Rapid Arc

Brain
Planning
By Antonette
Diagnosis

Patients:
 Glioblastoma of the right parietal lobe
 Who Grade III Anaplastic Astrocytoma of
the left temporal lobe
 RT Treatment Plan:
 6 MV
 4600 cGy in 23 fx
 Boost to 1400 cGy in 7 fx
 Total: 30 fx to 6000 cGy
 Using non-coplanar beams
Immobilization
and set up
DRRs
Noncoplanar VS. Coplanar
o Noncoplanar
o Positives
o Table kicks allow beams to enter in
different planes
o Better avoidance of critical structures
o Reduction in dose to normal tissue
o Negatives
o More tissue irradiated
o Longer treatment times
o Clearance
o Coplanar
o Beams enter the target on the same
axial plane
o Beam arrangement can result in
different volumetric shapes
Coplanar Noncoplanar
Tolerance Doses

Lens of the eye: 1000 cGy

Brain: 4500 cGy

Spinal Cord 4700 cGy

Optic Nerves: 5000 cGy

Optic Chiasm: 5000 cGy

Brainstem: 5000 cGy

Planning
objectives
Planning Process

 Planning structures and contours

 Ring Structures
Ring structures are used to
control dose
Can control the max dose
with-in the ring
Overlapping can cause hot or
cold spots
 Contour mask and body to make
sure all attenuation is accounted for
 PTVs and OAR
 Planning PTVs
Rapid Arc

 Arcs
 2-3 Arcs
 At least one Arc should be non-
coplanar
 Arc arrangements
 Laterality plays a major role
Beam entrance/ exit dose
Least amount of tissue affected
You want dose any where the tumor
is touching the skull
Optimization
Plan Report
Plan Sum: PTV + Boost
References

 Addington, M., CMD. (2018). VMAT Brain. Lecture presented in The Ohio State University.
 CNS Journal. (n.d.). Retrieved from https://www.oruen.com/cns-journal
 Comparison of Coplanar and Noncoplanar VMAT for Intracranial Target. (n.d.). Retrieved
from https://docplayer.net/48891359-Comparison-of-coplanar-and-noncoplanar-vmat-
for-intracranial-target.html
 Zoller, W., CMD. (2018). IMRT Brain/HN. Lecture presented in The Ohio State University.
 Zoller, W., CMD. (2018). IMRT/VMAT. Lecture presented in The Ohio State University.