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Lung

This document summarizes the planning of a lung radiotherapy treatment. The target is to deliver 6,480 cGy to the lung in 36 fractions. Critical structures include the lungs, spinal cord, and heart. Various treatment plans were created and modified to improve target coverage while meeting dose constraints for organs at risk. The best plan used 3 beams with wedges, achieving target coverage under 95% isodose with doses within tolerance for normal tissues. This assignment demonstrated how beam parameters like energy, weighting, and blocking affect dose distribution.

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253 views8 pages

Lung

This document summarizes the planning of a lung radiotherapy treatment. The target is to deliver 6,480 cGy to the lung in 36 fractions. Critical structures include the lungs, spinal cord, and heart. Various treatment plans were created and modified to improve target coverage while meeting dose constraints for organs at risk. The best plan used 3 beams with wedges, achieving target coverage under 95% isodose with doses within tolerance for normal tissues. This assignment demonstrated how beam parameters like energy, weighting, and blocking affect dose distribution.

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Planning Assignment (Lung)

Wael Mekhael

Target organ(s) or tissue being treated:


Prescription: 180 cGy, 36 fractions, total of 6480 cGy.

Organs at risk (OR) in the treatment area (list organs and desired objectives
in the table below):
Organ at risk
Rt.Lung

Desired objective(s)
V20 < 25-30%

Achieved objective(s)
50% got 2000 cGy

Lt.Lung

V20 < 25-30%

25% got 1000

4500 cGy

4300 cGy

V60 < 33%


V40 < 66%
V50 < 50%

33% got 500cGy

Spinal Cord
Heart

Contour all critical structures on the dataset. Place the isocenter in the
center of the PTV (make sure it isnt in air). Create a single AP field using the
lowest photon energy in your clinic. Create a block on the AP beam with a
1.5 cm margin around the PTV. From there, apply the following changes (one
at a time) to see how the changes affect the plan (copy and paste plans or
create separate trials for each change so you can look at all of them). Refer
to Bentel, pp. 370-376 for references:
Plan 1: Create a beam directly opposed to the original beam (PA) (assign
50/50 weighting to each beam)
a. What does the dose distribution look like?

Please look at photo (1), 6MV used. Normal structure are getting
high dose, right lung is getting 7248 cGy, left lung getting 6050cGy,
spinal cord 6389 cGy (very high), heart getting 1034 cGy.
b. Is the PTV covered entirely by the 95% isodose line?
No, PTV is not covered by 95%, please look at photo (1)
c. Where is the region of maximum dose (hot spot)? What is it?
Posterior to right lung, max dose is 7587 cGy, Spinal cord and
right lung are getting very high dose. Please look at photo (1)
Plan 2: Increase the beam energy for each field to the highest photon
energy available.
a. What happened to the isodose lines when you increased the beam
energy?
Energy increased to 15MV, we got better coverage, better dose to
the heart, but still high doses to other normal structures, heart is
getting 975 cGy, and right lung getting 6804 cGy, left lung is 5960
cGy, spinal cord getting 6325 cGy. Please look at photo (2).
b. Where is the region of maximum dose (hot spot)? Is it near the surface
of the patient? Why?
Posterior, yes it is, the reason is the patient equivalent separation is
less on the posterior.
Plan 3: Adjust the weighting of the beams to try and decrease your hot
spot
a. What ratio of beam weighting decreases the hot spot the most?
Was 60% AP, 40% PA
b. How is the PTV coverage affected when you adjust the beam
weights?
I got less PTV coverage. Normal organs still getting high dose.
Plan 4: Using the highest photon energy available, add in a 3rd beam to the
plan (maybe a lateral or oblique) and assign it a weight of 20%
a. When you add the third beam, try to avoid the cord (if it is being
treated with the other 2 beams). How can you do that?
i. Adjust the gantry angle?

ii. Tighter blocked margin along the cord


iii. Decrease the jaw along side of the cord
I used all 3 options to avoid the spinal cord, I adjust the gantry
angle, I tightened the margin along the cord, and also I decreased
the jaw alongside of the cord. Please look at photo (3)
b. Alter the weights of the fields and see how the isodose lines
change in response to the weighting.
I altered the weights to a point that hot spot would move from
posterior to anterior, Isodose shifted towards the beam that has
more weighting. Please look at photo (4) for the DVH that shows
doses normal organs are getting.
c. Would wedges help even out the dose distribution? If you think so,
try inserting one for at least one beam and watch how the isodose
lines change.
Yes, it will help, I start with 15 degree wedge to the 3
beams, but did not help as I did not get good PTV coverage,
tried the 30 degree wedge, I got much better coverage as
my PTV was covered under 95% isodose line, please look at
photo (5),
Tried remove the third beam wedge with keeping the
others, but did not help as much, block the spinal cord with
MLC that helped reduce dose to the cord, please look at
photo (6)

Which treatment plan covers the target the best? What is the hot spot
for that plan?
Please look at photo (7) for the final plan, I added the wedge
back, for LPO and RPO I used 15 degree wedge, for the RAO beam
I used 30 degree beam, so now we have 3 wedges, we got one
hot spot 6850 cGy but its inside the PTV, I believe this is the best
plan, as we get good coverage for PTV, and within tolerance

doses for normal organs, please look at photo (8) for the final
DVH.

Did you achieve the OR constraints as listed above? List them in the table
above.
Yes, constraints were achieved.

What did you gain from this planning assignment?


This assignment was very helpful, as it showed me step by
step, how isodose curve changes with changing energies and
with adding wedges, and using MLC for blocking normal
organs, as lung has a different density from organs around it,
this assignment was a good practice and very helpful, as it
showed me also how changing gantry angle can make big
difference in dose distribution.

What will you do differently next time?


I will not start with AP/PA, I will start with oblique, if the spinal
cord involved I will start with 3 beams, and try to give more
weighting to the beam away from the cord.
Please note that PTV is red, right lung is green, left lung is blue,
spinal cord is black, heart is orange. Red isodose line represent
110%, 100% is black, 95% is blue and 90% is yellow.

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

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