Heather Maurer

February 2014
Planning Assignment (Prostate)
Target organ(s) or tissue being treated: Prostate only (intact, not including SV)
Prescription:_75.85 Gy in 1.85 Gy fractions
Organs at risk (OR) in the treatment area (list organs and desired objectives in the table below):
Contour all critical structures on the dataset. Expand the prostate structure by 1cm in all
directions and call it PTV. Place the isocenter in the center of the PTV. Create a single AP
plan using the lowest photon energy in your clinic and 1.5cm margin around the PTV for
blocking. 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):
Plan 1: Create a beam directly opposed to the original beam (PA) (assign 50/50 weighting to
each beam)
a. Where is the region of maximum dose (hot spot)? Towards the ant and post skin
surfaces, hottest area is post, center of beam, close to surface
What is it? 115.8
Planning Goals:
Structures Priority Planning limit: Achieved Objective(s)
Rectum

1 or
1 or
1 or
1 or
1 or
3 or
3 or
3 or
4 or
Max Dose to 0.1 cc (including PTV overlap) Rx dose
<15% 75 Gy
<25% 70 Gy
<35% 65 Gy
<50% 50 Gy
<5% 75 Gy
<15% 70 Gy
<17% 65 Gy ALARA

Max 68.7 Gy
Y 12.9%
Y 23.2%
Y 26.7%
Y 44.3%
N 12.9% >75 Gy
N 23.2% >70 Gy
N26.7% >65 Gy

Bladder 3 or
3 or
3 or
4 or
<25% 75 Gy
<35% 70 Gy
<50% 65 Gy ALARA

12.8%
24.2%
29.1%

Femur R/L 3 or
4 or
Max 45 Gy
ALARA
30.3%

Penile Bulb 3 or
4 or
Mean 50 Gy
ALARA
29.3%

Bowel 1 or
4 or
Max to 1cc 54 Gy
ALARA
Max 3.5 Gy

Other
Heather Maurer
February 2014

b. What are the doses to the rectum, bladder and femoral heads (evaluate the DVH)?
Max dose
Rectum 103.6% = 78.6 Gy
Bladder 106.5% = 80.8 Gy
Femoral head (right) 7.6% = 5.8 Gy
Femoral head (left) 7.5% = 5.7 Gy

Plan 2: Increase the energy of both beams to the highest photon energy available.
a. How did the isodose distribution change with the higher energy?
Hot spots are slightly deeper but not as hot, 108.7%
b. Did the doses to the rectum and bladder change?
Yes, rectum higher, max from 103.6 to 104.2 and mean 67.2% to 67.3%
Yes, Bladder lower, max from 106.5% to 105.7% and mean 87.6% to 88.3%
c. If you change the weighting ratio, how does it affect the dose distribution?
The field with more weight has more of a hot spot and pulls dose from opposing field
Plan 3: Add a Rt Lateral field. Create a tighter blocked margin posteriorly along the rectum (try
using 0.7cm vs. 1.5cm). Now, create an opposed beam, or a Lt Lateral. Assign even weights to
all the beams (which should now be 4 beams)
a. What is the biggest change you noticed with the isodose lines?
Nothing over 80% goes beyond box where all 3 beams intersect. Low dose reaches to
skin surface of all 3 fields.
b. What happened to the rectal, bladder and femoral head doses?
Rectum and Bladder lowered and femoral heads increased





Which structure received the biggest dose change?
Femoral heads
Why?
The two lateral beams are treating directly through the femoral heads. Previously the
femoral heads were not directly in the field.


Max dose
Rectum 100.8% = 76.5 Gy
Bladder 101.8% = 77.2 Gy
Femoral head (right) 68% = 51.6 Gy
Femoral head (left) 66.3% = 50.3Gy
Heather Maurer
February 2014
Plan 4: Adjust the weighting of the beams to try and achieve the best possible dose
distribution.
Which treatment plan covers the target the best?
The 4-field box plan AP & PA weight of .358 and Rt & Lt lateral weight of .142
What is the hot spot for that plan?
Hot spot of 103% typically fairly centered in PTV

Did you achieve the OR constraints as listed in the table on page 1? List them in the
table
All of the priority 1 constraints are met; some of the priority 3 & 4 of the rectum are not
met.
What did you learn from this planning assignment?
Adding more fields can create a more conformal area with lower doses to the skin and
healthy tissues. I also learned there can be more than one restriction to a structure
depending on volume. Higher energies are better for thicker, denser areas and can help
with surface dose.
What will you do differently next time?
Angle off of the femoral heads, possible use some additional fields with table kicks
Still curious? Try adding 2 more beams, so youll have 6 total beams on the plan (PA, RPO,
RAO, AP, LAO, LPO). Assign even weighting to all 6 beams.
a. Now what does the isodose distribution look like?
More diamond shape in center with some horns. Lower doses are star shaped. The IDLs
are bowing to avoid femoral heads.
Is it more or less conformal than a 4 field plan?
Slightly more conformal than 4-field
b. What are the doses for the critical structures?






c. What are the advantages to using this technique?
Spares the femoral heads more, slightly more conformal, lower dose to bladder and
rectum overall.
Disadvantages?
More beams means more healthy tissue being treated, but it is to a lower dose. Also
the rectum has a higher max dose, but the mean dose is lower. This also creates a
slightly longer treatment time for the patient

Max dose
Rectum 102.2% = 77.5 Gy
Bladder 100.8% = 76.5 Gy
Femoral head (right) 39.4% = 29.9 Gy
Femoral head (left) 41.7% = 31.6 Gy