Planning Assignment (Prostate)

Target organ(s) or tissue being treated: Prostate (GTV defined by physician)

Prescription:___200 cGy for 39 fxn = 7800 cGy_______________________________

Organs at risk (OR) in the treatment area (list organs and desired objectives in the table below):
Organ at risk Desired objective(s) Achieved objective(s)
Bladder (2/3 of organ) 8000 cGy 66% of organ = 984.5 cGy
Rt/Lt Femoral Heads (whole) 5200 cGy 100% of organ = 65.6 cGy
Rectum (whole) 6000 cGy 100% of organ = 1135.0 cGy
Bowel (sm and lg) (whole) 4000 cGy 100% of organ = 11.8 cGy

Contour all critical structures on the dataset. Expand the prostate structure by 1cm in all
directions and call it PTV. Place the isocenter in the center of the PTV. Create a single AP
plan using the lowest photon energy in your clinic and 1.5cm margin around the PTV for
blocking. From there, apply the following changes (one at a time) to see how the changes
affect the plan (copy and paste plans or create separate trials for each change so you can look
at all of them):
Plan 1: Create a beam directly opposed to the original beam (PA) (assign 50/50 weighting to
each beam)
a. Where is the region of maximum dose (hot spot)? What is it?
The hottest spot is anteriorly on the patients pelvis, where the thickest part of the
field is, and receives a max dose of 117.6% or 9173.8 cGy.
b. What are the doses to the rectum, bladder and femoral heads (evaluate the DVH)?
Rectum 90% = 7590 cGy, 50% = 7953 cGy
Bladder 90% = 501.1 cGy, 50% = 5002 cGy
Rt/Lt Femoral Heads 90% = 44.6 cGy, 50% = 7953 cGy
Plan 2: Increase the energy of both beams to the highest photon energy available.
a. How did the isodose distribution change with the higher energy?
The 95% isodose line is still covering the PTV, and now the 100% isodose line is
covering the entire PTV as well. Max dose is 105.7% or 8241.1 cGy.

b. Did the doses to the rectum and bladder change?
Rectum 90% = 7159 cGy, 50% = 7880 cGy
Bladder 90% = 360.3, 50% = 4654
c. If you change the weighting ratio, how does it affect the dose distribution?
If the AP beam is weighted more, the maximum dose increases anteriorly, but if the
PA beam is weighted more, the maximum dose increases posteriorly. With either
scenario, the 100% isodose line breaks up more within the PTV.
Plan 3: Add a Rt lateral field. Create a tighter blocked margin posteriorly along the rectum (try
using 0.7cm vs. 1.5cm). Now, create an opposed beam, or a Lt. lateral. Assign even weights to
all the beams (which should now be 4 beams)
a. What is the biggest change you noticed with the isodose lines?
After adding the two additional fields, the isodose lines are much more conformal and
appear in a box shape around the PTV.
b. What happened to the rectal, bladder and femoral head doses? Which structure
received the biggest dose change? Why?
Rectum 90% = 3764 cGy, 50% = 4245 cGy
Bladder 90% = 308.6 cGy, 50% = 3006 cGy
Rt/Lt Femoral Heads 90% = 117.7 cGy, 50% = 4317 cGy
The Rectum dose received the largest dose change, mainly because the lateral beams
that were added had a tighter margin around the PTV to block out more of the
rectum.
Plan 4: Adjust the weighting of the beams to try and achieve the best possible dose
distribution.
By weighting the beams differently so the lateral beams had about 18%, the PA
contributed ~ 35% and the AP contributed ~ 27%, the dose shifts slightly anterior so
that the 95% isodose line completely covers the PTV.
Which treatment plan covers the target the best? What is the hot spot for that plan?
The 4 field pelvis plan with the weighting distribution described above works the best.
The hot spot was about 102.5% on the anterior part of the field on the pelvic bone.
Did you achieve the OR constraints as listed in the table on page 1? List them in the
table
Yes

What did you learn from this planning assignment?
I learned that it is important to have multiple beams and angles to reduce the dose to
surrounding critical structures. Adding more beams will create a more conformal dose
distribution. Adding wedges may also be a good idea depending on the size and shape
of the patient.
What will you do differently next time?
In the future, I will add multiple beams right away to reduce dose to the rectum. I will
also not contour as much as the small and large bowel unless the physician plans to
treat nodes that are more superior in the field.
Still curious? Try adding 2 more beams, so youll have 6 total beams on the plan (PA, RPO,
RAO, AP, LAO, LPO). Assign even weighting to all 6 beams.
a. Now what does the isodose distribution look like? Is it more or less conformal than a 4
field plan?
The dose distribution is much more conformal and the dose to the rectum is greatly
reduced with this conformity. The femoral heads are also avoided in this plan.

b. What are the doses for the critical structures?
Bladder 90% = 280.0 cGy, 50% = 2733 cGy
Rectum 90% = 2728 cGy, 50% = 4799 cGy
Rt/Lt Femoral Heads 90% ~69 cGy, 50% ~ 140 cGy

c. What are the advantages to using this technique? Disadvantages?
I think the major advantage to using a six field pelvis technique is limiting the dose to
the rectum and femoral heads. Using multiple beams helps to reduce dose to
surrounding critical structures. A disadvantage to using multiple beams is that more
of the surrounding tissue receives a low dose. Instead of a few structures receiving
large dose, more of the patient receives a small dose.