Beams Eye View

Beams eye view (BEV) is a tool that can be used to design treatment fields. BEVs are images
created by reconstructing computed tomography (CT) data to represent the patients anatomy and
define volumes from the viewpoint of the treatment beam. 3D and intensity modulated radiation
therapy (IMRT) treatment fields designed using BEV should include a margin to allow for full
dose coverage of the planning target volume (PTV). They should also account for beam
penumbral effects, as well as, the distance from the 50% to the 90% profile level. While this
margin accounts, predominantly, for possible lateral radiation-transport equilibrium losses, it
must also allow for exclusion of organs at risk (OR) or critical structures.1 Split fields can be
used in IMRT for large fields, such as for whole pelvis treatments or head and neck treatments.
The dosimetrists at the Minneapolis Veterans Affairs Medical Center (VAMC) ensure that the
split fields overlap in the middle to account for the penumbra. Figures 1-10 display the BEVs of
the beamlets for the 135-degree LPO beam of a prostate IMRT treatment plan. The BEVs
demonstrate that within the one beam the multileaf collimator leaves (MLCs) for each beamlet
are positioned differently. The treatment planning system optimizes the different field settings to
create the best possible combination of fields to deliver the prescribed dose to the PTV while
sparing the critical structures or organs at risk (OR). Figures 11- 17 demonstrate the use of BEV
in 3-dimensional conformal radiation therapy (3DCRT) planning of a tumor located at the
gastroesophageal junction. The dosimetrist utilized the field-in-field method to decrease the dose
delivered to both the left kidney and the heart. The BEV tool is very useful in designing
modified fields for field-in-field treatment planning. Figures 12-13 display the dosimetrists
efforts to provide additional protection to the left kidney. After the dosimetrist created the
additional block on the first modified posterior beam in figure 12, he used the BEV to manually
draw or shape the block. As this block still did not provide adequate protection of the left
kidney, the dosimetrist created the second posterior modified beam to protect the most superior
portion of the left kidney as seen in figure 13. Again, he utilized the BEV to visualize areas in
which he could manually manipulate the MLCs in order to increase protection of the kidneys.
Lastly, figure 15 displays, the additional left lateral field created to further block the dose to the
heart. Once again, the dosimetrist used the BEV to manually shape this field to best protect this
critical structure. In the case of volumetric modulated arc therapy (VMAT), the BEV of the
treatment field should be critiqued throughout the entire arc to ensure the PTV is included
throughout the angles of the arc beams. It is possible that the entire PTV is not seen in every
BEV when multiple arcs are utilized. For example, some BEV may include the lateral portion of
the PTV while others include the medial portion depending on the gantry position. However, the
superior and inferior portions of the PTV should be covered at all angles.1 BEV can be a useful
tool regardless of the treatment planning method. (James Schmitz, AAS, CMD, oral
communication, March 15, 2016).

Figure 1. Beamlet 1

Figure 2. Beamlet 2

Figure 3. Beamlet 3

Figure 4. Beamlet 4

Figure 5. Beamlet 5

Figure 6. Beamlet 6

Figure 7. Beamlet 7

Figure 8. Beamlet 8

Figure 9. Beamlet 9

Figure 10. Beamlet 10

Figure 11. BEV of the posterior treatment field, 1a Post, with MLC blocking.

Figure 12. BEV of the first posterior field-in-field, beam 1a mod was designed to protect the left
kidney.

Figure 13. BEV of the second posterior field-in-field, 1a Post was designed to blocked dose to
the most superior portion of the left kidney.

Figure 14. BEV of the left lateral field, 1b Lt Lat OC, with MLC blocking.

Figure 15. BEV of the left lateral field-in-field, beam 1b Lt Lat Mod, was designed to provide
additional protection to the heart posteriorly.

Figure 16. BEV of the anterior field, beam 1c Ant, with MLCs.

Figure 17. BEV of the right lateral field, beam 1d Rt Lat OC, with MLCs.

1. Washington CM, Leaver DT. Principles and Practice of Radiation Therapy. 4th ed.
St. Louis, MO: Mosby Elsevier; 2015.