In my last semester at UWL, I worked on another employer volunteer service project.

I could not
find a good opportunity to volunteer in the professional scope, but attempted to make my volunteer
experience as well rounded as possible. Eric Paulson is a physicist at Froedtert Hospital and he
approached me with an opportunity to take part in a research project involving the MRLinac (MRL). Eric
is the lead MRL physicist and is very involved with incorporating new workflows and ideas into the
department in every way possible.
The MRL is a great tool used by the RadOnc team to help visualize and more accurately treat
tumors in every area of the body. This machine is still relatively new to our field, which leaves room for
new research to further adapt the technology to improve patient care in the best way possible. In this
situation specifically, Eric approached me with a problem about the field size limitation of the MRL.
Unlike a normal linac, which has a maximum field size of 40x40cm, the MRL is limited to a maximum
field size of 22x22cm. The limitation of field sizes is due to the large number of components in the
machine that help with generating MRI imaging for treatment. Ultimately, the problem with a 22x22cm
field size is that Radiation Oncologists are unable to treat long fields like what you see in some head and
neck or prostate and nodes cases. Eric thought if a new way to approach these cases was developed, it
would open so many more possibilities for the MRL. Below is a picture of the phantom we used which
had an overall PTV length of 24cm. Without our research project, this patient would not be able to be
treated on the MRL.

This project involved a lot of communication between Eric and I as we would come up with
possible solutions to problems as they would arise. We were attempting to generate an entirely new
workflow for patients being treated on the MRL, so this was a rather difficult project to work on. The
idea we focused on was creating a two isocenter plan for PTVs that would stretch further than the
22x22cm field size. Maximizing the distance between the isocenters theoretically gives you a 44x22cm
field size to work with. There is no bias dose tool for the MRL, so the main issue was figuring out how to
match the two plans together in a feasible way while avoiding cold and hot spots in the plan. What we
came up with involved generating a normal plan on the first isocenter. You would then take the isodose
lines from that plan and create new PTV_evals for the second isocenter. You would ultimately come
away with a set number of new PTVs that were generated based on the dose from Plan 1 to use in the
optimizer for Plan 2. Essentially, you’re trying to account for overlap between plans, and are working to
avoid hot and cold spots. This step adds extra time to the planning process, but Eric plans to create a
MiM workflow to expedite the process. Below is a picture of the different colored PTVs that were
created based on dose from Plan 1.

Eric and I came up with a great start to this project. I believe it’s something that will continue to
need work before being implemented clinically, but I think with some more progress it can turn into an
important research paper. I am very appreciative of Eric for trusting me to help him with this project.
The amount of research and innovation that goes into our field is one of the aspects I like most. New
treatments and technologies are always being introduced with a common goal, to treat the patient in
the best way possible. I felt like I was part of that as I volunteered my time to work on this project, and
I’m very excited to see what direction it takes in the future.