Adriana Dalea

Planning Assignment (Lung)

Target organ(s) or tissue being treated: Right Lung.
Prescription: 6000 cGy. 300 cGy/day. 20 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)
Carina

ALARA 951.3 cGy
Spinal Cord

Less than 4500 cGy 39.3 cGy
Heart

Less than 4000 cGy 11.2 cGy
Left Lung

Less than 1750 cGy 65.4 cGy
Right Lung ALARA 769.5 cGy

Contour all critical structures on the dataset. Place the isocenter in the center of the PTV (make
sure it isnt in air). Create a single AP field using the lowest photon energy in your clinic. Create
a block on the AP beam with a 1.5 cm margin around the PTV. 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). Refer to Bentel, pp. 370-376 for
references:
All the plans were normalized to deliver 100% of the dose at the isocenter. An MLC was placed
and was fitted with a 1.5 margin to the PTV.
Plan 1: Create a beam directly opposed to the original beam (PA) (assign 50/50 weighting to
each beam)
The beams energy was 6 MV.
a. What does the dose distribution look like?
The isodose lines were not uniform.
b. Is the PTV covered entirely by the 95% isodose line? No.
c. Where is the region of maximum dose (hot spot)? What is it?
The hot spot was 120.2 % and was situated posteriorly, outside of the thoracic cavity
(within the muscle), in the same transversal plane with the tumor.
Plan 2: Increase the beam energy for each field to the highest photon energy available.
The energy was increased to 18 MV.
a. What happened to the isodose lines when you increased the beam energy?
The isodose lines became more uniform. The 95% isodose line covered the entire tumor,
but the 100 % isodose line didnt.
b. Where is the region of maximum dose (hot spot)? Is it near the surface of the
patient? Why?
The hot spot was 120.3 %, it moved slightly more interior than in plan 1. This is because
of the increase in energy, the beam penetrated better the tissues and deposited the
energy at a deeper depth.
Plan 3: Adjust the weighting of the beams to try and decrease your hot spot.
a. What ratio of beam weighting decreases the hot spot the most?
I adjusted the beams weighting to AP 62.3 % and PA 37.7%. The hot spot decreased the
most at this ratio, it was 115.2% and it was situated in the posterior area, outside the
thoracic cavity.
b. How is the PTV coverage affected when you adjust the beam weights?
The PTV coverage decreased slightly. The 95% isodose line didnt cover the PTV entirely.
Plan 4: Using the highest photon energy available, add in a 3
rd
beam to the plan (maybe a
lateral or oblique) and assign it a weight of 20%

a. When you add the third beam, try to avoid the cord (if it is being treated with the
other 2 beams). How can you do that?
i. Adjust the gantry angle?
ii. Tighter blocked margin along the cord
iii. Decrease the jaw along side of the cord
I added a right posterior oblique beam. The gantry was angled 240 degrees to avoid the
cord. The hot spot was 100.6 % and was within the tumor volume.
b. Alter the weights of the fields and see how the isodose lines change in response to
the weighting.
If the beams weights are altered, the isodose lines change unfavorably, the 95% isodose
line didnt cover the PTV entirely.
c. Would wedges help even out the dose distribution? If you think so, try inserting
one for at least one beam and watch how the isodose lines change.
I didnt consider the need of using a wedge is this scenario.

Which treatment plan covers the target the best? What is the hot spot for that plan?
Plan 4 had the best coverage for the tumor and the hot spot was 100.6 % within the tumor
volume.

Did you achieve the OR constraints as listed above? List them in the table above.
The OR dose constraints were met and are listed in the table.

What did you gain from this planning assignment?
This planning assignment was a good practice , it was very useful to learn how the increase
of the beams energy can improve the dose distribution for the lung treatment cases.

What will you do differently next time?
I would probably add a 4
th
beam, try to adjust the beams weighting and observe and apply
the best arrangement in order to obtain the best dose distribution.