Planning Assignment (Prostate)

Target organ(s) or tissue being treated: Prostate

Prescription: 180 cGy x 28 fractions = 5040
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)
Bladder

< 50% receives < 65 Gy 42 % < 5257 Gy
Rectum

< 50% receives < 60 Gy < 47 % < 5341 Gy
Femoral Heads

Max < 50 Gy
25 % < 45 Gy
40 % < 40 Gy
< 2691 Gy










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)? What is it? The area of maximum
dose in this plan is about 1cm into the entrance of the posterior field. The hot spot is
120.5%.
b. What are the doses to the rectum, bladder and femoral heads (evaluate the DVH)?
Rectum = 5764 cGy
Bladder= 5912.9 cGy
Femoral Heads = 358 cGy
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? Better coverage of the
95 and 100 % isodose line. The hot spot decreased to 109.3 cGy.
b. Did the doses to the rectum and bladder change? Yes, they both decreased.
c. If you change the weighting ratio, how does it affect the dose distribution? The hot spot
significantly increases with increase weighting to that particular side.
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? The isodose lines are
closest to the PTV are square shape conforming to the shape of the PTV
b. What happened to the rectal, bladder and femoral head doses? Which structure
received the biggest dose change?
Rectum = 5257
Bladder = 5353
Femoral heads = 3150
The femoral heads changed the most in dose due to the lateral fields being added and
the radiation beam going directly through them.
c. 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? What is the hot spot for that plan?
The best plan that I came up with to get the isodose lines to be the most conformal
around the PTV was a four field technique with 20 % dose from the anterior, 30 % dose
from the posterior, and 25 % dose from each lateral field. The hot spot for this plan was
105.4 %.
Did you achieve the OR constraints as listed in the table on page 1? List them in the
table. See table
What did you learn from this planning assignment? Four field standard pelvis technique
for prostate has almost equal weighting.

Comment [AV1]: This can be influenced by
patient shape, anatomy and location of PTV.

What will you do differently next time? Four field technique in this case is quite simple.
So I understood everything that I did.

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? Is it more or less conformal than a 4
field plan? The isodose lines are even tighter to the PTV making it more conformal.
b. What are the doses for the critical structures? Less because the dose in distributed into
two more fields.
c. What are the advantages to using this technique? Disadvantages?
Advantages: Decrease dose to critical structures by increasing the number of fields
By adding more fields it makes the dose around the PTV more conformal
Disadvantages: 2 more fields adds treatment time possibly
More normal tissue is being treated although it is a small dose Yes