Amanda Lisher

DOS 771: Clinical Practicum I

Pelvis Planning Assignment
Planning Assignment: Three Field Rectum
Target organ or tissue being treated: Rectum
Radiation Prescription: 180cGy x 25 fractions to a total dose of 4500cGy

Organs at Risk (OR):

Bladder

Desired Objective

Achieved Objective

Notes

Whole bladder less

Yes

TD5/5 for the whole

than 6500cGy

bladder is 6500cGy

Bowel

Max dose < 5000cGy Yes

LT Femoral Head

V50 < 10%

Yes

RT Femoral Head

V50 < 10%

Yes

a) Single 6MV PA beam: The 100% isodose line (green) covers roughly 50% of the PTV and
CTV. The hot spot (blue) is concentrated in the posterior pelvis, in the build-up region.

b) Single 15MV PA beam: The isodose lines shifted anterior; 60% of the CTV and PTV are
covered by the 100% isodose line (green). The hot spot (blue) is smaller, still concentrated in
the posterior pelvis.

c) 3 field 6MV: Adding the lateral beams brought the isodose lines out toward the lateral
pelvis, creating the classic box shape isodose coverage. The dose is still concentrated in the
posterior pelvis, but the hot spot (blue) has broken up and shifted laterally.

d) 6MV PA, 15MV Laterals: The isodose lines have shifted more anterior, the 100% line
(green) is no longer concentrated in the posterior pelvis, it has moved more central in the
body. The lower isodose lines (30%, 50%, 70%) have contracted, and the 80% line (yellow)
has moved from the lateral tissue to the center of the body.

e) 15MV 3-field: Increasing the energy of the PA beam pulled the isodose lines posterior.
The dose is not concentrated in the middle of the body as well as it was with the 6MV PA
beam.

f) Lateral wedges: I placed a 15-degree physical wedge, heel posterior to the patient, on both
the right and left lateral beams. I need to push the dose anterior in order to fully cover the
PTV; placing the wedge posterior forces the dose anteriorly.
g) Wedges: I applied a 15, 30, 45 and 60-degree physical wedge to the lateral beams, heel
posterior to the patient. Increasing the wedge angle pushes the dose more anterior. Increasing
the wedge angle also increases the monitor units necessary to deliver the prescribed dose.

h) For my final plan, I kept the 15MV beam on the PA, LT and RT lateral fields. I used a 15degree physical wedge on the lateral beams, heel posterior to the patient, to help push the
dose anteriorly. Because the rectum is S shaped from the lateral direction, the superior part
sits more posterior, and the inferior portion is more anterior. This means we need more dose
anteriorly at the inferior portion of the treatment fields, and more dose posteriorly at the
superior part of the field. In order to achieve this, I used a 20-degree dynamic wedge on the
PA field, with the heel superior to the patient, which pushes the dose inferior and helps cover
the anterior portion of the inferior rectum. I normalized at the 95% isodose line. Field
weighting is 33% for the PA field and RT lateral field, and 34% for the LT lateral. The
biggest hot spot is posterior and inferior, and is roughly 107%. All dose constraints were met.
i)

IS
ocked

Physician/Physicist:

AT/

Institution:

CTV
bladder
PTV

RT femoral
head

bowel

LT femoral
head

j) 4-field pelvis: The 4-field pelvis plan provides better coverage for the entire length of the
PTV. The dose is pulled more anterior, and evens out into a nice box isodose coverage. The
4-field also reduces dose to the femoral heads, and breaks up the hot spots. Disadvantages to
the 4-field technique include increased dose to the bowel and bladder, and slightly increased
treatment time due to the additional field. The dose to the bowel and bladder could possibly
be reduced by treating the 3-field technique with the patient positioned prone, on a belly
board, which helps drop the bowel out of the field.