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Amanuel Negussie Clinical Practicum I

Planning Assignment (Brain)

Target organ(s) or tissue being treated: Brain Prescription: 300 cGy per 10 fraction and normalized to the 100% isodose line Organs at risk (OR) in the treatment area (list organs and desired objectives in the table below): Organ at risk Right lens 500 500 Left lens Contour all critical structures on the dataset. Place the isocenter in the center of the skull. Create a single Rt. lateral plan using the lowest photon energy in your clinic. Refer to Bentel pp. 336-340 to add a block to the Rt. Lateral field. 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 evaluate all of them): Plan 1: Create a beam directly opposed to the original beam (Lt. lateral) (assign 50/50 weighting to each beam) a. What does the dose distribution look like? The whole brain is adequately covered by the 95% isodose line, but the 100% line misses few corners of the brain b. Where is the region of maximum dose (hot spot)? What is it? The maximum dose is 3440cGy at the superior edge of the brain Plan 2: Adjust the weighting of the beams to try and decrease your hot spot. a. Did it help the hot spot? No, the hot spot is lower when the fields are equally weighted Desired objective(s) 0 0 Achieved objective(s)

b. Did your isodose coverage of the brain change? Yes, the less weighted side is colder while the more weighted side is hotter

Plan 3: Does your facility ever use wedging or segmented fields to decrease the hot spot? If so, try one of those techniques (wedging is easier at this point). My facility does not use wedges in whole brain treatments

a. Evaluate the isodose lines. Which direction does the wedge need to go? The heel needs to go superiorly towards the region of the maximum dose

Amanuel Negussie Clinical Practicum I

b. Which wedge provides the most even dose distribution? The 15o wedge

Plan 4: Does your facility use other techniques to treat whole brains? Discuss this with your clinical instructors and work on creating different whole brain plans. Several of these other techniques include slight anterior obliques, collimator rotations, half-beam blocking with an off-axis prescription point. My clinical site treats whole brain cases with right and left lateral beams, without wedges, collimator angle at 0o, and blocking the eyes using MLC a. What are the advantages to these other techniques?

Half beam block helps avoid beam divergent to the structure near the blocked edge The anterior obliques and collimator rotation help spare the eyes

b. When designing and evaluating different techniques, which one produces the most ideal plan? The wedged lateral fields produces the most ideal plan

Which treatment plan covers the target the best? What is the hot spot for that plan? The plan with collimator rotation has a better PTV coverage, but is hotter compared to the other plans. The maximum dose is 3526.9cGy located superiorly 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 and practiced the different techniques that can be applied to plan a whole brain treatment. I was able to compare the plans and evaluate their difference What will you do differently next time? Although whole brains are simple palliative plans, I will start taking my time evaluating the plan and figuring out ways to improve it