil Beam
4301.1/30
-4.61/-14.25/0.83
Dmax
3.1
3.0
PDD(blk)
--102.4
---/--0.804(cGy/MU)
---/--110.0
3.1
--174.15 (MU)
174
All dose constraints were able to be met with this plan however there was an increase in
hotspot due to the electron field adding dose to the skin in the ear area. Of note the inner ear was
spared more with this technique. The PTVIS was covered by 95% and all critical structures were
with in the limits prescribed.
All critical structures with in constraints are an improvement over the photon and
electron paired technique however the hotspot was increased due to the electron field adding
dose to the ear. A table of the critical structures in the plan is as follows.
SUMNER
Radiation Oncology

Patient: Photon/Electron
Date: 8/7/2015
Rt Parotid
Structures
SPINAL CORD
Brain Stem
Mandible
RTOG 1016 Limits
Actual
Met
MAX 50 Gy
39.99 Gy
Yes

52 Gy Max Dose
0.0 vol
31.41
0.0 vol
Yes
Yes
Yes
Max 70 Gy
Max 66.78 Gy
Yes
Oral Cavity
Mean Dose 30-35Gy
15.52 Gy
Yes
Larynx
Mean dose < 20 Gy
3.17 Gy
Yes
< 50 Gy
Max 43.44 Gy
Yes

LT 13.91 Gy
LT 0.0 %
Yes
Yes
Inner Ears
Parotid
Physician
RT
Date
PLAN #3
The final technique in the comparison involved an IMRT technique. The beam
arrangements were of the planners discretion. I chose to use fields that encompassed a
resembled a half arc on the ipsilateral right side. The fields used the same previous isocenter and
abutted the lower supraclavicular field as well.
The contoured structures are the same as both plans prior to, with isodose line colors exactly the
same. The global hot spot was reduced and only contributed an added 10% over the prescribed
dose. The dose distribution is much more conformal of the three plans with added sparing to all
critical structures.
The planned angles are shown in the source data below. With all beams utilizing 6 MV
except for field #1 using an 18 MV beam to help push dose as this beam was nearly exactly full
posterior.
Sumner Radiation
Aug 07 2015 14:57:11
Planner ID: frank
Teletherapy Sources
Patient ID: M283958

Name: BROWN,LARRY R
Plan ID: 4B
Plan description: AARON IMRT SEG
Beam Number
1
__________________
Description
Machine ID
Collimator
Setup/Dist (cm)
SSD/Wt fan SSD (cm)
Field Size (cm)
Field Size (cm)
Couch (deg)
X, Y, Z(cm)
Tx aids:
Port
MLC Modulation Factor
Calc algorithm
X, Y, Z (cm)
Defined at
Depth; skin (cm)
TAR/TPR/PDD
At depth
At effective
PSCF(0)/PSCF(ec)
Dose Output
SCD/SWD (cm)
Min or MU(open/wdg)
Page 1 of 4
Doc: 01020150807.143829.001
Beam Number
2
__________________
Beam Number
3
__________________
1
196*
18Ximrtdmlc
Asym
SAD/100.0
92.8/92.8
2
224*
6ximrtdlmc
Asym
SAD/100.0
92.5/93.0
3
252*
6ximrtdlmc
Asym
SAD/100.0
93.0/92.1
LW/RW -1.3/8.7
UL/LL 9.9/0.0
8.47
2.54
196/0
0
Iso
-0.07/-18.75/1.55
X1/X2 0.4/7.7
Y2/Y1 10.1/0.0
8.99
2.53
224/0
0
Iso
-0.07/-18.75/1.55
X1/X2 3.3/6.4
Y2/Y1 10.3/0.0
9.99
2.71
252/0
0
Iso
-0.07/-18.75/1.55
SegMLC(320)
0.979
blocked
Fastsuperpos
700.5/30
-5.39/-14.50/1.03
Arb.point
5.3
5.4
1.527
0.697
0.667/0.993
0.945(cGy/MU)
100.0/98.0
10.0
1.000
51.85 (MU)
52
SegMLC(320)
0.985
blocked
Fastsuperpos
555.0/30
-4.38/-14.50/2.31
Arb.point
4.6
4.5
1.586
0.588
0.700/0.991
0.785(cGy/MU)
100.0/97.6
10.0
1.000
54.81 (MU)
55
SegMLC(320)
0.985
blocked
Fastsuperpos
744.9/30
-4.04/-14.50/1.17
Arb.point
4.0
3.9
1.634
0.788
0.700/1.000
0.799(cGy/MU)
100.0/96.1
10.0
1.000
52.85 (MU)
53
Sumner Radiation
Aug 07 2015 14:57:11
Planner ID: frank
Teletherapy Sources
Patient ID: M283958

Name: BROWN,LARRY R
Plan ID: 4B
Beam Number
1
__________________
Description
Machine ID
Collimator
Setup/Dist (cm)
SSD/Wt fan SSD (cm)
Field Size (cm)
Field Size (cm)
Couch (deg)
X, Y, Z(cm)
Tx aids:
Port
Calc algorithm
X, Y, Z (cm)
Defined at
Depth; skin (cm)
TAR/TPR/PDD
At depth
At effective
PSCF(0)/PSCF(ec)
Dose Output
SCD/SWD (cm)
Min or MU(open/wdg)
Page 1 of 4
Doc: 01020150807.143829.001
Beam Number
2
__________________
Beam Number
3
__________________
1
196*
18Ximrtdmlc
Asym
SAD/100.0
92.8/92.8
2
224*
6ximrtdlmc
Asym
SAD/100.0
92.5/93.0
3
252*
6ximrtdlmc
Asym
SAD/100.0
93.0/92.1
LW/RW -1.3/8.7
UL/LL 9.9/0.0
8.47
2.54
196/0
0
Iso
-0.07/-18.75/1.55
X1/X2 0.4/7.7
Y2/Y1 10.1/0.0
8.99
2.53
224/0
0
Iso
-0.07/-18.75/1.55
X1/X2 3.3/6.4
Y2/Y1 10.3/0.0
9.99
2.71
252/0
0
Iso
-0.07/-18.75/1.55
SegMLC(320)
0.979
blocked
Fastsuperpos
700.5/30
-5.39/-14.50/1.03
Arb.point
5.3
5.4
1.527
0.697
0.667/0.993
0.945(cGy/MU)
100.0/98.0
10.0
1.000
51.85 (MU)
52
SegMLC(320)
0.985
blocked
Fastsuperpos
555.0/30
-4.38/-14.50/2.31
Arb.point
4.6
4.5
1.586
0.588
0.700/0.991
0.785(cGy/MU)
100.0/97.6
10.0
1.000
54.81 (MU)
55
SegMLC(320)
0.985
blocked
Fastsuperpos
744.9/30
-4.04/-14.50/1.17
Arb.point
4.0
3.9
1.634
0.788
0.700/1.000
0.799(cGy/MU)
100.0/96.1
10.0
1.000
52.85 (MU)
53
Sumner Radiation
Aug 07 2015 14:57:11
Planner ID: frank
Teletherapy Sources
Patient ID: M283958

Name: BROWN,LARRY R
Plan ID: 4B
Beam Number
1
__________________
Description
Machine ID
Collimator
Setup/Dist (cm)
SSD/Wt fan SSD (cm)
Field Size (cm)
Field Size (cm)
Couch (deg)
X, Y, Z(cm)
Tx aids:
Port
Calc algorithm
X, Y, Z (cm)
Defined at
Depth; skin (cm)
TAR/TPR/PDD
At depth
At effective
PSCF(0)/PSCF(ec)
Dose Output
SCD/SWD (cm)
Min or MU(open/wdg)
Page 1 of 4
Doc: 01020150807.143829.001
Beam Number
2
__________________
Beam Number
3
__________________
1
196*
18Ximrtdmlc
Asym
SAD/100.0
92.8/92.8
2
224*
6ximrtdlmc
Asym
SAD/100.0
92.5/93.0
3
252*
6ximrtdlmc
Asym
SAD/100.0
93.0/92.1
LW/RW -1.3/8.7
UL/LL 9.9/0.0
8.47
2.54
196/0
0
Iso
-0.07/-18.75/1.55
X1/X2 0.4/7.7
Y2/Y1 10.1/0.0
8.99
2.53
224/0
0
Iso
-0.07/-18.75/1.55
X1/X2 3.3/6.4
Y2/Y1 10.3/0.0
9.99
2.71
252/0
0
Iso
-0.07/-18.75/1.55
SegMLC(320)
0.979
blocked
Fastsuperpos
700.5/30
-5.39/-14.50/1.03
Arb.point
5.3
5.4
1.527
0.697
0.667/0.993
0.945(cGy/MU)
100.0/98.0
10.0
1.000
51.85 (MU)
52
SegMLC(320)
0.985
blocked
Fastsuperpos
555.0/30
-4.38/-14.50/2.31
Arb.point
4.6
4.5
1.586
0.588
0.700/0.991
0.785(cGy/MU)
100.0/97.6
10.0
1.000
54.81 (MU)
55
SegMLC(320)
0.985
blocked
Fastsuperpos
744.9/30
-4.04/-14.50/1.17
Arb.point
4.0
3.9
1.634
0.788
0.700/1.000
0.799(cGy/MU)
100.0/96.1
10.0
1.000
52.85 (MU)
53
Sumner Radiation
Aug 07 2015 14:57:11
Planner ID: frank
Teletherapy Sources
Patient ID: M283958

Name: BROWN,LARRY R
Plan ID: 4B
Beam Number
1
__________________
Description
Machine ID
Collimator
Setup/Dist (cm)
SSD/Wt fan SSD (cm)
Field Size (cm)
Field Size (cm)
Couch (deg)
X, Y, Z(cm)
Tx aids:
Port
Calc algorithm
X, Y, Z (cm)
Defined at
Depth; skin (cm)
TAR/TPR/PDD
At depth
At effective
PSCF(0)/PSCF(ec)
Dose Output
SCD/SWD (cm)
Min or MU(open/wdg)
Page 1 of 4
Doc: 01020150807.143829.001
Beam Number
2
__________________
Beam Number
3
__________________
1
196*
18Ximrtdmlc
Asym
SAD/100.0
92.8/92.8
2
224*
6ximrtdlmc
Asym
SAD/100.0
92.5/93.0
3
252*
6ximrtdlmc
Asym
SAD/100.0
93.0/92.1
LW/RW -1.3/8.7
UL/LL 9.9/0.0
8.47
2.54
196/0
0
Iso
-0.07/-18.75/1.55
X1/X2 0.4/7.7
Y2/Y1 10.1/0.0
8.99
2.53
224/0
0
Iso
-0.07/-18.75/1.55
X1/X2 3.3/6.4
Y2/Y1 10.3/0.0
9.99
2.71
252/0
0
Iso
-0.07/-18.75/1.55
SegMLC(320)
0.979
blocked
Fastsuperpos
700.5/30
-5.39/-14.50/1.03
Arb.point
5.3
5.4
1.527
0.697
0.667/0.993
0.945(cGy/MU)
100.0/98.0
10.0
1.000
51.85 (MU)
52
SegMLC(320)
0.985
blocked
Fastsuperpos
555.0/30
-4.38/-14.50/2.31
Arb.point
4.6
4.5
1.586
0.588
0.700/0.991
0.785(cGy/MU)
100.0/97.6
10.0
1.000
54.81 (MU)
55
SegMLC(320)
0.985
blocked
Fastsuperpos
744.9/30
-4.04/-14.50/1.17
Arb.point
4.0
3.9
1.634
0.788
0.700/1.000
0.799(cGy/MU)
100.0/96.1
10.0
1.000
52.85 (MU)
53
The PTVIS was easily covered by the 95% and all critical structures were with
in tolerances of the prescription for this plan. The dose ranges are shown in this DVH graph
below.
The critical structures are shown here well below the tolerances due to IMRTs advantage of
conformal dose distribution.
The critical structure tolerances are shown in the graph here and clearly show
that although the photon and electron plan was acceptable the doses given in the IMRT plan are
lower while allowing for a lower global hot spot as well.
SUMNER
Radiation Oncology

Patient: IMRT
Date: 8/7/2015
Rt Parotid
Structures
SPINAL CORD
RTOG 1016 Limits
Actual
Met
MAX 50 Gy
20.20 Gy
Yes
Brain Stem

52 Gy Max Dose
0.0 vol
18.13
0.0 vol
Yes
Yes
Yes
Mandible
Max 70 Gy
Max 63.81 Gy
Yes
Oral Cavity
Mean Dose 30-35Gy
22.75 Gy
Yes
Larynx
Mean dose < 20 Gy
2.09 Gy
Yes
< 50 Gy
Max 28.10 Gy
Yes

LT 6.18 Gy
LT 0.0 %
Yes
Yes
Inner Ears
Parotid
Physician
RT
Date

Parotid Planning Assignment

Diunggah oleh

Informasi Dokumen

Deskripsi Asli:

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Parotid Planning Assignment

Diunggah oleh

Hak Cipta:

Format Tersedia

Aaron Wright

Aug 07 2015 15:03:32

Version XiO - Release 4.60.00

HIGHPOINT HEALTH SYSTEMS

RTOG 1016 Limits

0.03 cc PRV CANNOT EXCEED 50 Gy

Mean Dose 30-35Gy

Mean dose < 20 Gy

Mean Dose Contralateral <22 Gy

Patient ID: M283958

Version XiO - Release 4.60.00

RT LAT SALIVARY GLAN RT LAT e

HIGHPOINT HEALTH SYSTEMS

RTOG 1016 Limits

0.03 cc PRV CANNOT EXCEED 50 Gy

Mean Dose 30-35Gy

Mean dose < 20 Gy

Mean Dose Contralateral <22 Gy

Patient ID: M283958

Patient ID: M283958

Patient ID: M283958

Patient ID: M283958

HIGHPOINT HEALTH SYSTEMS

RTOG 1016 Limits

0.03 cc PRV CANNOT EXCEED 50 Gy

Mean Dose 30-35Gy

Mean dose < 20 Gy

Mean Dose Contralateral <22 Gy

Anda mungkin juga menyukai