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Treatment Planning 1
FRCR
Matt Clarke
May 2013
Radiotherapy
Treatment Planning
Lecture 1
– Concepts of ICRU reports 50 & 62
SHORT BREAK
Lecture 2
– Changing the variables
(i.e. the treatment parameters)
– Assessment tools
(e.g. DVH)
Introduction
• Organs at Risk
Does it matter what the
surrounding tissue is?
ICRU 50
Volumes
• Treated and Irradiated
Volume
Volume that receives a dose considered
significant in relation to normal tissue
tolerance
• Organs at Risk
Tissues whose radiation sensitivity may
influence a treatment plan (i.e. spinal
cord)
The criteria for the location of the ICRU reference point are also
those required for the prescription point (sometimes identified as the
‘isocentre’). Hence often the ICRU reference point and the
prescription point are the same thing. However, they serve two
different purposes – one for reporting and the other for prescribing.
ICRU 50
Dose Reference Point
The dose reference point criteria are, in the majority of 3D
conformal plans, fulfilled if the ICRU point is at the
gravitational centre of the PTV and on/near the central axis of
the beams.
• A “serial-parallel” string of
subunits (e.g. the heart)
The heart is a combination; the
serial component of the coronary
arteries combined with the parallel
component of the mycardium.
• a combination of “parallel”
and “serial” structures (e.g. a
nephron)
N.B.
• Deciding between 2D or 3D doesn’t just affect the superior and
inferior borders.
• Using rolling ball will alter the lateral extent of the volume as well
• This may affect the dose constraints i.e. plan acceptability
for example…
Outlining and Margins
Volume-Growing Tools
• Used in planning systems to create PTV
• Algorithms can be 2D or 3D
• 2D: adds margin to each individual transverse section
• 3D: rolling ball method is commonly used
2D 3D
Comparison:
Outlining and Margins
Volume-Growing Tools: Affecting PTV
2D 3D
Sagittal view
Outlining and Margins
Volume-Growing Tools: Affecting PTV
2D 3D
Transaxial view
Outlining and Margins
Volume-Growing Tools: Affecting PRV
This 3D expansion
causes overlap
between PRVs
(here, spinal canal &
brainstem).
However, this is
consistent with
concept of PRV
including motion of
organs.