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    Parotid Lab

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    1) This document summarizes three radiation treatment plans for a patient with a parotid tumor. Plan 1 used a wedge pair technique and met all dose constraints. Plan 2 used mixed photon and electron beams but did not adequately cover the tumor volume or meet the brainstem constraint. Plan 3 used 5-field IMRT and best met tumor coverage and critical structure constraints. 2) For Plan 3, beams were arranged more toward the left side of the patient where the tumor was located to reduce dose to normal tissues on the right side. The 5-field arrangement was selected over a 6-field plan as it produced similar target coverage and critical structure doses with one less beam. 3) Of the three plans,

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    Parotid Lab

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    80 views11 pages
    1) This document summarizes three radiation treatment plans for a patient with a parotid tumor. Plan 1 used a wedge pair technique and met all dose constraints. Plan 2 used mixed photon and electron beams but did not adequately cover the tumor volume or meet the brainstem constraint. Plan 3 used 5-field IMRT and best met tumor coverage and critical structure constraints. 2) For Plan 3, beams were arranged more toward the left side of the patient where the tumor was located to reduce dose to normal tissues on the right side. The 5-field arrangement was selected over a 6-field plan as it produced similar target coverage and critical structure doses with one less beam. 3) Of the three plans,

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    1) This document summarizes three radiation treatment plans for a patient with a parotid tumor. Plan 1 used a wedge pair technique and met all dose constraints. Plan 2 used mixed photon and electron beams but did not adequately cover the tumor volume or meet the brainstem constraint. Plan 3 used 5-field IMRT and best met tumor coverage and critical structure constraints. 2) For Plan 3, beams were arranged more toward the left side of the patient where the tumor was located to reduce dose to normal tissues on the right side. The 5-field arrangement was selected over a 6-field plan as it produced similar target coverage and critical structure doses with one less beam. 3) Of the three plans,

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    80 views11 pages

    Parotid Lab

    Uploaded by

    api-268707929
    1) This document summarizes three radiation treatment plans for a patient with a parotid tumor. Plan 1 used a wedge pair technique and met all dose constraints. Plan 2 used mixed photon and electron beams but did not adequately cover the tumor volume or meet the brainstem constraint. Plan 3 used 5-field IMRT and best met tumor coverage and critical structure constraints. 2) For Plan 3, beams were arranged more toward the left side of the patient where the tumor was located to reduce dose to normal tissues on the right side. The 5-field arrangement was selected over a 6-field plan as it produced similar target coverage and critical structure doses with one less beam. 3) Of the three plans,

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    1

    Yasmin Ahmed
    Clinical Practicum II- Parotid Lab
    August 9, 2015
    Note: Dose constraints for all plans are according to limits set by my clinical site. Plan 1 and 2
    were both planned with a 1cm auto-surround margin around the planning target volume (PTV).
    Plan 1: Wedge Pair
    Patient Positioning: The patient is lying supine with a headrest and aquaplast mask. A knee
    sponge was placed under the patients knees for comfort.
    Critical Structures:
    Critical Structure
    Spinal Cord
    Brainstem
    Anterior Oral Cavity

    Tolerance Dose
    Max Dose <4700cGy
    Max Dose <4700cGy
    D65<3000cGy

    Dose Received
    2825.2cGy
    3219.8cGy
    65%= 1840cGy

    Constraint Met
    Yes
    Yes
    Yes

    Mandible

    D35<3500cGy
    V6600cGy<0.1cc

    35%= 2026cGy
    Maximum= 6335.5cGy

    Yes

    Beam Parameters:
    Gantry
    Angle
    Beam 1 (Parotid)
    60
    Beam 2 (Parotid)
    120
    Beam 3 (Neck)
    0

    Beam
    Energy
    6x
    6x
    10x

    Wedge Angle
    EDW 45 In
    EDW 45 Out
    None

    Collimator
    Angle
    90
    90
    0

    Couch
    Angle
    0
    0
    0

    Field Size
    8.9cm x 8cm
    8.9cm x 8cm
    9.5cm x 12cm

    This is an axial slice showing the gross tumor volume (GTV) and PTV coverage, and the
    maximum point dose for the sum plan.

    This is an axial slice showing the neck nodes volume and coverage to that area.

    This is a coronal slice showing the GTV, PTV, and neck nodes coverage.
    Dose Volume Histogram (DVH) of plan 1 sum:

    1a) With the chin extended, it is easier to avoid having the beams enter or exit into the chin. The
    lower aspect of the field needs to be at the base of the mandible and extending the chin makes it
    a straight line. Also, with the anterior field for the neck nodes, it is easier to have a match line in

    4
    a place that avoids dose to the chin. If the chin is not extended, the anterior field will go thru the
    chin.
    1b) The GTV was covered by 95%, but the PTV was not adequately covered. This was due to the
    fact that the PTV was close to the skin and was not able to receive adequate dose to that area.
    This may have been remedied with the addition of a bolus.

    5
    Plan 2: Ipsilateral Photon/Electron (Mixed Beam)
    Critical Structures:
    Critical Structure
    Spinal Cord
    Brainstem
    Anterior Oral Cavity

    Tolerance Dose
    Max Dose <4700cGy
    Max Dose <4700cGy
    D65<3000cGy

    Dose Received
    4692cGy
    4711cGy
    65%= 100cGy

    Constraint Met
    Yes
    No
    Yes

    Mandible

    D35<3500cGy
    V6600cGy<0.1cc

    35%= 140cGy
    Maximum= 6345cGy

    Yes

    Beam Parameters:

    Beam 1
    (Photon)
    Beam 2
    (Electron)

    Gantry
    Angle
    72

    Beam
    Energy
    10x

    Bolus

    Couch
    Angle
    0

    Cone Size

    3mm

    Collimator
    Angle
    0

    72

    12e

    3mm

    10cm x 10cm

    NA

    Field
    Size
    8.7cm
    x
    9.6cm
    NA

    6
    This is an axial slice showing the GTV and PTV coverage with the placement of a 3mm bolus.

    This is an axial slice of plan 2 showing the location of the maximum point dose.
    DVH of plan 2:

    2a) For this plan a 3mm bolus was added to both the photon and electron beams. However, the
    DVH for plan 2 shows inadequate coverage to the GTV and PTV as compared to plan 1. This
    plan was also not as homogenous as plan 1. For this volume, the better approach may be the
    wedge pair with a bolus instead of mixed beams.
    2b) The dose constraint for the brainstem was not met.

    Plan 3: Static Beam IMRT


    Critical Structures:
    Critical Structure
    Spinal Cord
    Brainstem
    Anterior Oral Cavity

    Tolerance Dose
    Max Dose <4700cGy
    Max Dose <4700cGy
    D65<3000cGy

    Dose Received
    2307.5cGy
    2235cGy
    65%= 645cGy

    Constraint Met
    Yes
    Yes
    Yes

    Mandible

    D35<3500cGy
    V6600cGy<0.1cc

    35%= 888cGy
    Maximum= 6331.3cGy

    Yes

    Beam Parameters:

    Beam 1
    Beam 2
    Beam 3
    Beam 4
    Beam 5

    Gantry
    Angle
    10
    50
    90
    130
    170

    Beam
    Energy
    6x
    6x
    6x
    6x
    6x

    Wedge Angle
    None
    None
    None
    None
    None

    Collimator
    Angle
    0
    0
    0
    0
    0

    Couch
    Angle
    0
    0
    0
    0
    0

    Field Size
    6.2cm x 9cm
    7.0cm x 9.0cm
    8.0cm x 9.0cm
    7.0cm x 8.5cm
    5.8cm x 8.5cm

    This is an axial slice showing the GTV and PTV coverage.

    10

    This is a coronal slice showing the maximum point dose for plan 3.
    DVH of plan 3:

    11
    3a) I tried two different beam arrangements. I tried a 5 beam and a 6 beam plan. For both plans I
    kept the beams more toward the left side, which is where the tumor is located. There is no reason
    to have beams entering from the right side. Doing so will give unnecessary dose to normal tissue
    and structures on the contralateral side.
    3b) I decided to choose the 5 beam arrangement for my final plan. This plan was very similar to
    the 6 beam plan as far as the PTV coverage and dose to critical structures. Hence, there was no
    reason to keep the additional beam. Of all 3 plans, this was the best plan produced in terms of
    GTV/PTV coverage and dose to critical structures.

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