Pelvis Clinical Lab Assignment

Use the Pelvis CT data set provided in Canvas to complete the following assignment:

Prescription: 45 Gy in 25 Fractions to the PTV

Planning Directions: Place the isocenter in the center of the designated PTV (note: calculation point
will be at isocenter). Create a PA field with a 1 cm margin around the PTV. Use the lowest beam energy
available at your clinic. Apply the following changes (one at a time) as listed in each plan exercise
below. Each plan will build in complexity off of the previous one. After adjusting each plan, answer the
provided questions. Include a screen shot for each plan to show the isodose distribution along with a
DVH clearly displaying your PTV coverage.
 Important: Please do not normalize your plan when making these adjustments until instructed
to do so in the final plan.
 Tip: Copy and paste each plan after making the requested changes so you can compare all of
them as needed.

Plan 1: Calculate the single PA field.

 Describe the isodose distribution.
 Where is the hot spot and what is it?
 What do you think creates the hot spot in this location?
 Using your DVH, what percent of the PTV is receiving 100% of the dose?

Plan 2: Change the PA field to a higher energy and calculate the dose.
 Describe how the isodose distribution changed and why?
 Using your DVH, what percent of the PTV is receiving 100% of the prescription dose?

Plan 3: Insert a left lateral field with a 1 cm margin around the PTV. Copy and oppose the left lateral
field 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 fields.
 Describe the isodose distribution. What change did you notice?
 Where is the hot spot and what is it?
 What do you think creates the hot spot in this location?

Plan 4: Increase the energy of all 3 fields and calculate the dose.
 Describe how this change in energy impacted the isodose distribution.
 In your own words, summarize the benefits of using a multi-field planning approach? (Refer to
Khan, 5th ed, Ch. 11.5B)
 Compared to your single field in plan 2, what percent of the PTV is now receiving 100% of the
prescription dose?
Plan 5: Using your 3 high energy fields from plan 4, adjust the field weights until you are satisfied with
the isodose distribution.
 What was the final weighting choice for each field?
 What was your rationale behind your final field weight?

Plan 6: Insert a wedge on each lateral field. Continue to add thicker wedges on both lateral fields until
you are satisfied with your final isodose distribution. Note: When you replace a wedge on the left,
replace it with the same wedge angle on the right. Also, if you desire to adjust the field weights after
wedge additions, go ahead and do so.
 What final wedge angle and orientation did you choose? To define the wedge orientation,
describe it in relation to the patient. (e.g., Heel towards anterior of patient, heel towards head
of patient..)
 How did the addition of wedges change the isodose distribution? Include a screen shot
(including axial and coronal) of the isodose distribution before and after the wedge placement
using a plan evaluation/comparison view.
 According to Khan, what is the minimum distance a wedge or absorber should be placed from
the patient’s skin surface in order to keep the skin dose below 50% of the dmax? (Refer to
Khan, 5th ed, Ch. 11.4)

Plan 7: Insert an AP field with a 1 cm margin around the PTV. Remove any wedges that may have been
used. Calculate the four fields. At your discretion, adjust the weighting and/or energy of the fields, and,
if wedges will be used, determine which angle is best. Normalize your final plan so that 95% of the
PTV is receiving 100% of the dose. Discuss your plan rationale with your preceptor and adjust it based
on their input.
 What energy(ies) did you decide on and why?
 What is the final weighting of your plan?
 Did you use wedges? Why or why not?
 Where is the region of maximum dose (“hot spot”) and what is it?
 What is the purpose of normalizing plans?
 What impact did you see after normalization? Why? Include a screen shot (including axial and
coronal) of the isodose distribution before and after applying normalization using a plan
evaluation/comparison view.
 Embed a screen cap of your final plan’s isodose distributions in the axial, sagittal and coronal
views. Show the PTV and any OAR.
 Include a final DVH. Be sure to include clear labels on each image (refer to the Canvas Clinical
Lab module for clear expectations of how to format your DVH).
 Use the table below to list typical organs at risk, critical planning objectives, and the achieved
outcome. Provide a reference for your planning objectives.

Organ at Risk (OAR) Planning Objective Objective Outcome Objective Met? (Y/N)