1

Clinical Practicum II
Clinical Lab Assignment
Cinira Johnson

Plan # 1 Wedged Pair

Patient Positioning: Patient was supine with the black mat abutting the indexed U-frame. Head
holder B, large knee sponge, and an aquaplast mask were used.

All Constraints used in this plan are according to University of Colorado Hospital constraints.

Critical
Structure


Tolerance dose

Dose in Plan # 1

Meet Constraints

Spinal Cord


Maximum point
< 50 Gy


55.09Gy

No

Cochlea


Mean < 40 Gy

3.29 Gy

Yes

Oral Cavity


Mean dose of
20 Gy


20.67 Gy

No

Mandible


Maximum point
< 70 Gy


65.43 Gy

Yes







2

Plan #1 Beam Parameters:
Beam # 3 is the Lower neck anterior field.
The wedged pair plans weighting: 0.490/0.510

Gantry
Angle


Beam
Energy

3mm
Bolus

Cone
Size

Wedge
Angle

Normalization

Collimator
Angle

Cough
Angle

Field
Size

Beam
#1


35

6 MV

X

NA

45
degrees

100% to
calculation
point


90 degrees

0
9.5
cm x
5.2
cm

Beam
#2


135

6MV

X

NA

45
degrees

100% to
calculation
point


90 degrees

0
9.5
cm x
5.2
cm

Beam
#3


0

6 MV

NA

NA

NA

100% covers
95% of Target

0

0

8.5
cm x
11.3
cm





3


Plan # 1: Transverse slice showing PTV and GTV coverage.
PTV
GTV
100% isodose line
3mm Bolus
4


Plan # 1: Coronal slice of plan sum showing coverage of PTV, GTV and lower neck nodes.




PTV
50.4 Gy
Lower Neck Nodes
GTV
100% isodose line
3mm Bolus
5


100% isodose line
95% isodose line
75% isodose line
50.40 Gy
40% isodose line
3mm Bolus
6

Plan # 1: Coronal slice showing global maximum dose location and, 100%, 95%, 75% and 40%
isodose lines.

Plan # 1: DVH of plan sum showing PTV, GTV, lower neck nodes and critical structures
coverage.

Plan # 1:
1a) Chin extension is crucial for treatment of the parotid because of the matchline of lateral
ipsilateral field with anterior ipsilateral field. Beam entry and exit are ideal when the chin is
extended. The match line will have to be adjusted and it may end up too low. A low match line
may cause the mandible to be irradiated by the anterior field.
1b) In this plan due to deep-seated volume the spinal cord and oral cavity constraints were not
meet when the volume is covered with 95% of prescription dose.

Plan # 2 Mixed Beams
Patient Positioning: Patient was supine with the black mat abutting the indexed U-frame. Head
holder B, large knee sponge, and an aquaplast mask were used.



Mandible
LT Cochlea
Oral Cavity
Cord
GTV
PTV
Lower Neck nodes
7


All Constraints used in this plan are according to University of Colorado Hospital constraints.

Critical
Structure


Tolerance dose

Dose in Plan # 2

Meet Constraints

Spinal Cord


Maximum point
< 50 Gy

49.83 Gy

Yes

Cochlea


Mean < 40 Gy

7.69 Gy

Yes

Oral Cavity


Mean dose of
20 Gy


17.08 Gy

Yes

Mandible


Maximum point
< 70 Gy


64.03 Gy

Yes


Plan # 2 Beam Parameters:
Block for electron field (beam # 2): 1 cm margin around the PTV.
Block for field #1 (MLCs): 1 cm margin around PTV.
Beam # 1 and Beam # 2 weighting: 0.965/1 (top off technique used to get more coverage
superficially).

Gantry
angle


Beam
Energy

3mm
Bolus

Cone
Size

Wedge
Angle

Normalization

Collimator
Angle

Cough
Angle

Field
Size

Beam
# 1


72.2

6 MV

X

NA

NA

NA

90 degrees

0

12.2
cm x
10.9
cm

Beam
# 2


72.2

9 MeV

X

15 x
15

NA

NA

90 degrees

0

20
cm x
20
cm

8



Plain # 2: Transverse slice showing coverage with 100% isodose line of PTV and GTV.

100% Isodose line
GTV
PTV
3 mm Bolus
9


Plain # 2: Transverse slice showing global maximum dose location and, 100%, 95%, 75% and
40% isodose lines.




100% Isodose line
95% Isodose line
75% Isodose line
40% Isodose
line
3mm Bolus
Mandible
Spinal Cord
10


Plain # 2: DVH showing PTV, GTV and critical structures coverage.

2a) Mixed beams plans are not as homogenous and they are hotter than wedged pair plans. We
also will need to be mindful of skin dose in mixed beams plans. This technique is not ideal for
deep-seated volumes. The electron field tends to be weighted more in order to get proper
coverage. Proper coverage in mixed beams is achieved by: moving calculation points or give
more weight to the electron beam.
2b) All constraints were met.










Cord Cochlea
a
Oral Cavity
Mandible
GTV
PTV
11

Plan # 3 IMRT
Patient Positioning: Patient was supine with the black mat abutting the indexed U-frame. Head
holder B, large knee sponge, and an aquaplast mask were used.
All Constraints used in this plan are according to University of Colorado Hospital constrains.

Critical
Structure


Tolerance dose

Dose in Plan # 3

Meet Constraints

Spinal Cord


Maximum point
< 50 Gy


40.49 Gy

yes

Cochlea


Mean < 40 Gy

1.76 Gy

yes

Oral Cavity


Mean dose of
20 Gy


12.17 Gy

yes

Mandible


Maximum point
< 70 Gy


62.82 Gy

yes













12

Plan # 3 Beam Parameters:
Plan # 3 was not normalized.
IMRT Static beams technique used in Plan # 3.

Gantry
angle


Beam
Energy

3mm
Bolus

Cone
Size

Wedge
Angle

Field size

Collimator
Angle

Cough
Angle

Beam
# 1


0
degrees

6 MV

X

NA

NA

9.5cm x
8.4cm

0

0

Beam
# 2


36
degrees

6 MV

X

NA

NA

9.5cm x
8.4cm

0

0

Beam
# 3


72
degrees

6 MV

X

NA

NA

9.5cm x
8.4cm

0

0

Beam
# 4


108
degrees

6 MV

X

NA

NA

9.5cm x
8.4cm

0

0

Beam
# 5


144
degrees

6 MV

X

NA

NA

9.5cm x
8.4cm

0

0






13


Plain # 3: Transverse slice showing coverage with 100% isodose line of the PTV and GTV.

PTV
GTV
100%
isodose
line
3mm Bolus
14


Plain # 3: Transverse slice showing global maximum and 100%, 95%, 75% and 40% isodose
lines.

100%
Isodose line
40% Isodose
line
75% Isodose
line
95%
Isodose line
3 mm Bolus
15


Plain # 3: DVH showing PTV, GTV and critical structures coverage.

3a) I used an ipsilateral beam arrangement with 5 fields total. Usually an odd number of beams is
the best option for IMRT field arrangement in order to avoid parallel oppose beams.
3b) Beam arrangement was decided based on optimum dose distribution and location of lower
isodose lines.


Oral Cavity
Mandible
Cochlea
Cord
GTV
PTV