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Stephanie Olson
January 2014
Planning Assignment (3 field rectum)
Contour all critical structures (organs at risk) in the treatment area. List all organs at risk (OR) and
desired objectives/dose limitations, in the table below:
Organ at risk

Small bowel
Femoral heads

Bladder

Desired
objective(s)
Max = 50 Gy
V30 < 200 cc
V45 < 20 cc
V30 < 50%
V44 < 5%
Max = 65 Gy
V35 < 50%
V40 < 40%
V50 < 5%

Achieved objective(s)
Final 3 field
Max = 46.146 Gy
V30 = 19.37 cc
V45 = 1.91 cc
RT: V30=77.26%, V44=11.18%
LT: V30=85.59%, V44=8.28%
Max=45.648 Gy
V35=83.31%
V40=80.54%
V50=0%

Achieved objective(s)
4 field
Max = 46.412
V30 = 31.02 cc
V45 = 2.39 cc
RT: V30=16.89%, V44=8:46%
LT:V30=12.87%, V44=6.11%
Max=46.585 Gy
V35=85.91%
V40=83.28%
V50=0%

a. Enter the prescription: 45 Gy at 1.8 /fx (95% of the prescribed dose to cover the PTV).
Calculate the single PA beam. Evaluate the isodose distribution as it relates to CTV and PTV
coverage. Also where is/are the hot spot(s)? Describe the isodose distribution, if a screen shot
is helpful to show this, you may include it.
Isodose distribution is predominantly in the posterior half of the body. Approximately of the
PTV is covered by the 95% isodose line (42.8 Gy).

b. Change to a higher energy and calculate the beam. How did your isodose distribution change?
There was really not much change other than the isodose lines moving slightly more towards
the anterior of the body.

Stephanie Olson
January 2014
c. Insert a left lateral beam with a 1 cm margin around the ant and post wall of the PTV. Keep
the superior and inferior borders of the lateral field the same as the PA beam. Copy and
oppose the left lateral beam to create a right lateral field. Use the lowest beam energy
available for all 3 fields. Calculate the dose and apply equal weighting to all 3 beams. Describe
this dose distribution.
The isodose lines are square shaped centrally surrounding the PTV with a high dose region on
both lateral aspects of the body. The PTV coverage increases to approximately 97% being
covered by the 95% isodose line. The amount of dose being distributed anteriorly is reduced
due to the 3 field technique.

d. Change the 2 lateral fields to a higher energy and calculate. How did this change the dose
distribution?
The high dose regions above the 42.8 Gy isodose line on the hip region are now gone and there
is only a small volume of 40 Gy on the patients left hip region. The maximum hot spot has
moved slightly more inferiorly in the pelvis and was reduced by approximately 1 Gy. The overall
PTV coverage is about the same.
e. Increase the energy of the PA beam and calculate. What change do you see?
The high dose isodose line of 49.5 Gy has broken up in the posterior aspect of the pelvis and is
now a smaller volume on both posterior corners of the field where the fields abut between the
PA and the lateral fields. The maximum hot spot has been reduced by approximately 2.5 Gy.
There is slightly less of a dip in the 42.8 Gy isodose line anteriorly to better cover the PTV.

Stephanie Olson
January 2014

f.

Add the lowest angle wedge to the two lateral beams. What direction did you place the
wedge and why? How did it affect your isodose distribution?
When I added the 15 degree wedge to both lateral fields, I placed them with the heel towards
the posterior of the patient. I did this because the hot spot was in the posterior aspect of the
pelvis and by placing the wedge with the heel or the thickest part of the wedge in that posterior
region, the dose was re-distributed more internally into the pelvis and pushed the dose more
anterior. The isodose distribution is now more uniform and better covers the PTV by the 95%
isodose line. The wedges also got rid of the 49.5 isodose line near the posterior portion of the
pelvis.
g. Continue to add thicker wedges on both lateral beams and calculate for each wedge angle you
try. What wedge angles did you use and how did it affect the isodose distribution?
I used the 30 degree, 45 degree and 60 degree wedges. When the 30 degree wedge was used,
the maximum hot spot was pushed up into the middle of the body and close to the small bowel.
The 95% isodose line covered almost 100% of the PTV. When the 45 degree wedge was used,
the isodose distribution was pushed both anteriorly and laterally. Some higher dose regions of
45 Gy and above pushed lateral while the dose in the posterior region was pulled inward. When
the 60 degree wedge was used, the coverage is poor and the isodose lines are pulled inward and
laterally.
h. Explain how you arrived at your final plan.
My final plan is as follows: 10 MV for all beams, 30 degree wedges for both lateral fields, beam
weighting for PA=38%, R lat=30.5% and L lat=31.5%. This reduced the maximum hot spot to
only 47.6 Gy and the 95% isodose line covers 100% of the PTV.

Stephanie Olson
January 2014
i.

In addition to the answers to each of the questions in this assignment, turn in a copy of your
final plan with the isodose distributions in the axial, sagittal and coronal views. Include a final
DVH.

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Stephanie Olson
January 2014

4 field pelvis
Using the final 3 field rectum plan, copy and oppose the PA field to create an AP field. Keep the lateral
field arrangement. Remove any wedges that may have been used. Calculate the four fields and weight
them equally. How does this change the isodose distribution? What do you see as possible advantages
or potential disadvantages of adding the fourth field?
The dose distribution is much more uniform in a square shape and the 35 Gy isodose line which spilled
out laterally in the 3 field technique is now gone. Advantages to using the 4 field technique are a more
uniform dose distribution, reduction of hot spots, skin sparing where the PA and lateral fields meet, and
by having no wedges, this makes it easier for the therapists to treat by not having to go in to the room
for all fields to put in or take out the wedge. Disadvantages to using a 4 field technique would be a
higher bowel and bladder dose caused by the AP beam however the femur dose is now reduced by
approximately 5 Gy per side.