Sara Long

Clinical Practicum III

11/25/2019

3D Head & Neck Plan

• Tell us one new thing that you learned while creating and/or planning this unique
setup.

I planned this case with the dose-fractionation and PTV volumes given in the original plan.
There are three dose levels in this plan so designing a simple 3D plan to adequately cover all
dose levels is challenging. To meet the cord tolerance I created opposed laterals to cover the
PTV overlapping the cord for 32fx then created lateral cord blocks to use for the remaining 3fx
to bring the cord slightly below 45Gy. I used a cord block in the SCV field as well. I used the
field-in-field technique for the SCV and non-blocked left lateral field; additionally, there is
uneven weighting to pull dose left. I have created an opposed lateral 3D larynx plan but not such
a simple plan to cover such large volumes with multiple PTV doses. I imagine the total dose for
a 3D HN may be prescribed lower than 70Gy.

The SCV and lateral fields were matched using the half-beam technique at a level slightly above
the shoulders. I chose this level because the shoulders interfered in the lateral beams.

I learned in this activity to plan blocked and unblocked spine lateral spine fields to meet cord
tolerance.
Sara Long
Clinical Practicum III
11/25/2019

• Describe an anatomical location where you have seen a split field technique used, or
a possible location where you think it could be useful, and describe it's
purpose/value.

I have used the split field techniques to plan 3D breasts with tangents + SCV field. This
technique allows for no divergence into the matched field thus reducing the hot spot at the match
line. The trick to making a nice split field plan is to select a good location for the isocenter to
apply the match. In breast planning, if the field is too low the lung will get more dose from the
SCV field than it would if the point were higher toward the lung apex.