Cinira Johnson

February 10, 2014

Planning Assignment (Prostate)

Target organ(s) or tissue being treated: Prostate
Prescription: 180cGy in 28 fractions
Organs at risk (OR) in the treatment area (list organs and desired objectives in the table below):
Organs at risk Desired objectives Achieved objectives

Rectum: no more than 10ccs
getting the prescription dose
or more.
Bladder: V55 less than 50%
Femoral Heads: no more than
5ccs getting 50Gy or more



To give the prescription dose
to PTV while minimizing dose
to the organs at risk.



PTV got the prescribed dose
with minimal dose to rectum
volume. All constraints were
met.

Plan 1:
A The hot spot is posterior over the coccyx. The hot spot is so posterior because the isocenter
is deep in relation to the PA beam. It is a lot of tissue for a 6MV beam to go through.
B The dose to the rectum is 5416 cGy. It is high because rectum volume goes into the PTV
volume. The dose to Bladder is 5175 cGy. Dose to left femoral head is 266.7 cGy and dose to
right femoral head is 317.0 cGy.
Plan 2:
A The isodose lines are more boxy or square looking compare to in Plan 1 where they look like
an hour glass shape.
B The dose to the rectum is still high, because parts of it are in the PTV volume. There was not
much of a change with the rectum isodose line when the beam energy was increased. The dose to
the bladder changed dramatically. It decreased because the beam is going more forward then the
6mv beam therefore hitting less bladder in its path.
C I put more weight on the AP beam in order to decrease dose in the rectum. By doing that, the
PA beam effects are less compared to the AP beam. So we will be pushing the dose more
anterior, where the prostate is located.

Plan 3:
A - The biggest noticeable change is the isodoseline coverage of the femoral heads. Dose in Plan
1 to femoral heads average of 291.85 cGy. While in plan 3, the average femoral dose is 3401.8
cGy due to the lateral beams going through the femoral heads.
B- The femoral heads are the structure with the biggest dose change because the lateral beams
are going through them. The dose to the rectum has decreased because of the blocking from
lateral beams. The dose to the bladder has increased somewhat.
Plan 4:
A - The plan with best coverage was plan 4 with an AP beam more heavily weighted (.300) then
the PA beam (.200). Plan 4 has equally weighted laterals (.250). The target volume is covered
with the 95% isodose line and there is less rectum in the 100% isodose line. The global dose
maximum for this plan is 5425.4 cGy and it is in the region of the rt pubic bone.
B - Normally here at UCH we would treat with a higher dose, but because this was a 4 fld box
the dose used is low, and the patient would have a brachy boost. All the constraints were met
because this is treated to a lower dose.

This assignment was very helpful to make me understand how different energies and
weighting can help to plan around different structures depending on our goals.
Next time I will make sure to always play around with different energies and weighting
to see if it can help me to meet my constraints and goals.

Still curious?
A - The higher isodose lines look more like a diamond. The dose is more conformal than a 4 fld
plan.
B The average maximum dose for both femoral heads now is 2341.5 cGy compared to 3401.8
cGy for a 4 fld box plan. The dose for the femoral heads is lower because of the oblique beams.
The rectum maximum dose now is increased at 5297.5cGy compared to 5001.5cGy. The bladder
maximum dose now is 5104.0 cGy compared to 5219.4 for 4 fld box.
C The advantage of using this technique is that we get a more conformal plan and less dose to
the femoral heads. The only disadvantage is that the rectum dose is increased because of the two
posterior oblique flds.