Planning Assignment (Brain)

Derek Smith
Target organ(s) or tissue being treated:
Prescription: 2.5 Gy for 14 Fxs for a total dose of 35 Gy
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)

Lens
<7Gy 2.078Gy Lt and 2.062 Gy Rt
eye

<10Gy 2.380 Gy Lt and 2.342 Gy Rt
Optic chiasm

<56Gy 29.548 Gy

Brainstem
<60Gy 16.690 Gy

Optic nerve
<55Gy 15.062 Gy Lt and 10.964 Gy Rt




Contour all critical structures on the dataset. Place the isocenter in the center of the skull. Create a single Rt.
lateral plan using the lowest photon energy in your clinic. Refer to Bentel pp. 336-340 to add a block to the Rt.
Lateral field. 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 evaluate all of them):
Plan 1: Create a beam directly opposed to the original beam (Lt. lateral) (assign 50/50 weighting to each
beam)
a. What does the dose distribution look like?
-95% dose distribution cover the majority of the brain, but there is also way too much dose to the
organs at risk (OR) thus an MLC would help.
b. Where is the region of maximum dose (hot spot)? What is it?
- 113.8%, the hotspot is far too anterior the patient near the bridge of the nose.

Plan 2: Adjust the weighting of the beams to try and decrease your hot spot.
a. Did it help the hot spot?
- Not too much it mostly made it higher when I adjust the weighting on either beam if I placed too much
weighting on one beam.
b. Did your isodose coverage of the brain change?
- Yes, i.e. with weighting at 70% the left lateral beam and 30% the right lateral beam pulled the coverage
away from the right side of the patient.

Plan 3: Does your facility ever use wedging or segmented fields to decrease the hot spot? If so, try one of
those techniques (wedging is easier at this point).
a. Evaluate the isodose lines. Which direction does the wedge need to go?
- the wedge heel needs to go out to help drive the dose in.
b. Which wedge provides the most even dose distribution?
-15 out EDW

Plan 4: Does your facility use other techniques to treat whole brains? Discuss this with your clinical
instructors and work on creating different whole brain plans. Several of these other techniques include slight
anterior obliques, collimator rotations, half-beam blocking with an off-axis prescription point.
a. What are the advantages to these other techniques?
-These techniques provide more protection to the lens and eyes. Slight anterior obliques are used more often.

b. When designing and evaluating different techniques, which one produces the most ideal plan?
- Slight anterior obliques with an MLC beam blocking are used more in emergency clinical setup on the
treatment machine and provided the most ideal plan.


Which treatment plan covers the target the best? What is the hot spot for that plan?
-Plan 4, hot spot= 112.2%
Did you achieve the OR constraints as listed in the table on page 1? List them in the table.
-yes
What did you learn from this planning assignment?
-From this planning assignment I learned a lot about how using different dose weighting techniques can
either hurt or help dose conformity and the hot spot. For example, I learned that placing a wedge with
the heel in relation to the hotspot helps the dose distribution by pushing it toward the toe of the wedge.
Overall, I gained a further conceptualization of how these different techniques can be useful
What will you do differently next time?
- Next time I will most likely use a slight anterior oblique technique to remove more dose from the lens
because a whole brain is usually concerned with the dose to the lens. I would also use a field-in-field
technique to try to cutdown the hotspot if I cant achieve a lower dose from adjusting the beam
weighting.