Curtis Wilgenbusch

August 10, 2014

Fieldwork II Clinical Lab Assignment


Figure 1. Wedged pair with matching lower neck field. 0.5 cm bolus was added in Pinnacle for
the wedged pair fields.


Figure 2. IMRT beam arrangement and energy used. A 0.5 cm bolus was added to all fields in
Pinnacle.


Figure 3. Mixed photon and electron field arrangement and energies. 0.5 cm bolus added to
both fields.























Wedged Pair w/ Matching Neck Field
Organs At Risk Max Tolerance Dose Dose Received
Brainstem < 60 Gy Max 20.98 Gy
Spinal Cord 45 Gy Max 23.54
Contra Parotid Mean < 25 Gy Mean 1.06 Gy
Oral Cavity Mean < 40 Gy Mean 15.72

IMRT
Organs At Risk Max Tolerance Dose Dose Received
Brainstem < 60 Gy 18.72 Gy
Spinal Cord 45 Gy 21.41 Gy
Contra Parotid Mean < 25 Gy Mean 6.75 Gy
Oral Cavity Mean < 40 Gy Mean 15.72

Mixed Photo/Electron
Organs At Risk Max Tolerance Dose Dose Received
Brainstem < 60 Gy Max 32.28
Spinal Cord 45 Gy Max 38.82
Contra Parotid Mean < 25 Gy Mean 21.5 Gy
Oral Cavity Mean < 40 Gy Mean 2.38
Table 1. Organs at risk, dose tolerances, and dose received by each plan. All plans met all of
the goals for organs at risk.



Figure 4. Setup DRR's for the parotid fields.


Figure 5. Setup DRR's for the neck field, half beam block.


Figure 6. Wedged pair technique. Thick green isodose is 100%, dark blue is 95%, yellow is
75%, light blue is 40%.

Figure 7. Lower neck field matching with the inferior border of the wedged pair using couch
kick for the inferior border of the wedged pair and half beam block for the neck field. The green
isodose is 100%.


Figure 8. DVH for wedged pair and matching neck field.

Figure 9. IMRT isodose distribution showing hot spot of 6216 cGy. Thick green isodose is
100%, dark blue is 95%, yellow is 75%, light blue is 40%.


Figure 10. DVH for IMRT plan.

Figure 11. Mixed photon and electron fields showing hot spot of 6615 cGy. Thick green isodose
is 100%, dark blue is 95%, yellow is 75%, light blue is 40%.


Figure 12. DVH for mixed photon electron plan.


Questions
1a. How would, or how does, the patient postition (chin extended) affect your beam
arrangement?
Having the chin extended helps reduce doses to the eyes from exit dose.
2a. How does this plan (mixed) compare to the wedged pair plan?
The mixed beam plan introduces a higher hot spot and the doses to all of the OAR except
the oral cavity were higher than all the other plans.
2b. Dose constraints were all met.
3a. I only tried that one beam arrangement. I got good coverage and doses to OAR with it and
did not see a reason to try other angles.