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Yinanwang Pelvis Lab
Yinanwang Pelvis Lab
Yinan Wang
Pelvis Clinical Lab
April 2016
Small Bowel
Large Bowel
Femoral Heads
Desired objective(s)
V40 <= 40%
V45 <= 15%
Dmax < 50 Gy
V35 <= 180 cc
V40 <= 100 cc
V45 <= 64 cc
Dmax < 50 Gy
Dmax < 50 Gy
Achieved objective(s)
V40 = 10.5%
V45 = 0.0%
Dmax = 44.8 Gy
V35 = 40.0 cc
V40 = 32.9 cc
V45 = 6.0 cc
Dmax = 45.7 Gy
Dmax = 45.5 Gy
V40 = 33.2%
V45 = 13.2%
Dmax = 45.9 Gy
3
c. Insert a left lateral beam with a 1 cm margin around the ant and post
wall of the PTV. Keep the superior and inferior borders of the lateral
field the same as the PA beam. Copy and oppose the left lateral beam
to create a right lateral field. Use the lowest beam energy available for
all 3 fields. Calculate the dose and apply equal weighting to all 3
beams. Describe this dose distribution.
The dose distribution is more conformal and less hot in the
posterior region. (Figure 3) The hot spot was 108% of the
prescription (4856 cGy) and at the left side 4 cm away from the
patient posterior surface. However there are some doses in the
left and right lateral regions after two lateral beams were
added. The coverage to the PTV and CTV was not better. The
95% isodose line covers 80.9% of the PTV, and 85.5% of the
CTV.
see?
If the energy of the PA beam was increased to 18 MV, the
posterior region became less hot and the coverage was a little
better. (Figure 5) The 95% isodose line covered 86.9% of the
PTV, and 92.3% of the CTV. The hot spot was at the same place
and reduced to 105% of the prescription (4737 cGy).
f.
Add the lowest angle wedge to the two lateral beams. What direction
did you place the wedge and why? How did it affect your isodose
distribution? (To describe the wedge orientation you may draw a
picture, provide a screen shot, or describe it in relation to the patient.
(e.g., Heel towards anterior of patient, heel towards head of patient.)
A 10 degree wedge was added to each lateral beam with the
heel on the posterior side of the patient to compensate thinner
tissue passed by the beams. The heel (thicker part) of the
h. Now that you have seen the effect of the different components, begin
to adjust the weighting of the fields. At this point determine which
energy you want to use for each of the fields. If wedges will be used,
determine which wedge angle you like and the final weighting for each
of the 3 fields. Dont forget to evaluate this in every slice throughout
your planning volume. Discuss your plan with your preceptor and
adjust it based on their input. Explain how you arrived at your final
plan.
I adjusted the beam energies and weightings, and finally found
the best plan I can achieve was to use 18 MV for PA, left and
right lateral beams with weightings of 46%, 27%, and 27%,
respectively. Forty-degree wedges for both lateral beams
provided the plan with the best uniformity. By increasing the
weighting on the PA beam and reducing the weighting on the
lateral beams, the dose in the two lateral hot regions was
reduced dramatically. Although the hot spot increased a little
to 103% of the prescription (4621 cGy), it was pushed inside of
the PTV. The dose constrains to all the organs at risk were
achieved. My preceptor agreed with me that this was the best
result we can achieve.
i. In addition to the answers to each of the questions in this assignment,
turn in a copy of your final plan with the isodose distributions in the
axial, sagittal and coronal views. Include a final DVH.
Figure 8 and 9.
4 field pelvis
Using the final 3 field rectum plan, copy and oppose the PA field to create an
AP field. Keep the lateral field arrangement. Remove any wedges that may
have been used. Calculate the four fields and weight them equally. How does
this change the isodose distribution? What do you see as possible
advantages or potential disadvantages of adding the fourth field?
The coverage to the PTV and CTV did not change much. The 95%
isodose line covered 100% of both the PTV and CTV. Since adding
one AP beam reduced the weighting of the other three fields, the
dose in the two lateral hot regions and the femoral heads were
reduced. The maximum dose to almost all ORs decreased. However,
the anterior region of the patient got more dose and the mean dose
to the small bowel and bladder increased. (Figure 10)