1.

Introduction
1.1 Treatment Planning
Treatment planning is the process of determining the best method of treating a
tumor with radiation. The major objective of treatment planning is to ensure that the
tumor receives the uniform radiation dose while the healthy tissue and critical structure
are protected. The other objective is to develop reproducibility setups and maintain the
patient comfort.
In treatment planning, to spare normal tissue is very important. physician need to
obtain one ideal planning that can be delivered high dose to target volume which is at the
tumor area and give low dose to the normal tissue and sensitive organ without any side
effect. The shielding is most important way to block the sensitive organ to receive high
dose or from receive radiation. The H! of the blocking shield should be enough to stop
the radiation from receive to the patient. "sually use the lead block with #H!.

There are three aims of treatment planning$
%evelop the plan that treats the tumor volume. The plan should give the homogeneity of
the dose distribution as possible throughout the clinical target area. &t least '() isodose
curve surrounded the target volume. The ideal treatment planning is to give the 1(()
isodose at the target volume but in practically is hard to achieve.
'() isodose surrounded the
target volume
*inimi+e radiation dose to health structure. &rea outside the target volume should
receive as little radiation as possible. !imiting the dose to healthy tissue re,uired to know
the tolerance of the organ near the treated area. The list of the tolerance organ is below
-idney ...#/y 0ye lens 1/y
"terus .#(/y 2ladder 1(/y
3ectum #(/y !ung ...#/y
4pinal cord 5#/y 2rain #(/y
4tomach 5#/y 0ye retina #(/y
Provide a permanent record of dose calculation and distribution so that others may
understand the treatment plan and this recorded make ease to the further treatment if the
patient need to replan.
1.. 6asopharyngeal carcinoma
6asopharyngeal carcinoma is cancer that occurs in the nasopharyn7, which is located
behind the nose and above the back of the throat. The nasopharyn7 is the upper portion of
the pharyn7 at #8inch tube that e7tends from behind the nose to the top of the windpipe
and esophagus in your neck.
*en are more likely than women to develop nasopharyngeal carcinoma. It9s most
commonly diagnosed in people from age :( to age 1(, though nasopharyngeal carcinoma
can also occur in older adults and in children.
&ll cancers begin with one or more genetic mutations that cause cells to grow out of
control, invade surrounding structures and eventually spread ;metastasi+e< to other parts
of the body. 6asopharyngeal carcinomas begin in the s,uamous cells that line the surface
of the nasopharyn7.
Patient data
3egister 6umber$ 2:=>>(.
&ge$ #: years old
3ace$ *alay
4e7$ *ale
Patient history$ Heterogenously enhancing mass occupying almost whole at nasopharyn7
more prominent on left side, obliterating fossa of bilaterally. Obliterated left
parapharyngeal space, with some area show lost of fat plan with adjacent lateral
pterygoid muscle. The mass also encroach on the right paraphyaryngeal fat, mass
extended till below the base of skull. No bony erosin. Posteriorly the mass involve
the preventable muscle bilaterally. nferiorly the mass extanded till oropharyx at
level of cervical !"#$ vertebra. %tage & cancer, NP" T#N#'(
?rom the simulation sheath$ The body was supine. )sing *+, - ./%. 0 cm air gap.
%%/ techni1ue. # field2 right lateral, left lateral and anterior. 3ield si4e 05x00 for
lateral and 05x06 for anterior. %ource to film distance is 078 for lateral and 07( for
anterior. %eparation is 07.9cm
?rom the treatment card$
Purpose for treatment is radical which is to cure. 77:y;55 fraction. <ateral part
treat at mid line plane and an anterior part treat at #cm depth.
?ield si+e 181 18. .8:
1.711 1.711 1.71'
4ide for treatment 3ight lateral !eft lateral &nterior
Treatment
mac
hine
*@0AB P3I*"4
%,/;%%/
techni1ue
%%/
Tumor dose 5((c:y 5((c:y
4eparation 07.9 cm
Treatment data
Patient is treated with three fieldsC right lateral facial cranial and left lateral facial cranial
and anerior facial cranial. The field si+e prescribed is 1.711 cm for lateral field and
1.71' cm for anterior field. This treatment is using source to skin distance ;44%<
techni,ue. Patient use 2%4 and set up supinely with head rest type D&E underlying his
head and shoulder rest type 1 under his shoulder. The skin separation of the patient is 1.
cm. the gap is 1cm.
Patient "alculation
&nterior
0nergy F 1 *e
%epth F : cm
?ield si+e$ 1.71' cm
0,uivalent ?ield 4i+e F . &2 B ;&G2<
F . ;1.71'<B1.G1'
F 1#
&re of field F 1.71'
F..> cm
5
2locking area 1;trape+ium< F H;aGb<B.I 7 c
F H;#.# G :.5<B.I 7 #..
F .5.55 cm
.
2locking area .;trape+ium< F H;aGb<B.I 7 c
F H;:.5 G 1.=<B.I 7 #.1
&rea
blocking .
&rea
2locking .
F .=.=. cm
.
&rea of unblock F ..> J .=.=. J .5.55
F 1=#.>5 cm
.
Parameter unblock F =.1 G :.' G #.# G 1.' G 1' G #.. G 1.. G :.5
F #=.. cm
6ew field si+e F 5&BP
F 5;1=#.>5<B#=..
F 1...1 K 1. cm
4catter collimator F 1#71#
F 1.(.(
4catter phatom F 1.71.
F 1.(..
Lorrection field si+e, L
?4
F 4c 7 4p
F 1.(.( 7 1.(..
F 1.(5.55
*" F .((B H;1c/yB*"< 7 (.'#. 7 0.(7577=
> 5(0.8# ')
!ateral
0nergy F 1 *e
%epth F =.:# cm
?ield si+e$ 1.711 cm
0,uivalent ?ield 4i+e F . &2 B ;&G2<
F . ;1.711<B1.G11
F 11.5= K 11
&re of field F 1.711
F 1:. cm
5
2locking area 1;trape+ium< F H;aGb<B.I 7 c
F H;=.' G 1.=<B.I 7 1(.>
F #1.>5 cm
.
.locking area 5!trape4ium$ > ?!a-b$;5= x c
> ?!5.0 - 5.8$;5= x (.9
Trape+ium 1
Trape+ium .
F 1.11 cm
5
&rea of unblock > 0#5 @ 0.A0 @ 80.B7
F =>.## cm
.
Parameter unblock > 7 - 00 - 9.6 - (.9 - 05.0 - 5
F :=.= cm
New field si4e > 7,;P
F 5;=>.##<B:=.=
F >.:: K > cm
4catter collimator F 11711
F 1.((:#
%catter phantom > BxB
F (.'=>
"orrection field si4e, "
3%
> %c x %p
F 1.((:# 7 (.'=>
F (.'>15.:
') > 0((; ?!0c:y;')$ x (.960A9 x (.6B075#=
F 1.>.= ')
*" using T*3 method F 3ield si4e is 2 00 > 0((
@ > 0(9.#8
@ F 1.
>0((;?0c:y;')$x(.B9Bx!0(0.8;0(9.#8$
5
x !0.((6x(.69B$=

F 05B.7 ')
/iscussion
&ccording to the both image radiograph, the area shielded is the area of the eye,
apex of lung and the brain stem. The tolerance of the lens eye and retina to the
radiation is A:y and 8(:y respectively. Chile the tolerance of the lung and brain is
55.8:y and 8(:y. %o that radiographer must prepare one reference field with the
blocking area. .y using the magnification plastic, radiographer draws the field with
the blocking part. This plastic are use when treatment to see exact the blocking
region.
In treatment planning the planning target volume is determined. This includes the
gross tumor volume, the palpable or visible e7tent of tissue that makes up the tumor and
clinical target volume, the gross tumor plus a margin to include any areas of subclinical
disease spread. Planning target volume is the clinical target volume plus need margin to
ensure delivery of dose to the target motion, setup variation taken into account. Treated
volume is volume of tissue that actually receives the tumor dose, large but should not be
smaller than clinical target volume. Irradiated volume is entire volume of tissue hit by
any portion of the radiation aimed at the tumor that receives a significant absorbed dose.
The prescription of dose is made during the treatment planning after the simulation
procedure. %uring prescription of dose to be given to the patient, doctor has to consider #
factorsC
a< ?ield 4i+e
?ield si+e must include the target volume which includes gross tumor volume and
clinical target volume.
b< 4ensitivity of the tumor
The radiation prescribed must be enough to kill the cancer cells. If the cancer cells is
not kill effectively, the recurrence of the cancer might happen.
c< 4ensitivity of the other organs and healthy tissue surround the tumor.
The radiosensitivity of the tissue and organs surrounding the treatment area has to be
taken into account before prescribing dose.
d< %epth of tumor to be treated
%epth of tumor to be treated is very crucial to be known for choosing the techni,ue of
treatment. It is also important to avoid the radiation to be e7posed on certain area.
e< Techni,ue use ;44% or 4&% techni,ue<
4&% techni,ue are usually chose when the separation of the skin is more than .( cm
to make sure the isodose distribution is between '()81(().The isodose distribution
has to be accurate without involving area outside of the treatment volume.
3adiation therapy remains the primary treatment for 6PL. 3adiotherapy uses high8
energy 78rays to kill cancer cells or to stop them from growing further. &lthough
radiotherapy can affect both cancer cells as well as normal cells, but normal cells are
better able to resist or recover from its effects.
/enerally, cancer cells are more sensitive to radiation damage than normal cells.
3adiotherapy will not leave you radioactive and the treatment does not hurt. The
radiation is not hotC in fact that patient will not hear, see or feel the radiation at all. It is
just like when they have an ordinary 78ray e7amination. The area of treatment for
nasopharyngeal cancer involves the back of the throat and sometimes to the lymph glands
in the neck. The treatment is planned carefully to ensure that the rays are targeted
precisely onto the cancer, and do as little harm as possible to the surrounding healthy
tissues.