Abdomen Lab Discussion

For our first case study we had to plan a simultaneous integrated boost (SIB) abdomen.

The images, contours, and instructions came from ProKnow using the TG244 Plan Study. I

really enjoyed working on this plan since we are currently doing many SIB patients at my clinic.

I have had a lot of practice with SIB treatments over the last year and it was nice to see how my

plan was scored. Even though there was nothing to compare my plan to currently, I felt like my

plan was very reasonable for the constraints that were given in the case study.

The first issue I ran into was to figure out if I wanted to do a VMAT or IMRT plan. I

decided to go with a VMAT plan because that is what is preferred at my clinic and I was curious

to see how it would come out as if it was a real patient in my clinic. The next issue I

encountered was choosing my arc angles. I tried a couple different approaches including 2 full

arcs, 2 full arcs with avoidance segments near the left kidney, 3 full arcs, and 3 partial arcs. I

was happy with my plans for most of these arc arrangements but decided that the 3 full arcs with

high priority on the kidneys resembled the plans where I avoided them completely. I calculated

the plan multiple times and adjusted my priorities accordingly to achieve the closest ideal value

described in the instructions.

I don’t feel that I encountered many issues while planning other than decided on the arcs

I should use and trying to meet the constraints. I did add a spinal cord PRV contour to help me

keep the spinal cord close to 30Gy. I probably could have improved this plan by spending a little

more time planning but my clinic has been very busy the past couple of weeks and my time has

been limited. I did think that the constraints were very tight but I was happy how my plan turned

out and I did have a peer review with a physician at my clinic before submitting it to ProKnow.
Attached are screenshots of my plan, objectives used for planning, and the location of my

hotspot. My hotspot was 105.7% with ideal coverage to the PTVs and CTVs.

I think one huge lesson I learned while planning is to constantly remind myself to slow

down and take the appropriate amount of time to get a good plan for our patients. These types of

plans take a lot of time, especially if you do not normally plan SIB, and it is important to slow

down and make sure you are taking all the time you need. I also learned that I should step out of

my comfort zone and try some new techniques because I might have come up with a better plan.

It is important to keep an open mind and to see what works best for each individual case.
ABDOMEN, TG244 (002442)
Printed on Friday, February 09, 2018 4:03:19 PM by JCS136 Franklin Square Radiation Oncology Center, Radamerica II LLC
Patient Name: ABDOMEN, TG244 (002442) Course: C1 Plan normalization value: 97.3 %
Hospital: Franklin Square Radiation Oncology Center, Radamerica II LLC Plan: ABDOMEN, 5200cGy/26 FX 1-2 Calculation grid: 2.5 mm
Plan last modified: Friday, February 09, 2018 2:25 PM by JCS136 Image: ROQS_GOLD Maximum dose: 5498.9 cGy
Save Status Not saved! Maximum dose in PTV_5200: 5498.9 cGy
Minimum dose in PTV_5200: 5023.2 cGy
Mean dose in PTV_5200: 5353.9 cGy

Hidden field and field accessory outlines not included in the printout
Fields in plan 'ABDOMEN' of course 'C1'
Field ID Technique Machine Energy Scale Wedge ID Weight X1 X2 Y1 Y2 Gantry Rtn Coll Rtn Couch Rtn X Y Z SSD MU
[cm] [cm] [cm] [cm] [deg] [deg] [deg] [cm] [cm] [cm] [cm]
1 ARC-I FSROCTB 6X IEC61217 0.832 -5.7 +6.7 -5.1 +6.6 181.0 - 179.0 15.0 0.0 -0.6 -3.2 -1.7 88.0 171
1A ARC-I FSROCTB 6X IEC61217 0.881 -5.7 +6.7 -5.1 +6.6 181.0 - 179.0 15.0 0.0 -0.6 -3.2 -1.7 88.0 181
2 ARC-I FSROCTB 6X IEC61217 0.954 -6.7 +5.7 -5.1 +6.6 179.0 - 181.0 345.0 0.0 -0.6 -3.2 -1.7 88.0 196

Patient Name: ABDOMEN, TG244 (002442) Z: 2.23 cm External Beam Planning 13.5.37
Course: C1 Scaling Factor: 55% Printed Friday, February 09, 2018 4:05 PM by JCS136
Plan: ABDOMEN - Unapproved Head First-Supine Page 1/1
User origin DICOM offset = (0.00cm, 0.00cm, 0.00cm)
Patient Name: ABDOMEN, TG244 (002442) Course: C1 Plan normalization value: 97.3 %
Hospital: Franklin Square Radiation Oncology Center, Radamerica II LLC Plan: ABDOMEN, 5200cGy/26 FX 1-2 Calculation grid: 2.5 mm
Plan last modified: Friday, February 09, 2018 2:25 PM by JCS136 Image: ROQS_GOLD Maximum dose: 5498.9 cGy
Save Status Not saved! Maximum dose in PTV_5200: 5498.9 cGy
Minimum dose in PTV_5200: 5023.2 cGy
Mean dose in PTV_5200: 5353.9 cGy

Hidden field and field accessory outlines not included in the printout

Patient Name: ABDOMEN, TG244 (002442) Z: -0.03 cm External Beam Planning 13.5.37
Course: C1 Scaling Factor: 55% Printed Friday, February 09, 2018 4:05 PM by JCS136
Plan: ABDOMEN - Unapproved Head First-Supine Page 1/1
User origin DICOM offset = (0.00cm, 0.00cm, 0.00cm)
Patient Name: ABDOMEN, TG244 (002442) Course: C1 Plan normalization value: 97.3 %
Hospital: Franklin Square Radiation Oncology Center, Radamerica II LLC Plan: ABDOMEN, 5200cGy/26 FX 1-2 Calculation grid: 2.5 mm
Plan last modified: Friday, February 09, 2018 2:25 PM by JCS136 Image: ROQS_GOLD Maximum dose: 5498.9 cGy
Save Status Not saved! Maximum dose in PTV_5200: 5498.9 cGy
Minimum dose in PTV_5200: 5023.2 cGy
Mean dose in PTV_5200: 5353.9 cGy

Hidden field and field accessory outlines not included in the printout

Patient Name: ABDOMEN, TG244 (002442) Z: -2.78 cm External Beam Planning 13.5.37
Course: C1 Scaling Factor: 55% Printed Friday, February 09, 2018 4:05 PM by JCS136
Plan: ABDOMEN - Unapproved Head First-Supine Page 1/1
User origin DICOM offset = (0.00cm, 0.00cm, 0.00cm)
Patient Name: ABDOMEN, TG244 (002442) Course: C1 Plan normalization value: 97.3 %
Hospital: Franklin Square Radiation Oncology Center, Radamerica II LLC Plan: ABDOMEN, 5200cGy/26 FX 1-2 Calculation grid: 2.5 mm
Plan last modified: Friday, February 09, 2018 2:25 PM by JCS136 Image: ROQS_GOLD Maximum dose: 5498.9 cGy
Save Status Not saved! Maximum dose in PTV_5200: 5498.9 cGy
Minimum dose in PTV_5200: 5023.2 cGy
Mean dose in PTV_5200: 5353.9 cGy

Hidden field and field accessory outlines not included in the printout

Patient Name: ABDOMEN, TG244 (002442) Z: -4.78 cm External Beam Planning 13.5.37
Course: C1 Scaling Factor: 55% Printed Friday, February 09, 2018 4:06 PM by JCS136
Plan: ABDOMEN - Unapproved Head First-Supine Page 1/1
User origin DICOM offset = (0.00cm, 0.00cm, 0.00cm)
Patient Name: ABDOMEN, TG244 (002442) Course: C1 Plan normalization value: 97.3 %
Hospital: Franklin Square Radiation Oncology Center, Radamerica II LLC Plan: ABDOMEN, 5200cGy/26 FX 1-2 Calculation grid: 2.5 mm
Plan last modified: Friday, February 09, 2018 2:25 PM by JCS136 Image: ROQS_GOLD Maximum dose: 5498.9 cGy
Save Status Not saved! Maximum dose in PTV_5200: 5498.9 cGy
Minimum dose in PTV_5200: 5023.2 cGy
Mean dose in PTV_5200: 5353.9 cGy

Hidden field and field accessory outlines not included in the printout

Patient Name: ABDOMEN, TG244 (002442) Y: -4.14 cm External Beam Planning 13.5.37
Course: C1 Scaling Factor: 55% Printed Friday, February 09, 2018 4:06 PM by JCS136
Plan: ABDOMEN - Unapproved Head First-Supine Page 1/1
User origin DICOM offset = (0.00cm, 0.00cm, 0.00cm)
Patient Name: ABDOMEN, TG244 (002442) Course: C1 Plan normalization value: 97.3 %
Hospital: Franklin Square Radiation Oncology Center, Radamerica II LLC Plan: ABDOMEN, 5200cGy/26 FX 1-2 Calculation grid: 2.5 mm
Plan last modified: Friday, February 09, 2018 2:25 PM by JCS136 Image: ROQS_GOLD Maximum dose: 5498.9 cGy
Save Status Not saved! Maximum dose in PTV_5200: 5498.9 cGy
Minimum dose in PTV_5200: 5023.2 cGy
Mean dose in PTV_5200: 5353.9 cGy

Hidden field and field accessory outlines not included in the printout

Patient Name: ABDOMEN, TG244 (002442) X: -0.66 cm External Beam Planning 13.5.37
Course: C1 Scaling Factor: 55% Printed Friday, February 09, 2018 4:06 PM by JCS136
Plan: ABDOMEN - Unapproved Head First-Supine Page 1/1
User origin DICOM offset = (0.00cm, 0.00cm, 0.00cm)
External Beam Planning
External Beam Planning 13.5.37 Franklin Square Radiation Oncology Center, Radamerica II LLC

Patient: ABDOMEN, TG244 Plan ID Plan Status Course ID Plan Last Modified
Patient IDs: 002442 ABDOMEN Unapproved: Thursday, February 08, 2018 1:53:38 PM by JCS136 C1 Friday, February 09, 2018 2:25:33 PM by JCS136
Comment:

DVH Structure Structure Status Coverage [%/%] Volume Min Dose Max Dose Mean Dose Modal Dose Median Dose Std Dev
STOMACH Unapproved 100.0 / 100.0 230.2 cm³ 70.0 cGy 4778.2 cGy 781.7 cGy 112.5 cGy 325.9 cGy 909.3 cGy
ESOPHAGUS Unapproved 100.0 / 100.0 17.1 cm³ 0.0 cGy 160.7 cGy 51.7 cGy 0.4 cGy 35.5 cGy 47.3 cGy
CORD Unapproved 100.0 / 100.0 31.5 cm³ 0.0 cGy 3179.6 cGy 1117.5 cGy 0.4 cGy 172.5 cGy 1278.8 cGy
CTV_5200 Unapproved 100.0 / 100.0 35.0 cm³ 5280.9 cGy 5498.9 cGy 5391.4 cGy 5395.6 cGy 5392.5 cGy 24.8 cGy
PTV_5200 Unapproved 100.0 / 100.0 68.6 cm³ 5023.2 cGy 5498.9 cGy 5353.9 cGy 5395.6 cGy 5375.0 cGy 65.4 cGy
CORD PRV Unapproved 100.0 / 100.1 105.1 cm³ 0.0 cGy 3541.4 cGy 1094.2 cGy 0.4 cGy 153.5 cGy 1284.6 cGy
LT KIDNEY Unapproved 100.0 / 100.0 114.0 cm³ 246.5 cGy 2076.0 cGy 918.6 cGy 691.3 cGy 878.7 cGy 291.1 cGy
RT KIDNEY Unapproved 100.0 / 100.0 117.2 cm³ 197.0 cGy 3501.7 cGy 1344.8 cGy 1082.9 cGy 1328.5 cGy 448.0 cGy

Patient: ABDOMEN, TG244 (002442) Printed Friday, February 09, 2018 4:18:19 PM by JCS136
Course: C1
Plan: ABDOMEN - Unapproved Page: 1/2
External Beam Planning
External Beam Planning 13.5.37 Franklin Square Radiation Oncology Center, Radamerica II LLC

DVH Structure Structure Status Coverage [%/%] Volume Min Dose Max Dose Mean Dose Modal Dose Median Dose Std Dev
SPLEEN Unapproved 100.0 / 100.0 177.5 cm³ 51.6 cGy 1857.4 cGy 314.1 cGy 82.4 cGy 136.4 cGy 371.5 cGy
CTV4680-CTV5200 Unapproved 100.0 / 100.0 206.8 cm³ 4708.7 cGy 5497.6 cGy 4963.8 cGy 4870.5 cGy 4895.2 cGy 166.2 cGy
PTV4680-PTV5200 Unapproved 100.0 / 100.0 302.8 cm³ 3855.1 cGy 5328.4 cGy 4868.4 cGy 4865.5 cGy 4867.0 cGy 112.7 cGy
HEART Unapproved 100.0 / 100.0 801.4 cm³ 0.0 cGy 136.8 cGy 39.7 cGy 23.1 cGy 34.1 cGy 24.2 cGy
LIVER Unapproved 100.0 / 100.0 1262.1 cm³ 36.4 cGy 4378.5 cGy 550.9 cGy 59.5 cGy 246.3 cGy 581.9 cGy
LT LUNG Unapproved 100.0 / 100.0 1481.4 cm³ 0.0 cGy 2182.5 cGy 37.8 cGy 0.4 cGy 24.2 cGy 68.6 cGy
RT LUNG Unapproved 100.0 / 100.0 1951.9 cm³ 0.0 cGy 2066.0 cGy 42.6 cGy 0.4 cGy 30.3 cGy 78.5 cGy
BOWEL Unapproved 100.0 / 100.0 2628.4 cm³ 0.0 cGy 5493.2 cGy 1080.9 cGy 20.1 cGy 170.6 cGy 1446.2 cGy
BODY Unapproved 100.0 / 100.0 21152.9 cm³ 0.0 cGy 5498.9 cGy 481.5 cGy 0.4 cGy 53.3 cGy 982.6 cGy

Patient: ABDOMEN, TG244 (002442) Printed Friday, February 09, 2018 4:18:20 PM by JCS136
Course: C1
Plan: ABDOMEN - Unapproved Page: 2/2
Study Name: UW TG244 Case 02 Abdomen

Participant Name: Jeanette Smith

Participant Email: smith1403@uwlax.edu

Participant Role: student

Participant Institution: University of Wisconsin

Created: Fri Feb 09 2018 19:39:21 GMT+0000

TPS Manufacturer: Varian Medical Systems

TPS Model: Eclipse

Number of Treatment Beams: 3

Radiation Type(s): Photon

Delivery Type(s): VMAT