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Pelvis Clinical Lab Assignment

Chelsea D. Gehrig

University of Wisconsin- La Crosse

DOS 771: Clinical Practicum I

Instructor: Anne Marie Vann

March 10, 2021

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Pelvis Clinical Lab Assignment

Plan 1:
 The isodose distribution is very uneven through the PTV. Since the dose is only
entering at one angle, the 100% isodose line covers nearly 1/2 of the posterior
portion of the PTV with the dose quickly dropping off to the 50% covering the
anterior portion of the PTV and beyond.
 The hot spot in this plan is 171.5% and is located very posterior to the PTV and
superior from isocenter.
 The hot spot was created here because the energy at 6x gives a more superficial
dose, causing the highest dose to begin at a shorter depth when compared to
higher energies.
 47.8% of the PTV is receiving 100% of the dose.
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Plan 2:
 The isodose distribution in this plan is similar to plan 1, however, the dose is
pushed deeper with the higher energy. The 80% isodose line now covers more of
the PTV anteriorly while the 50% isodose line includes more normal tissue. All of
the isodose lines have moved slightly anterior. Because of the higher energy,
Dmax is at a farther depth and the dose is more penetrating through the body.
 51.85% of the PTV is receiving 100% of the prescription dose.
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Plan 3:
 The isodose distribution has changed quite drastically in this plan. The lateral
fields have brought hot spots on both sides of the patient (laterally) up to 105%.
The 80% isodose line surrounds the entire PTV now and the 50% isodose line
drops off closely after the 80%, it no longer extends into normal tissue anteriorly.
The 20% isodose line also shifted posteriorly from the anterior surface of the
patient. The 110% isodose line has decreased drastically and now shows as hot
spots posteriorly and laterally to the PTV.
 The highest hot spot is at 113.2%. This hot spot is posterior to the PTV where the
right lateral field and the posterior field begin to intersect.
 This hot spot is located here because this is where two fields began to overlap,
depositing dose in the same location. It is posterior to the PTV because the
energies of the fields are 6x, giving a more superficial dose than 16x would.
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Plan 4:
 The isodose distribution has changed quite a bit with the increased energy. The
100% and 110% isodose lines that were lateral to the PTV have now
disappeared and decreased to 90%. The 90% isodose line now covers a majority
of the PTV. The hot spot has also decreased slightly from 113.2% to 111.7%.
 By using a multi-field plan, we are able to deposit the prescribed dose to the area
planned for treatment while minimizing this dose to the surrounding healthy
tissues. Using multiple fields also allows the dose to enter and exit through the
target area at various locations, allowing a more conformal dose distribution
throughout.1 (p 189)
 57.1% of the PTV is receiving 100% of the prescription dose. Compared to plan 2
with a single field, this plan is covering 5.25% more of the PTV.
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Plan 5:
 The final beam weighting I selected for the PA field is at 43.5% and the lateral
fields are both at 28.3%.
 I chose this weighting because it pushes the 80% isodose line to move medially
so there are not any unnecessary high doses so far from the PTV laterally. This
also allowed a more uniform dose distribution across the PTV with the 80%
isodose line covering the entire PTV and the 90% isodose line extending as far
as possible, close to the edges of the PTV.
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Plan 6:
 The final wedge angle I chose was 45 OUT for the RLAT field and 45 IN for the
LLAT field. These wedges are orientated so the heels are towards the posterior
of the patient. I also adjusted the beam weights so the PA is weighted at 55.7%
and the lateral fields are both 22.2%.
 Adding these wedges to the lateral fields allowed for the dose to be pushed
anteriorly through the PTV and provide a more uniform coverage with a higher
dose. Now 78.4% of the PTV is being covered by 100% of the dose with the hot
spot being 110.1%. The 110% isodose line has decreased drastically posterior to
the PTV and the 100% isodose line has extended considerably to cover most of
the PTV anteriorly with the 95% isodose line covering most of the PTV in all
directions.

 According to Khan, in order to keep skin dose below 50% of Dmax, there should
be at least 15 cm between any absorber in the beam and the skin surface. 1 (p
185)
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Plan 7:
 I decided to use 16x for my energies instead of 6x because it provided better
coverage since the PTV is fairly midline and deep so the energy needed to be
more penetrating.
 I weighted my plan so the PA field is 31.3%, AP is 20.2%, LLAT is 22.6%, and
the RLAT is 25.9%.
 I chose to not use wedges on my plan because the PTV is midline and centrally
located in the body. Using 4 fields provides a uniform coverage, therefore,
wedges were not needed to push dose in any direction.
 The hot spot is 109.7% and is located just posterior to the PTV on the right side.
 Normalizing plans allows us to provide a certain dose level to a specific area or
target. Normalizing either decreases or increases (for this case) the number of
monitor units in order to deliver the specific dose to the target.
 After normalizing my plan so 95% of the PTV was covered by 100% of the dose,
the 100% isodose line extended to include the majority of the PTV anteriorly. The
95% isodose line now covers the entire PTV in all directions and the 105%
isodose line has increased in mid- PTV. Plan 7 before normalization is on the left
and after normalization is on the right.
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 Final isodose distributions including the PTV and OARs.

 Final DVH including the PTV and OARs.

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 The table below demonstrates the planning objectives, objective outcome, and if
the objective for each OAR was met in the plan.
Organ at Risk Planning Objective2 Objective Outcome Objective Met?
(Gy) (Gy)
Rectum V(50) < 50% 47.62 Y
Bladder V65 ≤ 50% 46.53 Y
Bowel Space Max < 50 48.47 Y
Femoral Heads Max < 50 47.07 Y
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References

1. Gibbons, JP. Kahn’s the Physics of Radiation Therapy. 6th Ed. Wolters Kluwer

Health; 2020.

2. Chao K.S.C., Perez C.A., Wang T.J.C. Radiation Oncology: Management

Decisions. 4th Ed. Philadelphia, PA: Wolters Kluwer Health; 2019.