Cinira Johnson

February 25, 2014

Planning Assignment (Lung)

Target organs or tissue being treated: Right Lower Lobe of the lung
Prescription: 45 Gy in 25Fx
Organs at risk (OR) in the treatment area (list organs and desired objectives in the table below):

Organs at risk Desired objective(s) Achieved objective(s)
Esophagus No hot spot touching the
esophagus
No hot spots touching the
esophagus
Heart V40 < 30% V40 is 12%
Cord Max dose < 45Gy Max dose is 34.01 Gy
Bilateral Lung V20 < 30% V20% is 23%
Bilateral lung Mean dose < 20 Gy 10.88 Gy

Plan 1a - The dose distribution is not optimum. The 100% IDL (isodose line) does not cover
the PTV and does not meet at midplane.
1b - PTV is not covered entirely by the 95% IDL. This line has an hour glass shape that breaks
off at times due to the lower energy beam.
1c The hot spot is 5047centigray (cGy), and is located at the region of the posterior ribs.

Plan 2a With the increase in beam energy the 100% IDL now meets at midplane but still does
not cover the PTV appropriately. The 95% IDL covers 95% or more of the PTV.
2b The hot spot is at posterior rib region, therefore near the surface of the patient. This happens
because the patient is thicker posteriorly and due to an increased contribution from anterior beam
due to inhomogeneity between soft tissue and lung tissue.





Plan 3a AP = 0.552 and PA = 0.448
3b I tried putting more weight in the AP field, although it got rid of the hot spot it also decrease
PTV coverage.

4a I placed a new RPO field with the gantry rotated to 230 degrees to avoid the spinal cord
and I made the block tighter close to the spinal cord side.

4b I changed the field weights and I got a good dose distribution with a small hot spot at the
posterior ribs region. The cord dose was decreased.
4c I placed a 30 degree wedge on the AP field to compensate for the slope of the chest and it
got rid of the hot spot posteriorly. It also helps to even out the dose distribution.

Which treatment plan covers the target the best? What is the hot spot for that
plan?
The plan with best PTV coverage is Plan 4. The hot spot in this plan is at the same
location as the other plan (at posterior rib region). It is 4926 cGy, the smallest hot spot of
all plans.
Did you achieve the OR constraints as listed on page 1? List them in the table.
All the constraints were met.

What did you learn from this planning assignment?
I have learned:
1 How inhomogeneity effects treatment planning.
2 - How to manipulate the weight and wedges in order to decrease the size of the hot spot.
3 How different energies can make a difference improve PTV coverage.

What will you do differently next time?
Next time, I will be more attentive to how heterogeneity can play a major role in treatment
planning.