TREATMENT PLANNING

3 FIELD VS. 4 FIELD PRONE PELVIS ON BELLYBOARD

Elizabeth Muha

PLANNING OBJECTIVES

Look at dose constraints

Cubic centimeters for bowel
Absolute volume

3 FIELD PRONE PELVIS

100 SAD

PA

RIGHT LATERAL

LEFT LATERAL

WHERE ARE WE NORMALIZED?

We are normalized to have 95% percent coverage of the PTV

In this plan, 96.44% line was used (everytihng is scaled up)

WHAT WEIGHTING WAS USED AND WHY?

The Right and Left Lateral are each weighted as about

The PA beam is weighted as about

A little less but this is a good rule of thumb

Higher weighting on PA bc the beam interferes with fewer critical structures

WHY ARE WEDGES USED ON THE LATERALS?

Wedges are mainly used to avoid a high dose to the femoral heads
Wedges move the dose more anterior and avoid creating hot spots

WHAT IS THE SHAPE OF THE ISODOSE CURVES?

The isodose curves make a rectangle/square shape because there are no oblique fields
to round them out

MAX: 4949.0cGy

MIN: 4306.2cGy

WHAT ARE THE MONITOR UNITS OF EACH

FIELD?

PA- 89 MU

LEFT LATERAL- 67MU + 10MU (reduced field)

RIGHT LATERAL- 68MU + 10MU (reduced field)

DVH OF THE PTV AND THE BLADDER/BOWEL

(THIS PLAN HAS BOOST)

PTV crosses right @ 95%

Part of bladder is inside of PTV so some will get full dose.

4 FIELD PRONE PELVIS

100 SAD

PA

AP

RIGHT LATERAL

LEFT LATERAL

WHAT ARE WE NORMALIZED?

97.50%
Everything is scaled up

WHAT WEIGHTING WAS USED AND WHY?

No weighting was used

They give weight that was in PA field during 3 field plan to AP

WERE WEDGES USED IN THE PLAN AND WHY?

Remove wedges because dose is coming from AP also

May be used depending on patients body shape

WHAT IS THE SHAPE OF THE ISODOSE COVERS?

Square/rectangle still due to no obliques

IMRT always more rounded

WHAT ARE THE MONITOR UNITS OF EACH

FIELD?

PA- 48MU

LEFT LATERAL- 59 MU

RIGHT LATERAL- 59MU

AP- 52MU
MUs are higher because they are going though more tissue

DISCUSS THE DVH OF THE PTV AND THE

BLADDER/BOWEL

3 field has a bigger hot spot

100cGy less for 4 field (to PTV)

ADVANTAGES/DISADVANTAGES OF USING A
BELLY BOARD

ADVANTAGE: moves the field up and away from bowels and lets it hang down through
the board.

DISADVANTAGES: squished bladder so more of it is treated.

WHICH PLAN IS BETTER AND WHY

4 field has better coverage of PTV because you didnt have to alter isodose lines as much
overall.

Small bowel is treated less in 4 field because it is blocked out with PA beam

But now there is a beam entering directly through the bladder instead of just getting exit
dose.
25% gets full dose in 4 field plan
6% gets full dose in 3 field plan

REFERENCES

IHIS/ARIA

KYLE RIFFLE