Discussion 3

Electron treatments haven't changed as much as photons over the years of advancement. 
Does your clinic perform CT planning for electron treatments? Does your clinic use the
treatment planning system MU, or do the staff use the MU from a hand calculation?
Why/or why not? 

Most of our electron treatments at my facility are simulated. Some of our physicians do
draw electron field outlines on patient skin and the therapists do a clinical set up by transferring
that outline to a plexiglass plate that is then transformed into a Cerrobend block. Sometimes we
even get copper blocks from a company called .Decimal and these are cut off site. We see the
clinical set up with no simulation on chest wall boosts. This is a flat surface where we don't have
to worry about tumor bed changes or skin changes necessarily so they can be planned from the
original CT. We also see clinical set ups for BCC skin lesions when tumor depth/margins are
known. Since we know the depth we do not need a CT sim to show us the tumor for planning. 
After the enface clinical set up, therapists record and document the coordinates of the table,
gantry, collimator, and SSD. The dosimetrist then makes a treatment plan with this using the
original CT data set in order to place a field.

For the clinical set ups, ClearCalc (another app not part of TPS) is used for calculation
and then a hand-calc is done as a second check. These MUs are assigned to the plan. When using
a treatment planning CT, these MUs are calculated in external beam planning (TPS) and the
second check is in ClearCalc.