Dakota Sturgess

Prostate Plan Study

Dosimetry Practicum II

For this plan study, Proknow provided the data set and the dose prescription to be used
for a prostate SIB technique. The prescription called for 56 Gy and 68 Gy to be delivered to the
pelvic nodes and prostate over 34 fractions. The treatment planning system used was Varian
Eclipse for a Truebeam.
After importing the patients CT data set, I went into contouring and created optimization
structures and a PTV_Total structure. The PTV optimization structures created were
zPTV_opt56 and zPTV_opt68. The zPTV_opt56 was cropped 3mm from PTV_68 to allow the
overlap of the PTV’s to receive prescription dose. This also helps the optimizer from fighting the
two PTV’s when I set the priorities. The zPTV_68 was cropped out of the prostate_bed to allow
the max dose to be pushed there. I created a zRectum structure that was cropped out of both
PTV’s to minimize as much dose as I can to the rectum, while still giving adequate coverage to
the overlap of the PTV and rectum. Also, I created a zBladder that was cropped 3mm from the
PTV’s to minimize dose to the bladder while still cover with prescription dose. The PTV_Total
structure was used to center my isocenter.

Figure 1. Image of zRectum, zPTV_opt68, and prostate_bed

Figure 2. Image of zPTV_opt56 and zBladder cropped away from PTV_68.

After contouring my structures, I proceeded to external beam planning to select my field size,
arcs, energy, and collimator angles. At my clinical site, we use 6 MV when planning an intensity
modulated radiation therapy (IMRT) or volumetric modulating arc therapy (VMAT) plan. I used
two arcs with 6 MV using two collimator angles. I used the arc geometry tool to fit my fields to
the zPTV_Total. Below you can see my field arrangements and collimator angles used.

Figure 3. Field arrangements.

I used collimator angles of 30 and 85 degrees. After further review, I like to use angles 10 and 85
to allow the MLC to modulate in both directions. Rotating the collimator to 85 degrees helps
shape the dose to the organs at risk (OAR), especially the rectum and bladder in this case.
Figure 4. Collimator angles and MLCs.

30 degrees

85 degrees

After selecting my arcs, I’m ready for optimization. During the optimization process, I
put upper and lower objectives for my prostate_bed, zPTV_opt68, and zPTV_opt56. I also put
upper and mean objectives for my zRectum and zBladder. The upper objectives help restrict the
higher doses to a specified volume, where the mean objective helps restrict the lower doses to the
whole organ. I used a normal tissue objective with a priority relative to my OAR upper priorities
and set the distance from the target border to 1mm, starting at 98% and ending at 30% with a fall
off of 1mm.
Figure 5. Optimization table.
After optimization, I look over the plans isodose to ensure I like how everything is looking. At
my clinic we do not normalize. I will also look over the dose volume histogram (DVH) to look at
the dose to OAR.

Figure 6. DVH.

Figure 7. Isodose Coverage.

The images in Figure 7 show the isodose coverage at the level of the maximum dose of the plan.
The max dose of 107% is within the prostate bed. I was able to achieve this by cropping the
prostate bed from the zPTV_opt68 and put a higher priority on the prostate_bed. When assessing
my plan, I like to look at the 100% (red), 95% (orange), 82% 56Gy (light green), and the 50%
(dark blue) isodose lines. I verify both prescription doses are covering and make sure the 50% is
cutting out of the rectum.

While doing the plan study write up, I realized I could have improved my rectum constraints by
cropping out the rectum from the zPTV_opt68 to minimize more dose to the rectum and still
achieve my dose coverage for my PTV_68. At my clinic, we like to still cover the overlap of the
PTV_68 and rectum with 95% of the prescription dose.

Figure 8. Proknow scorecard.