Peter S Metuge

DOS 792
PAROTID CLINICAL LAB ASSIGNMENT
Goal: 60Gy with 95% isodose surrounding the PTV
Plan 1:
Ipsilateral Wedge pair plan
40
Yellow100
%

95
Orange
75%

Gantry angles used for this plan; G315 and G225

6X was used for planning
30 Physical wedge was used
Half Beam Block technique used
A) The patients position would not affect the beam arrangement. However, with the chin
extended, the mandible, eyes and lens dose will be minimized.
B) Constraints for the Parotid
Coverage to the parotid was adequate. Low coverage to the PTV was due to the ptv
extending close to the skin.
Critical Structures
Mandible
Spinal Cord

Tolerance Doses
Max Dose 70Gy
Max Dose 45Gy

Plan Doses
64.6Gy
36.6Gy

Rt Eye
Rt Lens
Rt Optic Nerve
Chiasm
Cochlea

Max Dose 45Gy

Max Dose 10Gy
Max Dose 45Gy
Max Dose 50Gy
Mean<35Gy

100
95
%

75
40

Gantry Angle 180

Energy Used 6X
Half Beam Block techniques used
Plan sum Wedge pair and Neck (Plot)

Rt Parotid and Neck Plan sum DVH

5.8Gy
2.9Gy
2.5Gy
1.9Gy
1.7Gy

GTV

Nod

Plan #2
Electron Only

Gantry Angle 270

Cone Size 15X15
9E energy used
Wedge pair and Electron Combined

75
100
95
%
40%

Plans Sum Electron and Wedge pair ( Mixed Beam) DVH

gtv
pt

a) This plan is very inhomogeneous. GTV coverage is good but the volume of gtv getting
110% or more of the prescription is 90%. Volume of PTV getting 110% is 60%. Dmax
was 75.4Gy for the mixed beam plan and 64.7Gy for the wedge pair plan. Also, the
addition of the electron plan to the wedge pair plan (mixed beam) increased dose to the
mandible taking the tolerance dose over the limit.
b) Dose constraints were within tolerance levels for these critical organs except for the
mandible which was over the recommended maximum dose of 70Gy.
Critical Organs

Tolerance Doses

Plan Doses

Mandible
Spinal Cord
Rt Eye
Rt Lens
Rt Optic Nerve
Chiasm
Cochlea

Max Dose 70Gy

Max Dose 45Gy
Max Dose 45Gy
Max Dose 10Gy
Max Dose 50Gy
Max Dose 50Gy
Mean<35Gy

Plan #3
4 Field IMRT
100
%

75
%

4Field IMRT DVH

40
95

74Gy
23.7Gy
5.7Gy
2.6Gy
2.5Gy
1.9Gy
1.7Gy

Exceeded
Met
Met
Met
Met
Met
Met

a) G340, G175, G235, G295

b) These beam arrangements were better in avoiding dose spilling into the oral cavity,
eye and lens. Also, better dose conformity around the target was the reason these beam
angles were finally selected.
Critical Organs
Mandible
Spinal Cord
Rt Eye
Rt Lens
Rt Optic Nerve
Cochlea
Chiasm

Tolerance Doses
Max Dose 70Gy
Max Dose 45Gy
Max Dose 45Gy
Max Dose 10Gy
Max Dose 50Gy
Mean< 35Gy
Max Dose 50Gy

Plan Doses
64.2Gy
2.4Gy
1.74Gy
1.4Gy
1.3Gy
1.02Gy
0.9Gy