The aims of treatment planning

Treatment Planning for EBT

Rena Widita

To localize the tumour volume in patient Imaging/diagnostic

To define the target volume for treatment
To measure the outline of the patient and to place
within it the target volume and other anatomical
structures which may affect the dose distribution
To determine the optimum treatment configuration
required to irradiate the target volume
To calculate the resultant dose distribution in the
patient
To prepare an unambiguous set of treatment
instructions for the radiographers.

Optimisation of treatment may be

constrained by several factors
In treatment planning consideration must
not only be given to the accuracy and
precision of dose to a specified point/s, but
also to the geometric tolerance of dose
delivery
It has been estimated that there is a 4
mm positional error in treatment and this
should be taken into account when the
target volume is defined

SINGLE FIELDS

Physical factors:
Fundamental nature of the radiation used
The limitation of treatment equipment

Clinical factors, which may make it

inappropriate to give the most
sophisticated treatment when the patient
will not gain any significant benefit.

In photon therapy, treatments with a single

field are generally used only for palliative
purposes
It is only with low energy x-rays that
single-photon beams are used curatively

Output Chart for 6 MV X-rays

beam

Calculation
Two data charts are required for the
calculation of the monitor units or a linac
or the time to be set on a cobalt unit to
deliver the prescribed dose to the target
An output chart
A depth dose table

The data are normally tabulated for square

fields

Giving the required number of monitor units to deliver a dose of

100cGy to the position of the dose maxon the central axis at 100 cm
SSD

Field Size (cm2)

Output (mu/100cGy)

6x6

104.3

8x8

102

10 x 10

100

12 x 12

98.5

15 x 15

96.7

20 x 20

94.8

Depth dose chart for 6 MV (SSD =

100 cm)
Depth (cm)

Field Size (cm)

6x6

8x8

1.5

100

100

10 x 10
100

98.1

98.2

98.3

89.3

89.8

90.2

80.6

81.8

82.6

71.6

72.9

74

10

63.7

65.1

66.2

Example

Prescribed dose
No. Of fractions
Target depth
Field size
SSD
Equivalent square
PDD
Output Factor

: 1500 cGy
:5
: 6 cm
: 12 cm x 7 cm
: 100 cm
: 8.8 cm
: 82.1%
: 101.2 mu/100cGy

Daily monitor units = (1500/5)*(101.2/100)*(100/82.1)

= 370 mu
Output and depth dose data have been
interpolated

If the field is rectangular, an equivalent

square field size which would have the
same output and depth dose
characteristics is used

s = the side of the equivalent square

a,b = the sides of the rectangular field

Non-standard treatment
distance
When the field size needed is larger than can be
obtained at the standard SSD, and so an extended
SSD is required
Shortened SSD can be used to increase the dose rate
and therefore to decrease treatment time
Altering SSD causes a change in output factor and to
a lesser, in the depth dose
The variation in output factor with SSD can be
assumed to depend on the inverse square law (ISL)
provided that the deviation from the standard SSD is
not large (less than about 10 cm)

The correction for the output factor

The variation of dose with depth depends on both the

attenuating properties of tissue and on the ISL
For a point at a depth d in a beam with its dose max at dmax,
the correction to the depth dose measured at an SSD of fo is:

f = the treatment distance

fo = the nominal SSD
dmax = the depth of dose max

Can be used to irradiate volume of tissue in which the tumour

cannot be accurately defined
Or because the intention is to give a relatively low dose of
palliation
For isocentric opposed field: separations of 12-24 cm would
produce an error of 0.5% or less

Opposed Coaxial Fields

Example for opposed coaxial

fields

Prescribed dose
: 3000 cGy
No. Of fractions
: 10
Separation
: 18 cm
Field size
: 14 cm x 8 cm
SSD
: 100 cm
Equivalent square
: 10.2 cm
Central depth dose
: 70.2 * 2 = 140.4%
Maximum percentage dose
: 100 + 46.5 = 146.5%
Output Factor
: 99.8 mu/100cGy

Daily monitor units = (3000/10)*(99.8/100)*(100/140.4)

= 213 mu
Maximum dose = 3000*(146.5/140.4) = 3130 cGy
Output and depth dose data have been interpolated

MULTIPLE FIELDS

Beam Weighting
Curative treatments generally require a
higher dose
> 3 fields are used (except head & neck, 2
fields)
TP is concerned with the selection of the
parameters required to produce the optimum
dose distribution:

A method of achieving uniformity in the

target volume
to adjust the contribution
from each beam

Number of fields
Orientation of fields
Field sizes
Wedges
Weights

I
Depth dose data for the field arrangement
A
B

C
III

II

Point

II

III

70

48

44

58

62

40

52

56

50

58

42

56

60

52

48

Make sure that the doses to B and D from field I are equal. If not use a
wedge on this field to make them equal
Dose to B = 62 w2 + 40 w3
and
Dose to D = 42 w2 +
56 w3
20 w2 = 16 w3 (if w2 = 1, w3 = 1.25)
Determine the weight for field I so that the total doses to point A and C
are equal
Dose to A = 70 w1+ 48 w2 + 44 w3 and Dose to C = 52 w1+ 56 w2
+ 50 w3
18 w1 = 8w2 + 6w3
w1 = 0.86
Use the weights to calculate the doses to each point:
Dose A = dose C = 163, dose B = dose D = 162, dose O = 164

A three field treatment technique. The

dose to 5 points within the target volume
is to be balanced by altering the relative
weights of the three fields

Dose calculation

Dose calculation within the

patient

In the previous section, in the calculation of the dose at a point it was assumed that
the radiation beam was normally incident on a unit density medium
in practise, a
patient differs from this homogeneous situation both in shape and composition

these differences must be taken into account when calculating the depth dose.
For routine treatment planning by computer it is not necessary to know how these
algorithms work.
However, the physicist responsible for the purchase of new planning software should
understand the limitations and accuracy of the methods used
Algorithms for dose calculation in an inhomogeneous medium can be divided into 4
types that are essentially a compromise between speed and accuracy.

Type

Algorithm

Account for

[1] manual methods

Effective depth

[2] power law TAR

Distance between inhomogeneity and

point of calculation

[3] equivalent TAR Scatter correction Volume

integration of differential scatter-air ratios

Position and shape of inhomogeneity

[3] convolution methods Monte Carlo

As type 3 but includes electron

equilibrium at interfaces

Dose calculation for multiple fields involves the sumation of the dose
distributions of the individual fields.
The total relative dose Dp at a point P for an irradiation with n fields
is given by

DDi,p = the depth dose at point P from the ith field

wi = the weight for that field

[1] manual methods

Can be used manually but occasionally
are used in computer calculations
Only correct for the effective depth of a
point, considering only changes in the
primary component of dose

[2] power law TAR

Takes account of the position of the
calculation point with respect to the
inhomogeneity, but considers the
inhomogeneity to be of uniform thickness
over the beam width
This is known as the tissue-air-ratio (TAR)
power law method

[3] convolution methods Monte

Carlo
Not considered to be practical owing to the
lengthy calculation times involves
Monte carlo calculations are not practical
but the technique has been used to
provide the input data for convolution
methods.

[3] equivalent TAR Scatter correction

Volume integration of differential
scatter-air ratios

Takes into account the [3] shape of the

inhomogeneity
These algorithms are the most complex
used on commercial planning systems