Escolar Documentos
Profissional Documentos
Cultura Documentos
Constraint Met?
GTV: V100=76%
PTV: V95=95%
Max=27.83 Gy
V60=0%
Max=27.27 Gy
No
Max=2.85 Gy
Mean=1.26 Gy
Max=4.07 Gy
Mean=1.42 Gy
Max=1.5 Gy
Yes
Lt Lens
Rt Lens
Max=1.89 Gy
Yes
Lt Optic Nerve
Max=1.73 Gy
V60=0%
Max=1.36 Gy
V60=0%
Mean=3.37 Gy
Yes
Larynx
Mandible
Max=64.41 Gy
Yes
Oral Cavity
Mean=22.91Gy
Yes
Rt Parotid
Mean=1.07 Gy
V30=0%
Yes
Brainstem
Spinal Cord
Lt Orbit
Rt Orbit
Rt Optic Nerve
Yes
Yes
Yes
Yes
Yes
Yes
MCHATTON, JAMES,
Date/Time:
20150807 18:46:23
L2889
Comment:
PPPplan 1
PAROTID PLANNING PROJECTInstitution:
9.6 Lawrence Radiation Oncolog...
Trial_1
Physician/Physicist: AT/RH
R04.P04.D05
Planner:
ML
Not Locked
Patient Name:
Patient ID:
Plan Name:
Trial Name:
Revision:
Lock Status:
Machine
LMH IX
LMH IX
LMH IX
Energy
6XLCCO
6XLCCO
15XLCCO
Modality
Photons
Photons
Photons
Beam
LAO
LPO
AP SCV
Prescription
LT PAROTID
LT PAROTID
AP SCV
Gantry
Start / Stop
45 / 45
135 / 135
0 / 0
Couch
0
0
0
SSD (cm)
Isocenter Start / Avg
isoM
98.07 / 98.07
isoM
97.94 / 97.94
scv is... 100.00/ 100.00
Coll Block
0.0 MLC
0.0 MLC
0.0 MLC
MU Per Fraction
217
218
186
Wedge
Bolus
45_MLC... No
45_MLC... No
None
No
Comp
No
No
No
Prescriptions
LT PAROTID
Prescribe 200 cGy per fraction to 97 % of point dose at "calc ptM" for 30 fractions.
Beam weights are proportional to point dose.
Actual point dose at "calc ptM" from all prescriptions/beams is 6211.89 cGy.
2 beams are assigned to this prescription.
AP SCV
Prescribe 180 cGy per fraction to 100 % of point dose at "scv calc ptM" for 28 fractions.
Beam weights are proportional to point dose.
Actual point dose at "scv calc ptM" from all prescriptions/beams is 5063.72 cGy.
1 beam is assigned to this prescription.
Isocenter
isoM
Position patient such that lasers line up with patient marks.
Move the table LEFT 5.00 cm (looking from foot of table.)
Move the table UP 2.02 cm.
Move the table IN (toward the gantry) 0.00 cm.
scv isoM
Position patient such that lasers line up with patient marks.
Move the laser RIGHT 5.00 cm (looking from foot of table.)
Move the table UP 2.28 cm.
Move the table IN (toward the gantry) 9.50 cm.
Pinnacle v9.6
Pg 1 of 1 PLN
Patient Name:
Patient ID:
Plan Name:
Lock Status:
MCHATTON, JAMES,
L2889
PAROTID PLANNING PROJECT
Not Locked
Date/Time:
20150807 18:15:53
Comment:
PPPplan 1
Physician/Physicist:
AT/RH
Revision:
Planner:
Institution:
R03
ML
9.6 L
Patient Name:
Patient ID:
Plan Name:
Lock Status:
MCHATTON, JAMES,
L2889
PAROTID PLANNING PROJECT
Not Locked
Date/Time:
20150807 18:18:18
Comment:
PPPplan 1
Physician/Physicist:
AT/RH
Revision:
Planner:
Institution:
R03.P04.D05
ML
9.6 Lawrence
Patient Name:
Patient ID:
Plan Name:
Lock Status:
MCHATTON, JAMES,
L2889
PAROTID PLANNING PROJECT
Not Locked
Date/Time:
20150807 18:34:29
Comment:
PPPplan 1
Physician/Physicist:
AT/RH
Revision:
Planner:
Institution:
R04.P04.D05
Page:
ML
Scaling:
9.6 Lawrence Radiation Oncology
1 of 1
Fill Page
Patient Name:
Patient ID:
Plan Name:
Lock Status:
MCHATTON, JAMES,
L2889
PAROTID PLANNING PROJECT
Not Locked
Date/Time:
20150807 18:34:47
Comment:
PPPplan 1
Physician/Physicist:
AT/RH
Revision:
Planner:
Institution:
R04.P04.D05
ML
9.6 Lawrence
Patient Name:
Patient ID:
Plan Name:
Lock Status:
MCHATTON, JAMES,
L2889
PAROTID PLANNING PROJECT
Not Locked
Date/Time:
20150807 18:36:28
Comment:
PPPplan 1
Physician/Physicist:
AT/RH
Revision:
Planner:
Institution:
R04.P04.D05
Page:
ML
Scaling:
9.6 Lawrence Radiation Oncology
1 of 1
Fill Page
Patient Name:
Patient ID:
Plan Name:
Lock Status:
MCHATTON, JAMES,
L2889
PAROTID PLANNING PROJECT
Not Locked
Date/Time:
20150807 18:36:07
Comment:
PPPplan 1
Physician/Physicist:
AT/RH
Revision:
Planner:
Institution:
R04.P04.D05
Page:
ML
Scaling:
9.6 Lawrence Radiation Oncology
1 of 1
Fill Page
Plan #2
Table 2: OR constraints for LT parotid plan 2, mixed beam.
Structure
Constraint
Actual Dose
LT Parotid
Constraint Met?
GTV: V100=90.4%
PTV: V95=98%
Max=32.6 Gy
V60=0%
Max=29.8 Gy
No
Max=2.29 Gy
Mean=0.85 Gy
Max=1.33 Gy
Mean=0.76 Gy
Max=0.84 Gy
Yes
Lt Lens
Rt Lens
Max=0.94 Gy
Yes
Lt Optic Nerve
Max=4.63 Gy
V60=0%
Max=1.88 Gy
V60=0%
Mean=1.35 Gy
Yes
Larynx
Mandible
Max=70.7 Gy
No
Oral Cavity
Mean=11.8 Gy
Yes
Rt Parotid
Mean=16.4 Gy
V30=0%
Yes
Brainstem
Spinal Cord
Lt Orbit
Rt Orbit
Rt Optic Nerve
Yes
Yes
Yes
Yes
Yes
Yes
MCHATTON, JAMES,
Date/Time:
20150807 19:44:06
L2889
Comment:
PPPplan 2
PAROTID PLANNING PROJECTInstitution:
9.6 Lawrence Radiation Oncolog...
Trial_2
Physician/Physicist: AT/RH
R04.P05.D06
Planner:
ML
Not Locked
Patient Name:
Patient ID:
Plan Name:
Trial Name:
Revision:
Lock Status:
Beam
LT LAT
LT LAT e
Machine
LMH IX
LMH IX e
Energy
6XLCCO
15 MeV
SSD (cm)
Modality Prescription
Isocenter Start / Avg
Photons LT PAROTID
calc p...
96.30 / 96.30
Electrons LT PAROTID e 12e is... 100.50/ 100.50
Gantry
Start / Stop
90 / 90
90 / 90
Couch
0
0
Coll Block
0.0 MLC
0.0 Yes
MU Per Fraction
177
133
Wedge
Bolus
45_MLC... No
None
Yes
Comp
No
No
Prescriptions
LT PAROTID
Prescribe 80 cGy per fraction to 97 % of point dose at "calc ptM" for 30 fractions.
Beam weights are proportional to point dose.
Actual point dose at "calc ptM" from all prescriptions/beams is 6319.35 cGy.
1 beam is assigned to this prescription.
LT PAROTID e
Prescribe 120 cGy per fraction to 90 % of point dose at "12e calc pt" for 30 fractions.
Beam weights are proportional to point dose.
Actual point dose at "12e calc pt" from all prescriptions/beams is 6609.11 cGy.
1 beam is assigned to this prescription.
Isocenter
calc ptM
Position patient such that lasers line up with patient marks.
Move the table LEFT 3.05 cm (looking from foot of table.)
Move the table UP 2.02 cm.
Move the table OUT (away from the gantry) 0.75 cm.
12e iso
Position patient such that lasers line up with patient marks.
Move the table LEFT 7.25 cm (looking from foot of table.)
Move the table UP 2.01 cm.
Move the table OUT (away from the gantry) 0.75 cm.
Pinnacle v9.6
Pg 1 of 1 PLN
Patient Name:
Patient ID:
Plan Name:
Lock Status:
MCHATTON, JAMES,
L2889
PAROTID PLANNING PROJECT
Not Locked
Date/Time:
20150807 19:43:48
Comment:
PPPplan 2
Physician/Physicist:
AT/RH
Figure 6: Isodose distribution and maximum dose point for plan 2, wedged pair (Green=100%,
Purple=95%, Red=75%, Aqua=40%).
Revision:
Planner:
Institution:
R04.P
ML
9.6 L
Patient Name:
Patient ID:
Plan Name:
Lock Status:
MCHATTON, JAMES,
L2889
PAROTID PLANNING PROJECT
Not Locked
Date/Time:
20150807 19:45:27
Comment:
PPPplan 2
Physician/Physicist:
AT/RH
Revision:
Planner:
Institution:
R04.P05.D06
Page:
ML
Scaling:
9.6 Lawrence Radiation Oncology
1 of 1
Fill Page
RTP System
Patient Name:
Patient ID:
Plan Name:
Lock Status:
MCHATTON, JAMES,
L2889
PAROTID PLANNING PROJECT
Not Locked
Date/Time:
20150807 19:45:44
Comment:
PPPplan 2
Physician/Physicist:
AT/RH
Revision:
Planner:
Institution:
R04.P05.D06
Page:
ML
Scaling:
9.6 Lawrence Radiation Oncology
1 of 1
Fill Page
Patient Name:
Patient ID:
Plan Name:
Lock Status:
MCHATTON, JAMES,
L2889
PAROTID PLANNING PROJECT
Not Locked
Date/Time:
20150807 19:46:45
Comment:
PPPplan 2
Physician/Physicist:
AT/RH
Revision:
Planner:
Institution:
R04.P05.D06
Page:
ML
Scaling:
9.6 Lawrence Radiation Oncology
1 of 1
Fill Page
Patient Name:
Patient ID:
Plan Name:
Lock Status:
MCHATTON, JAMES,
L2889
PAROTID PLANNING PROJECT
Not Locked
Date/Time:
20150807 19:47:09
Comment:
PPPplan 2
Physician/Physicist:
AT/RH
Revision:
Planner:
Institution:
R04.P05.D06
ML
9.6 Lawrence Radiation O
B. The mandible max dose increased slightly in the mixed beam plan, enough that it
exceeded the dose constraint. The mandible volume directly abuts the parotid gland,
making it a difficult OR to avoid. Also, while the isodose coverage was better with the
mixed beam plan, the prescribed dose was still not achieved. Dose was lost in the PTV
inferiorly due to the 45-degree wedge placed to push dose superior. There was also some
of the deeper PTV tissue that was not adequately covered. The GTV dose was suboptimal
superficially, again, despite the electron beam and a 0.5cm bolus placed on the skin
surface. Incidentally, I should have done a better job cleaning up the bolus. I built it using
the tools in Pinnacle, but I did not look closely enough to notice that the bolus overlapped
itself around the ear, making the effective bolus 1.0cm or more. This most likely
contributed to the placement of the maximum dose point, in addition to the wedge.
Plan 3
Table 3: OR constraints for LT parotid plan 3, IMRT.
Structure
Constraint
Actual Dose
LT Parotid
Constraint Met?
Yes
Max= 4.29 Gy
Mean= 1.35 Gy
Max= 4.04 Gy
Mean= 0.89 Gy
Max= 1.74 Gy
Yes
Lt Lens
Rt Lens
Max= 1.43 Gy
Yes
Lt Optic Nerve
Max= 1.66 Gy
V60= 0%
Max= 1.12 Gy
V60= 0%
Mean= 0.53 Gy
Yes
Larynx
Mandible
Max= 63.27 Gy
Yes
Oral Cavity
Mean= 13.77 Gy
Yes
Rt Parotid
Mean= 6.8 Gy
V30= 0%
Yes
Brainstem
Spinal Cord
Lt Orbit
Rt Orbit
Rt Optic Nerve
Yes
Yes
Yes
Yes
Yes
Yes
MCHATTON, JAMES,
Date/Time:
20150809 14:05:22
L2889
Comment:
PPPplan 3
PAROTID PLANNING PROJECTInstitution:
9.6 Lawrence Radiation Oncolog...
Trial_3
Physician/Physicist: AT/RH
R05.P06.D07
Planner:
ML
Not Locked
Patient Name:
Patient ID:
Plan Name:
Trial Name:
Revision:
Lock Status:
Beam
180PA
220RPO
340RAO
20LAO
60LAO
100LPO
140LPO
Machine
LMH IX
LMH IX
LMH IX
LMH IX
LMH IX
LMH IX
LMH IX
Energy
6XLCCO
6XLCCO
6XLCCO
6XLCCO
6XLCCO
6XLCCO
6XLCCO
Modality
Photons
Photons
Photons
Photons
Photons
Photons
Photons
Prescription
parotid IMRT
parotid IMRT
parotid IMRT
parotid IMRT
parotid IMRT
parotid IMRT
parotid IMRT
Gantry
Start / Stop
180 / 180
220 / 220
340 / 340
20 / 20
60 / 60
100 / 100
140 / 140
Isocenter
imrtM
imrtM
imrtM
imrtM
imrtM
imrtM
imrtM
Couch
0
0
0
0
0
0
0
SSD (cm)
Start / Avg
93.65 / 93.65
90.58 / 90.58
90.55 / 90.55
95.99 / 95.99
98.09 / 98.09
98.12 / 98.12
97.72 / 97.72
Coll Block
0.0 MLC
0.0 MLC
0.0 MLC
0.0 MLC
0.0 MLC
0.0 MLC
0.0 MLC
Wedge
None
None
None
None
None
None
None
MU Per Fraction
61
39
82
42
57
50
45
Bolus
No
No
No
No
No
No
No
Comp
No
No
No
No
No
No
No
Prescriptions
parotid IMRT
Prescribe 200 cGy per fraction to 97 % of "PTVmGAP" mean dose for 30 fractions.
Actual "PTVmGAP" mean dose from all prescriptions/beams is 6170.13 cGy.
7 beams are assigned to this prescription.
Isocenter
imrtM
Position patient such that lasers line up with patient marks.
Move the table LEFT 5.00 cm (looking from foot of table.)
Move the table UP 2.02 cm.
Move the table OUT (away from the gantry) 1.00 cm.
Plan Authorization:
Pinnacle v9.6
Pg 1 of 1 PLN
Patient Name:
Patient ID:
Plan Name:
Lock Status:
MCHATTON, JAMES,
L2889
PAROTID PLANNING PROJECT
Not Locked
Date/Time:
20150809 14:01:35
Comment:
PPPplan 3
Physician/Physicist:
AT/RH
Figure 9: Isodose distribution and maximum dose point for plan 3, IMRT (Green=100%,
Purple=95%, Red=75%, Aqua=40%).
Revision:
Planner:
Institution:
R05.P06.D0
ML
9.6 Lawrenc
Patient Name:
Patient ID:
Plan Name:
Lock Status:
MCHATTON, JAMES,
L2889
PAROTID PLANNING PROJECT
Not Locked
Date/Time:
20150809 14:03:16
Comment:
PPPplan 3
Physician/Physicist:
AT/RH
Revision:
Planner:
Institution:
R05.P06.D07
Page:
ML
Scaling:
9.6 Lawrence Radiation Oncology
1 of 1
Fill Page
Patient Name:
Patient ID:
Plan Name:
Lock Status:
MCHATTON, JAMES,
L2889
PAROTID PLANNING PROJECT
Not Locked
Date/Time:
20150809 14:03:36
Comment:
PPPplan 3
Physician/Physicist:
AT/RH
Revisio
Planne
Institut
Patient Name:
Patient ID:
Plan Name:
Lock Status:
MCHATTON, JAMES,
L2889
PAROTID PLANNING PROJECT
Not Locked
Date/Time:
20150809 14:05:02
Comment:
PPPplan 3
Physician/Physicist:
AT/RH
Revision:
Planner:
Institution:
R05.P06.D07
Page:
ML
Scaling:
9.6 Lawrence Radiation Oncology
1 of 1
Fill Page
Patient Name:
Patient ID:
Plan Name:
Lock Status:
MCHATTON, JAMES,
L2889
PAROTID PLANNING PROJECT
Not Locked
Date/Time:
20150809 14:04:44
Comment:
PPPplan 3
Physician/Physicist:
AT/RH
Revision:
Planner:
Institution:
R05.
ML
9.6 L
typically resides near the skin surface, where there are tissue irregularities and varying target
depths. I felt that scooting the beams closer together would increase the area where beams
overlap, which would contribute dose to already hot tissue. So I decided to keep the beams
spaced 40 degrees apart. My final plan consisted of 7 beams, at 180, 220, 340, 20, 60, 100 and
140 degrees. This arrangement allowed me to achieve the isodose distribution I was hoping for,
without making the plan too hot. Fewer beams might have achieved the same coverage, with
less time on the table for the patient. However, I feel this plan was a good balance between target
coverage and hot spots. With 7 beams the dose to normal tissue, namely the shallow area near
the parotid gland, was spared excess entry dose. The exit dose from all beams was also nicely
spread among the adjacent OR, making it so no one area took a larger amount of exit dose.